Case of the Month
Tony, a 3-year-old male Greyhound, presented to the Animal Emergency and Referral Hospital on July 10, 2008, for several days of inappetence and vomiting. Following his 
examination, Dr. DelGiudice recommended blood work, urinalysis, and radiographs. Blood chemistry revealed elevated renal (kidney) values, and urinalysis detected a decreased concentration to urine, the diagnosis made was acute renal failure. Dr. DelGiudice recommended hospitalizing Tony on IV fluids, antibiotics, gastric protectants, and antiemetics. Further diagnostics were recommended to determine the cause of the renal failure. Acute renal failure can occur secondary to infection, toxicity, ischemia (decreased blood supply), and urinary obstruction. Blood work was submitted to an outside laboratory to rule out tick born diseases and leptospirosis. Leptosporosis is a bacterial infection that can cause liver disease and renal failure. This bacteria is contracted by dogs from drinking water contaminated with the bacteria. The bacteria is shed in the urine of wild animals. Humans can contract this disease as well.
Tony was hospitalized in our intensive care unit (ICU), and his care was undertaken by our critical care department which is led by Dr. DelGiudice our hospital’s chief of staff and intensivist. A central venous catheter was placed in Tony’s jugular vein allowing us to deliver IV fluids (mainstay of treatment for renal failure), draw blood to monitor Tony’s condition, and measure his central venous pressure (an indirect measurement of blood volume), which helps guide IV fluid therapy. A urinary catheter was placed to monitor his urine output. This is important because with acute renal failure the kidneys can completely shut down and stop producing urine. If this occurs in combination with the aggressive fluid therapy used to flush the body, it could result in too much fluid being given to the patient, causing fluid overload to develop and potential deadly complications such as pulmonary edema (fluid in the lungs). The combination of a central venous catheter to measure blood volume and a urinary catheter, allows for intensive monitoring of the patient to help prevent unwanted complications. An abdominal ultrasound was performed and Tony’s kidneys were large and bright. Under ultrasound guidance, Dr. DelGiudice took fine needle aspirates of the spleen, liver, and kidneys. These aspirates were submitted to a pathologist to evaluate the cells and see if they could help determine the cause of Tony’s renal failure. Tony’s blood pressure was also monitored during his hospitalization because hypertension can occur, secondary to renal failure. This was detected in Tony and he was started on Amlodipine (anti-hypertensive medication). At a point during Tony’s hospitalization his urine output decreased and his central venous pressure elevated indicating that his kidneys were shutting down further. A medication was administered to increase his urine output and avoid complications.
By the time Tony left our facility, his renal values had almost completely normalized. The kidneys can take several months to completely recover. The first set of leptosporosis titers revealed a slight elevation in antibodies. This can occur from a recent or previous vaccination, or acute disease. A second set of titers has to be repeated in two weeks to confirm leptosporosis. If the antibody levels are rising this confirms a leptosporosis infection. Tony was discharged with several medications; Amoxicillin (an antibiotic), Omeprazole (a gastric acid secretion suppressor), and Amlodipine (an anti-hypertensive). We also dispensed a kidney diet.
Tony was rechecked one week after being discharged and he was doing well. His kidney values normalized, and a second leptosporosis test was submitted. Tony still had an elevated blood pressure so his anti-hypertensive medication was continued. The second leptosporosis anti-body levels were extremely elevated confirming that this bacterial infection was the cause of Tony’s renal failure. After two weeks of therapy with amoxicillin which is used to treat acute leptosporosis infections, Tony’s antibiotic was changed to doxcycline for two weeks to treat the chronic stage of the disease. As of the last phone follow up with Tony’s owner, he was doing well and had completely recovered.
Acute renal failure is a deadly disease and generally carries a poor prognosis. Luckily for Tony he had a strong will, and combined with the intensive care he received from our critical care department he was able to survive this deadly disease. Due to the deadly nature of this disease, a discussion with your RDVM about the benefits and contraindications of having your pet vaccinated is recommended.