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Old July 6th, 2007, 04:07 PM
psywzrd psywzrd is offline
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12 yr. old female pug drinking and peeing a lot

My 12 yr. old female pug had her gallbladder removed about 2 1/2 months ago due to a mucocele - they also did a liver biopsy during the surgery and that came back normal. Ever since the surgery she has been urinating more frequently and seems to be drinking a bit more as well. She definitely does not drink all time so I can't really say that her water consumption is really excessive, but it does appear to have increased a bit since the surgery.

Anyway, her urine specific gravity has tested out around 1.005-1.007 and my regular vet says that is very low. Her urine has been cultured - negative for any type of infection and no sign of glucose spilling over into the urine. Bloodwork has been done - everything normal (including kidney function) except for elevated liver enzymes which the surgeon told me to expect after gallbladder surgery. An ACTH stim test was negative as well. Because of the elevated liver enzymes, my primary vet put her on Marin and Denosyl for a month and she is having more bloodwork done next week to determine if the liver enzymes have come down. She has urinated in the house several times (4-6 times) since the surgery and she hadn't done that since we housetrained her as a pup. She is not leaking urine at all (her beds, couches, etc. are never wet) and seems to have no problem holding it in through the night (10+ hrs sometimes). Basically, I can't really say there's been a pattern to when she has peed in the house. The first couple times it was less than a week after her surgery and it was first thing in the morning before we had a chance to take her out, so I kind of wrote it off as a post-surgery fluke (we've since been extremely diligent about taking her out right away in the morning). Those two times first thing in the morning were the only times I actually saw her pee in the house (she actually squatted and peed - it didn't leak out) The other times I've come home to wet spots on the rug and even though I can't be 100% sure it's urine (it didn't really smell like it ), I can't imagine what else it could be.

My vet wants me to start measuring her water intake over the next few days so they can do a water deprivation test for diabetes insipidus. I'm a little hesitant to have them do it because of the risks (she always has access to water at home) but I want to know what's wrong with my dog. Also, I understand that condition is extremely rare so the odds are that it's something else. Her appetite is great, no weight loss or weight gain, there were no masses or abnormal cells on any of her ultra-sounds, etc. - it's just the increased peeing and drinking. She's an indoor dog who only goes out to go to the bathroom and we don't live near any woods, streams, etc.

Any ideas what this could be?

Last edited by psywzrd; July 6th, 2007 at 04:54 PM.
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Old July 7th, 2007, 12:01 PM
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Dr Lee Dr Lee is offline
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Low specific gravities can be a difficult to diagnose in some cases. Many are easy, some are very difficult. Sounds like your veterinarian is doing a great job. If you are concerned about the water deprivation test, I would talk to your vet some more. Perhaps she/he might have some alternative testing. Did your vet say that the liver enzyme elevation was contributing to the low specific gravity? Sometimes liver disease can be the cause.... Hard to say. There is a standard list of causes (more than a dozen) for low specific gravity but after the most common ones are ruled out the others can become more difficult and/or expensive to evaluate for.
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Old July 7th, 2007, 07:22 PM
psywzrd psywzrd is offline
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Quote:
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Low specific gravities can be a difficult to diagnose in some cases. Many are easy, some are very difficult. Sounds like your veterinarian is doing a great job. If you are concerned about the water deprivation test, I would talk to your vet some more. Perhaps she/he might have some alternative testing. Did your vet say that the liver enzyme elevation was contributing to the low specific gravity? Sometimes liver disease can be the cause.... Hard to say. There is a standard list of causes (more than a dozen) for low specific gravity but after the most common ones are ruled out the others can become more difficult and/or expensive to evaluate for.
I seem to remember them mentioning that liver disease could be a possible cause of the low specific gravity but they dismissed it because the liver biopsy was completely normal (can't get a better test than a biopsy right?). The surgeon who removed the gallbladder indicated that it could be a couple months before her blood levels would return to normal so I would anticipate her liver enzymes being normal when she's tested again this week. If not, I guess it's possible that something happened to her liver after the gallbladder surgery and liver biopsy but I would find that very hard to believe.

As far as the water deprivation test goes, we're only going to proceed with that if everything else is ruled out first. I really don't think she has diabetes insipidus though - everything I've read about that disease talks about constant drinking and my dog has consumed less than 4 cups of water today (we started measuring as of this morning). That coupled with the fact that's it's a rare condition leads me to believe that something else is in play.

I'm having a very hard time wrapping my mind around the idea that this is unrelated to her surgery (my surgeon swears it's unrelated). How does my dog go from peeing 2 or 3 times a day at most to peeing at least 6 times a day post-surgery? Is it possible that her bladder and/or urethra were somehow weakened because of the surgery and she just can't hold it like she used to? I guess if her urine specific gravity is still low when it's tested again, we'll know there's definitely something else going on.
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Old July 7th, 2007, 07:56 PM
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I am glad that the liver biopsy came out normal. That is good news.

Sounds like we also need to differential between a PU/PD disorder (increased urine volume and increased water consumption) and pollakiuria (increased frequency of urination with normal urine volume).

Is your pet drinking too much and urinating too much?
Two ways of finding out: 1) specific gravity. Measuring the sample given first in the morning is the best as the pet has not drank water all night and the chances for a high specific gravity are better. 2) Measure water intake and if possible urine outgo. What constitutes a PU/PD situation? Water consumed greater than 100mls/kg/day and/or urine produced greater than 50mls/kg/day.

If your pet is not and there is just pollakiuria, then I would be concerned about bladder inflammation. Common causes: urinary tract infections, crystal build up, bladder stone formation, some medications/vitamins, and far less likely bladder cancer.

