Clinical Presentation: Hematuria
Dusty, a 6-year-old spayed female Golden Retriever
|Dusty presented with hematuria of 2 days' duration in the winter. There were no signs of polyuria, polydipsia, or straining and she maintained urinary continence. Dusty had received her annual vaccination boosters (no leptospirosis vaccine) 3 months prior to the onset of hematuria. Her physical exam was unremarkable.|
|An initial urinalysis confirmed the presence of red blood cells, protein, a small number of bacteria, and 3+ struvite crystalluria. Her veterinarians placed Dusty on antibiotic therapy for cystitis. Urolithiasis was also in the differential diagnosis.|
|However, the hematuria did not resolve during the next few months. A follow-up at 3 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 suggested possible infection caused by L. pomona. Other MAT titers were less than 1:100.|
|Dusty was treated with doxycycline and fully recovered 4 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.
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