Page 780 - Small Animal Clinical Nutrition 5th Edition

808 Small Animal Clinical Nutrition

VetBooks.ir CASE 37-4

Chronic Kidney Disease in a Miniature Schnauzer with Multiple Problems
S. Dru Forrester, DVM, MS, Dipl. ACVIM (Small Animal Internal Medicine)
Hill’s Scientific Affairs
Topeka, Kansas, USA
Patient Assessment
A 12-year-old spayed female miniature schnauzer was presented for evaluation of vulvar discharge, possible polydipsia and occa-
sional vomiting that began within the past month. Laboratory evaluation performed by the referring veterinarian revealed mild
a
azotemia. The dog was currently receiving a low dose of enrofloxacin once daily. The dog’s appetite was normal. However, the
owner thought it was losing weight. Physical examination abnormalities included a grade III/VI holosystolic murmur (left side),
purulent vulvar discharge and vulvar erythema, malodorous breath and markedly decreased body condition (body condition score
= 1.5/5); body weight was 5.5 kg (Figure 1).
Initial diagnostic evaluation included a CBC, serum biochemistry profile, urinalysis and diagnostic imaging (Table 1). Significant
abnormal laboratory findings included leukocytosis characterized by mature neutrophilia, azotemia, low-normal serum albumin,
inappropriately concentrated urine (specific gravity = 1.028), proteinuria (3+ dipstick) and hematuria (60 to 70 RBCs/hpf).
Thoracic radiographs revealed no significant abnormal findings. Abdominal ultrasound revealed a mildly enlarged left renal pelvis.
Additional diagnostic tests were performed to further evaluate initial abnormal findings.Urine culture revealed growth of Escherichia
coli (800 colony forming units/ml of urine) and the urine protein-creatinine (UPC) ratio was 4.3. Systolic blood pressure measured
indirectly by Doppler technique was 180 mm Hg. Results of an assay for canine pancreatic lipase immunoreactivity were normal.
On the basis of all findings, CKD, hypertension and urinary tract infection (UTI) were diagnosed. Mitral valvular disease was
also considered likely. CKD was determined to be stage 2, P, Hnc (P = proteinuric, Hnc = high risk for target organ damage due
to hypertension but no current evidence of complications [Table 37-1]). Pyelonephritis was suspected because of renal ultrasound
findings and presence of leukocytosis.There was no evidence of cardiac decompensation on thoracic radiographs. Active pancreati-
tis was considered unlikely.
Assess the Food and Feeding Method
Because of several episodes of apparent pancreatitis in the past, the patient
was eating a commercial dry, low-fat veterinary therapeutic weight-reduction
b
food. Water was available free choice at all times.
Questions
1. What treatment is indicated for UTI and hypertension in this dog?
2. What treatment recommendations are appropriate for managing CKD in
this patient?
3. What key nutritional factors should be considered in a dog with a history
of pancreatitis?
4. What are some guidelines for managing patients with concurrent disorders
such as CKD and pancreatitis?

Answers and Discussion
1. Because this dog has CKD, UTI and a dilated left renal pelvis, treatment
for pyelonephritis is indicated. An extended course of treatment is needed;
therefore, an appropriate antimicrobial should be selected based on suscep-
tibility testing. In addition, urine cultures should be done periodically dur-
ing and after treatment to confirm therapeutic success.
Controlling hypertension is indicated because this patient is at severe
risk for target organ damage because systolic blood pressure is ≥180 mm
Hg. Hypertension may worsen progression of CKD in dogs and has been
associated with increased risk of uremic crisis and death in dogs with nat-
urally occurring CKD.Treatment of hypertension also is indicated to avoid
worsening of mitral valve disease. Excessive dietary intake of sodium should
Figure 1. A 12-year-old miniature schnauzer that pre-
be avoided; however, selection of an appropriate food should be based on sented for evaluation of multiple problems.