Diagnosis and Treatment

Clinical Cases - Dusty

The following case is taken from actual medical records. Names, photographs and minor details have been changed to maintain client/patient confidentiality.

CASE 1: Dusty, a 6-year-old spayed female Golden Retriever

Dusty presented with hematuria of two days duration in the winter. There were no signs of polyuria, polydypsia or straining and she maintained urinary continence. Dusty had received her annual vaccination boosters (no leptospirosis vaccine) three months prior to the onset of hematuria. Her physical exam was unremarkable.

An initial urinalysis confirmed the presence of red blood cells, protein, small numbers of bacteria and 3+ struvite crystalluria. Her veterinarians placed Dusty on antibiotic therapy for cystitis. Urolithiasis was also a differential diagnosis.

However, the hematuria did not resolve during the next months. A follow-up at three months revealed no abnormal findings on physical examination. A urinalysis now showed elevated creatinine and 3+ hematuria. The differential diagnoses were now a long list including endothelial damage, clotting disorders and neoplasia. Leptospirosis was still not considered as a differential diagnosis. Blood chemistries indicated elevated liver enzymes, urea and creatinine with depressed levels of glucose and thyroid hormone. Only now was leptospirosis considered as a possible diagnosis. A MAT titer of 1:400 confirmed leptospirosis caused by L. pomona. Other MAT titers were less than 1:100.

Dusty was treated with doxycycline and fully recovered four months after initial presentation.

Case Note: Leptospirosis was not included in the initial rule-out list in the diagnostic workup. The delay in treatment coupled with shedding of leptospiral organisms provide adequate opportunity for the pathogens to spread to others. Signs of kidney disease should alert veterinarians to the possibility of leptospirosis infection.