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Low protein and leaking urine.

Species: Dog
Breed: German Shepherd mix
Age: 5-8 years
A German Shepherd mix, approximately 4-6 years old, was dropped off and we started caring for him until a home could be found. The first vet we took him to for vaccinations diagnosed heartworm. The 2nd vet ran the heartworm test twice and found no heartworm. (I am confused how this could occur). However, polydipsia and polyuria is a problem along with some urinary dribbling. He has been tried on Proin twice daily, with perhaps a little help. Urinalysis was negative for infection, blood, protein, etc. Specific gravity was very low though, with the vet stating his kidneys are not concentrating the urine. A urine for C & S came back normal. He is on Proin BID that has helped possibly a little but not much. Blood work was within normal limits except ALB was low at 13 (normal 20-150); Creatinine 1.3 (normal 0.3-1.4). BUN was 11 (normal 7-25) and glucose 109 (normal 60-110). X-rays showed bladder moderately distended, normal in opacity; no urethral calculi seen; kidneys difficult to identify but likely normal; moderate spondylosis deformans of cranial lumbar and lumbosacral regions; minimal thickening of femoral necks. So nothing has been identified but the dribbling continues. The vet is now recommending an ultrasound of the bladder to look for a tumor, but this would have to be done at another location yet to be determined, and sending him to a veterinary hospital, but I can not afford all this. Jack is a sweet boy, very friendly, smart, and loves everyone. Unfortunately, our 3 dogs are not very tolerant of him. I would like to get his health issues resolved so there is a greater chance of finding a good home for him, as I doubt I can find someone to take him with the current problems. He is getting attached to us, and us to him, but we can't keep him and the sooner we can get this taken care of, the better. Any suggestions on what could be occurring or how we can get it fixed? I can send you a copy of the lab work and x-rays, or a picture of Jack, if anything will help. Thank you for your assistance, it is sincerely appreciated.


Online vet, Dr. Marie

Dr. Marie replied:

This sounds like a difficult case. I can really sympathize with how frustrating cases like this are.

It's hard to say exactly what is going on with the heartworm test. These tests are not 100% accurate and it is possible that the first test was a false positive.

I am a little concerned with the fact that the urine is not concentrating, but the fact that the kidney enzymes are normal is good. I would probably want to be rechecking the kidney enzymes in a few weeks to make sure that the values are not increasing.

The low Albumin has me quite concerned. This is something I would probably want to be rechecking. In fact, the low albumin is probably the most concerning fact in all of the test results that you gave me. Albumin is a type of protein. To be low on protein it can be that it is being lost through the kidneys (except that there is no protein in the urine, so that's not it) or through the intestines or for some reason it is not being made.

One thing you could ask your vet about is the possibility of something called atypical addison's disease. It can sometimes be a cause of low protein and dilute urine but it's a bit of a stretch.

From what you've told me, a bladder tumor seems unlikely as it would not cause low albumin and dilute urine. A bladder tumor can be a cause of leaking urine and it could be worthwhile to look for one but I am guessing there is something else going on.

The problem is that there is no easy answer to this question. And there is no easy way to know whether this is going to be a temporary or a lifelong issue.

If cost is a concern (and that is totally valid) then I would ask your vet for low cost options. For example, rather than doing more expensive tests then they may decide to just keep an eye on things for now and retest the kidney and protein (albumin) levels in a few weeks. This has probably already been done, but you could ask if there is a different type of heartworm test that they can try to do such as a DNA test. Heartworm disease can be a cause of protein loss and dilute urine as well.

If the albumin levels are decreasing then this may very well be a very serious condition.

I feel like I may not have helped at all but just added more confusion. The key points that I want to make here are that there is no easy answer here and there is a good possibility that this is something serious. You may have some hard decisions to make. The best advice I can give you is to trust your vets and let them help you make these decisions.

Dr. Marie



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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. AskAVetQuestion.com and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

I apologize, Dr. Marie. I was being read the test results as I was constructing my message and I either heard wrong or was given the wrong letters. Either way, it was not ALB that was low but ALP. I am sure this may make a difference in your opinion, as it is not the albumin that is low but alk phos. I don't believe this is as serious.

Considering this, would you have any different suggestions?

Thank you. And again, I apologize.

Lori


Online vet, Dr. Marie

Dr. Marie replied:

Woops! That definitely changes things! I'm not worried at all about a low ALP (alkaline phosphatase).

That makes things sound much less serious. So now the main problems are that the urine is not concentrating well and that there is urinary leakage (which is probably because the lack of concentration causes more urine to be produced.)

I'd still probably want to recheck kidney enzymes in a couple of weeks to see if there is something developing there.

I just had one additional thought. I have had several cases that have had difficulty in concentrating their urine (and subsequent accidents in the house) with no known cause but we suspected that some sort of treat was the problem. There have been off and on problems with some chicken jerky treats (see http://www.askavetquestion.com/news/2011/chicken-jerky-fanconi/.) If Jack eats any chicken jerky treats then I would stop them and you may find that things get better on their own within a couple of weeks.

Hope that helps!

Dr. Marie.



Customer reply:

Thank you.

I had heard about the chicken jerky. I don't know his history of course but he hasn't had any here. He has had some rawhide bones but usually I will give the dogs rawhide-free. But even these are perhaps once every 2 weeks or so. Although some of the rawhide free usually have chicken in them...

Should diabetes insipidus be considered? If so, is there something that can be tried to see if it is first without hurting him, before going through a lot more diagnostic tests?

He's been here for 2 -1/2 months now and once he was found to be heart worm negative (which was initially my primary focus) we have been working on this issue. I initially thought diabetes but labs didn't support that. Then Cushing's, glomerular nephritis, but those didn't fit either.

By the way, the vet I'm now taking him to works a lot with rescues and has donated some of her services to help. She did not charge for the second heart worm test, gave the Proin at cost, gave a $43 discount, etc. This has helped a lot and kept charges spent on Jack down to about $600-700. But going for an US and to a vet hospital are outside of her practice. We can't afford to keep searching for a solution so we can find him a good home, but I won't release him until we know what is going on as I want to give him every chance possible. But if we don't find out what is going on and some treatment, the dribbling will continue meaning chances of finding him a home are slim. This is a never-ending circle!

Thanks.

Lori



Online vet, Dr. Marie

Dr. Marie replied:

Diabetes insipidus is pretty rare. Also, in order to be diabetes insipidus the urine has to be extremely dilute. We usually give a number to indicate how dilute the urine is, called specific gravity. If the specific gravity is between 1.030 and 1.050 that's probably normal. Between 1.012 and 1.030 could be a little dilute. Between 1.008 and 1.012 makes us worried about kidneys and much lower than 1.008 could be diabetes insipidus.

I hear your frustration as I have had cases like this and the toughest thing is not knowing. If you knew that it was going to be a lifelong decision then you could make decisions perhaps a little easier.

I wish I had more answers for you!

Dr. Marie.



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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.