Could the surgery have caused this?
Not directly, no. Different area of the abdomen. However, the stress can sometimes decrease water intake, leading to increased concentration (high specific gravity) which can lead to bladder inflammation. Some antibiotics can lead to bladder inflammation. Also some crystals could form in relationship to the liver problem (urate stones) or any change in urine pH. Stress can also bring out pre-existing problems to light, such as urinary tract infections, crystal problems, stones, etc...

I hope this helps.
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Old July 11th, 2007, 08:57 PM
psywzrd psywzrd is offline
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Quick update. I dropped off a urine sample this morning and brought my dog to the vet this evening. The urine specific gravity was 1.011 (he said it's within the "fixed" range) but there was no sign of anything else in the urine. Bloodwork is pending but they're leaning towards early kidney disease because of the low specific gravity. She's not exhibiting any other symptoms and her water intake was well within normal limits over the last 4 days that I was measuring it (a little over 2 cups/day for a 24lb dog). The vet has all but ruled out DI since she would probably be drinking about twice that amount of water if she had it. It doesn't sound like there's much we can do if it is CKD (special diet, low in sodium and phosphorus, etc.), but he doesn't seem overly concerned since she's otherwise fine. I guess we need to wait for the bloodwork to see if there's anything else going on (or to definitively say it's CKD) but that's the story for now. I'll report back once I get the lab results. Thanks for the help.
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Old July 12th, 2007, 02:01 PM
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The specific gravity makes DI inprobable as they often have much lower specific gravities.

If there is kidney disease present, there are many things that can be done. I would like to break them into two categories: diagnostics and therapy.

Diagnostics:
In addition to blood and urine testing, radiographs, ultrasound, blood pressure, urine culture and microalbumin urine testing may be helpful. Why? not all kidney disease is the same. While garden variety kidney failure is the most common cause, chronic kidney infections, stones, tumors, cystic conditions, etc... may also be present and present as slowly progressive kidney issues. If these were present, then there may be specific treatments available. Blood pressure is also important regardless of the cause because if hypertension is present, it can worsen the progression of the kidneys. Blood pressure medication is inexpensive, safe and dogs typically respond well to it.

Therapy for chronic kidney failure/insufficiency:
In addition to the mainstay of an appropriate food which you described excellently. Making sure the phosphorus blood level stays below 6 with phosphorus binders such as epikitin (an effective, well tolerated, nutriceudical) is essential. Also Azodyl can naturally help reduce BUN levels (if elevated) which can help the pet feel better. Again I would mention blood pressure medications if indicated. Depending upon the above tests there may be additional medications. For example, protein losing kidney diseases often require medications like enalapril (most people may recognize this as a heart medicine) may be helpful.

Kidney therapy and support is advancing fast and currently there are lots of options to help maximize both quantity and quality of life.

Good luck.
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Old July 12th, 2007, 03:00 PM
psywzrd psywzrd is offline
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Quote:
Originally Posted by Dr Lee View Post
The specific gravity makes DI inprobable as they often have much lower specific gravities.

If there is kidney disease present, there are many things that can be done. I would like to break them into two categories: diagnostics and therapy.

Diagnostics:
In addition to blood and urine testing, radiographs, ultrasound, blood pressure, urine culture and microalbumin urine testing may be helpful. Why? not all kidney disease is the same. While garden variety kidney failure is the most common cause, chronic kidney infections, stones, tumors, cystic conditions, etc... may also be present and present as slowly progressive kidney issues. If these were present, then there may be specific treatments available. Blood pressure is also important regardless of the cause because if hypertension is present, it can worsen the progression of the kidneys. Blood pressure medication is inexpensive, safe and dogs typically respond well to it.

Therapy for chronic kidney failure/insufficiency:
In addition to the mainstay of an appropriate food which you described excellently. Making sure the phosphorus blood level stays below 6 with phosphorus binders such as epikitin (an effective, well tolerated, nutriceudical) is essential. Also Azodyl can naturally help reduce BUN levels (if elevated) which can help the pet feel better. Again I would mention blood pressure medications if indicated. Depending upon the above tests there may be additional medications. For example, protein losing kidney diseases often require medications like enalapril (most people may recognize this as a heart medicine) may be helpful.

Kidney therapy and support is advancing fast and currently there are lots of options to help maximize both quantity and quality of life.

Good luck.
My vet did mention checking for hypertension. He did say that checking blood pressure in dogs is very different from checking in humans but they routinely do it there. I did bring another urine sample in this morning and they are checking protein and creatinine levels in the urine as well as microalbumin (results will probably be in on Monday). The bloodwork came back today and it looks much better. The liver enzymes are down significantly (not quite within the normal range yet but he is not concerned about it at all) and everything else looks good. I'll speak with him again early next week and post an update. Once again, thank you so much for your input - it has been extremely helpful!

Last edited by psywzrd; July 12th, 2007 at 03:03 PM.
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Old July 17th, 2007, 10:08 AM
psywzrd psywzrd is offline
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Quote:
Originally Posted by psywzrd View Post
My vet did mention checking for hypertension. He did say that checking blood pressure in dogs is very different from checking in humans but they routinely do it there. I did bring another urine sample in this morning and they are checking protein and creatinine levels in the urine as well as microalbumin (results will probably be in on Monday). The bloodwork came back today and it looks much better. The liver enzymes are down significantly (not quite within the normal range yet but he is not concerned about it at all) and everything else looks good. I'll speak with him again early next week and post an update. Once again, thank you so much for your input - it has been extremely helpful!
Quick update. Urine results came back negative. At this point, my vet thinks we're dealing with very early kidney disease (not kidney failure). He doesn't think we should do a thing other than monitor it over the next few months.
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