Low protein and leaking urine.

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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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.

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.