5. An old Pom is diagnosed PLN (Protein Losing Nephropathy)

March 30, 2016


March 29, 2016
Patient: Pom, FS, 11 years
Vet 1 - low albumin
Vet 2 - PLN. Advised kidney biopsy.


The following are the tests done by the vets:

9.5.13    ALKP, ALT, CREA, LIPA  normal


6.9.14    ALKP, ALT, CREA, GLU, K  normal.  Na/K  38
              CPL (pancreatic lipase) 0  normal
SUMMARY:  CBC, Electrolytes, Kidney/Liver, Pancreatic lipase tests normal
 Maropitant citrate 16 mg tab  1/4 sid as necessary
              

18.3.16   CBC normal. GHP & Electrolyte tests NA.
               Urinalysis  - pH 7 (5.5-8.5)    SG 1.011 (1.015 - 1.045)   Protein 3+   2+cocci

28.3.16  ALB  2 g/dL  (2.2-3.9).  Lipemic plasma.
              UPRO  309  mg/dL (0)
              UCRE   30  mg/dL (0)
              UPC 10.3  (abnormal)*


28.3.16  Urinalysis  - pH 6.5 (5.5-8.5)    SG 1.009 (1.015 - 1.045)   Protein 3+   1+cocci
Blood pressure check done.  Fortekor 5 mg (benazepril) 1/2 tab once daily.


TENTATIVE PROCEDURES

Significant findings:
Urinary protein was 3+ on 18.3.16 and 28.3.16
UPC was 10.3 on 28.3.16
However, there is no kidney failure at this time.


1. Owner was apprehensive about damage in a kidney biopsy advised by Vet 2.
2. Dog was given Bravecto in Nov 2015 (anti-tick lasting 3 months) and said to be very effective against tick infestation.
3. Urine test on 30.3.16 to another lab. 
    Urinalysis  - pH 6.0 (5.5-8.0)    SG 1.019 (1.005 - 1.030)   Protein 4+   2+bacteria,  WBC 30/uL, Epithelial cells 5/uL.  No RBC. No Casts or Crystals.  


4.  To monitor water intake and urine protein (dipstick) daily for 2 weeks
5.  To consult Cornell Univ Nutrition to look into how to formulate a home diet for PLN.
      Owner - surfed internet. US commercial companies for dietary management of PLN. One company formulates special diet but will not add vitmains and minerals. Another will advise home diet in working with her local vet.

FURTHER TEST
After the blood and urine tests, the next stage will be ultrasound to look for
for blood clots, stones, injury or other abnormalities. If any stone, clots or damage is found, an x-ray or CT scan may be needed.



TREATMENT
There is no cure for PLN. Treatment depends on the causes.   Causes of PLN include:  autoimmune diseases, diabetes, blood clots, stones or damage to the kidneys, parasitic infections, food allergy or intolerance and genetics.

Vet 2 has prescribed benazepril which is an angiotensin converting enzyme (or ACE) which decreases the amount of protein lost in urine.  A low dose aspirin to avoid blood clotting. Buffered aspirin helps minimize the inflammation or irritation while still allowing proper absorption. A beta-blocker or a calcium channel inhibitor that is used to treat high blood pressure that can occur in dogs with protein-losing-nephropathy e.g. Amlodipine Besylate is a calcium channel inhibitor or Atenolol is a beta blocker. A diet low in salt and protein is advised. 

Owner will wait 2 weeks and am consulting Cornell Univ Nutrition for home-formulated diet for PLN.