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Pyelonephritus

Dear veterinarians, good afternoon.

My name is Svetlana, and I am asking you to help us.

The problem is the following one: there is an 8-year-old Russian spaniel. She is a female. In August 2013 she had piroplasmosis. The diagnosis took a week as all the analysis made in 4 different pet clinics were negative. In August 2014 breast cancer was diagnosed, made a surgery with removal of the both ridges of lacteal glands, and Sarah was sterilized. Every 6 months we visit this animal oncological clinic for to be checked. In March 2015 pyelonephritis, stone kidney disease, and cystitis were diagnosed. We manage to keep them in remission with rare phases of exacerbation by keeping a diet of Hills Urinary Care s/d. Sarah’s been on this diet for a year already as any attempt to change the food is followed with diarrhea.

What we have now: we can not stabilize the situation since the end of March. Sarah’s urine test showed pH 7,5 and 25-30 white blood cells within sight. Amoxicillin/clavulanate was taken for 7 days. The rate of white blood cells dropped down and pH came back to 6,5. We stopped taking the drug. The blood cells went up in two weeks. Marbofloxacin was prescribed for 7 days. The white blood cells dropped to zero. In a week, a urine test taken t2 days ago showed white blood cells in the whole field of vision, and then Cefazoline was prescribed - 1 g diluted with 4 ml of novocaine; 2 ml of this solution twice a day intramuscularly.

Other tests:

  1. Ultrasound investigation made 26.03.2017 - no signs of metastasis anywhere. The kidneys demonstrated signs of pyelonephritis, stone kidney disease in remission. The urinary bladder showed moderate thickening, no stones.
  2. Biochemical blood test made 8.05.2017- all the parametres in their referential rates, including Potassium and Mg rates.
  3. Complete blood count made 8.05.2017- all the parametres in their referential rates.

To sum up, in all her analyses white blood cells are the only one parameter which is out of its referntal rates.

Dear veterinarians, it seems as we have no progress. We are completely stuck. I am asking you for your opinion. What do we need to do? Am I doing everything possible? Is there anything we can or must do? I am ready to provide you with all analysis and tests for the extra verification. Let me know what rates or tests you need.

Please, help us fight.

Kindest regards,

Svetlana

box1323

1 Answer

Melissa

Thank you for your detailed history, it certainly sounds like little Sarah has had her fair share of medical issues and I am sorry to hear that they are continuing to this date.

Sarah’s main problem currently seems to be contained to her urological system – bladder and kidneys with persistence of pyelonephritis and cystitis. Inflammation of the kidneys and bladder can potentially lead to an increase in WBC on urine cytology as you have found. The various antibiotics that Sarah has been on sound as though they have cleared any infection but until the inflammation is completely resolved she is at risk of redeveloping both stones and bacterial infections.

In cases like this, urine is often sent off for culture and sensitivity to ensure that there is no remaining infection or determine the best antibiotic to treat existing infection. Further investigation of Sarah’s kidney’s and bladder may involve endoscopic examination if necessary to give a better idea of what is happening within these structures. Lastly Veterinary small animal medicine specialists are highly trained clinicians and often best equipped to investigate challenging cases such as Sarah’s.

Melissa

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