While it is not unusual for a pet to have an accident in The Animal Medical Center waiting room or while standing on an examination table, my reaction to that accident may be considered unusual. As the embarrassed pet family is grabbing for a paper towel or a tissue to mop up, I blurt out “stop” so I can get a syringe to collect the urine for analysis in the laboratory.
18 Tests in One Tube
At The Animal Medical Center, a urinalysis tests 18 different parameters from just a teaspoon of urine. Some of the parameters are assessed visually, like color and clarity. A special dipstick measures six values simultaneously – especially important here are glucose and ketones – indicators of potential diabetes. The urine is spun in a centrifuge and the material that collects on the bottom of the test tube is specially stained and evaluated under the microscope. Finally, a drop or two of urine is placed on a refractometer, a device that measures the specific gravity and assesses how concentrated the urine is.
A Snapshot of Your Pet’s Health
The results from tests performed on that teaspoon of urine I have collected off the table or floor gives me a whole lot of information about your pet’s health. The finding of red and white blood cells and bacteria when the urine is evaluated under the microscope suggests a urinary tract infection. Observation of crystals in the urine is common and may not represent disease, but if your pet has bladder stones, the presence of crystals gives a hint as to the type of stones, and knowing the type of stone makes treatment more specific and successful. For example, the presence of ammonium biurate crystals in a dog with bladder stones suggests the presence of an abnormal liver blood vessel, and the presence of struvite crystals in a dog with a urinary tract infection and bladder stones suggests struvite stones. In addition to filtering the blood to remove waste products from the body, the kidneys help maintain the body’s water balance. Drink too much and they excrete the excess, drink too little and they hang on to every molecule of water they can. When the kidneys don’t work well, they lose the ability to dilute and concentrate the urine. Measurement of a urine specific gravity, part of a routine urine test, helps veterinarians assess the kidney’s ability to dilute and concentrate and is a partial measure of kidney health.
So much information from something you, the pet owner thought was just an accident. No wonder I am crazy about getting that urine sample from your pet.
One of @amcny’s Twitter followers posted the question that is the title of this post. This person also asked, “Should the high end of the normal range of creatinine be 2.4?” These are very good questions, especially for cat families since cats are seven times more likely to have kidney disease than dogs. I am devoting this week’s blog to the answers.
A standard panel of blood tests includes measurement of blood urea nitrogen and creatinine. These tests are commonly used to evaluate kidney function, but the results can be abnormal with dehydration, intestinal bleeding and a high protein diet. When combined with a physical examination and an analysis of the pet’s urine, they become a more powerful assessment of how well the kidneys work.
For many years, when veterinarians discovered elevations in blood tests to measure kidney function, we talked with pet families about chronic renal failure or CRF, and before that we talked about chronic interstitial nephritis or CIN. Today we more commonly use the term chronic kidney disease or CKD. As time passed, the name has changed to more correctly reflect our understanding of the disease. Chronic interstitial nephritis comes from microscopic evaluation of a kidney biopsy, something most pets never have. Chronic renal failure was a confusing term to pet owners who were unfamiliar with the medical term for kidney – renal. Failure was a misnomer since the abnormal blood tests indicate decreased function, but not necessarily an absence of function or failure. Thus, renal became kidney and failure was swapped out for disease.
If There is Chronic, There is Also Acute
In medicine, if a disease has the modifier “chronic” you can bet there is also an ”acute” form of the same disease. Acute renal failure has a very abrupt onset in a decline of kidney function and is caused by a variety of disorders including leptospirosis, antifreeze ingestion and lily intoxication. Some pets with acute renal failure completely recover; others improve but continue to have chronic kidney disease and sadly, others don’t make it. The term chronic indicates a long term process that may or may not get worse, but one that, with treatment, can achieve a good quality of life.
Is 2.4 the High End of Normal Range for Creatinine?
Normal range is another term largely gone from the veterinary lexicon because normal depends on the age, sex and even breed of the dogs or cats used for comparison. Now we use the term “reference range or reference interval.” The upper end of the reference range is variable from lab to lab, based on testing methodology, equipment and the exact animals used to develop it. Perhaps more important than the exact reference range from the lab is what is normal for your pet, i.e. what was the creatinine last year and the year before and is the number trending upwards? When that happens, it suggests decreased kidney function and suggests more testing may be indicated.
Thank you to our Twitter follower for asking such important questions. If you are interested in more information about what blood tests tell your veterinarian about your pet’s health, read this recent blog on blood tests. Learn more about feline kidney disease.
Since New Year’s has passed, I suspect many pet families are hard at work on their list of resolutions. Weight loss is a common human New Year’s resolution and since estimates of overweight and obese pets range from 25-40%, I suspect it is on the list of many pet families as well. If you have a Labrador Retriever, Beagle, Cocker Spaniel, Basset Hound, Dachshund or Sheltie, breeds at high risk for obesity, weight loss is probably perpetually on your to do list.
Here are my tips to help your pet keep its resolve when it comes to weight loss:
- Many pet owners don’t recognize chubbiness in their favorite furry friend. Have your veterinarian assess your pet’s body condition score. This will help determine if weight loss is necessary.
- Using your pet’s body condition score, decide how much weight loss is necessary and have your veterinarian calculate the number of calories required daily to attain that weight. Ask if a weight loss food would be nutritionally better than simply cutting back on the current daily portion.
- Determine how many calories are in each can, bag or box of your pet’s food and calculate exactly how many ounces, grams or portions of a can are required to meet your pet’s daily calorie allotment. Then feed that number of calories – no more, no less.
- Limit treats to 10% of the calculated daily calorie allotment AND include treats in the daily calorie total. Treats can look deceptively calorie free and help to pack on the pounds. A small Milk Bone biscuit contains 20 calories and a Bully Stix has up to 22 calories per inch. A six inch stick could be nearly 25% of your 30 pound dog’s calorie allotment for the day.
- Keep your pet active. Throw a ball. Use the laser pointer with your cat. Exercise with your pet. Scientific research has shown exercising your dog is good for those on both ends of the leash.
Let’s clink our glasses of no calorie seltzer water to a healthy, happy and thinner 2015 for the whole family!
For over 100 years, The Animal Medical Center has held fast to the mission of community service embraced by our founder, Ellin Prince Speyer. In 1910, Mrs. Speyer and her organization, the New York Women’s League for Animals, established a dispensary and out-patient clinic for all animals whose owners could not afford to pay for medical treatment. The clinic treated 6,028 animals in the first full year. To this day, in addition to caring for New York City pets 24/7, The Animal Medical Center continues to give back to the community.
AMC TO THE RESCUE
Because The AMC’s main mission lies in promoting the health and well-being of companion animals through advanced treatment, research and education, we recently created a new Community Fund, AMC TO THE RESCUE, to provide subsidized specialty care to animals currently cared for by rescue groups. Through AMC TO THE RESCUE, we have provided a means for needy animals to receive care from one of our 30 board certified veterinary specialists. Since its inception in 2013, 20 dogs, 15 cats and one rabbit have received medical care supported by AMC TO THE RESCUE, which has led to the adoption of many of these pets into a forever home. Without the specialty care provided by The AMC’s board certified ophthalmologist, neurologist, internist, dentist, cardiologist, soft tissue and orthopedic surgeons, these pets might be spending yet another holiday as homeless and unadoptable rescue animals.
The Westminster Kennel Club Dog Show
Veterinarians from The AMC volunteered their time to manage minor health issues and triage emergencies for the dogs competing at the 2014 Westminster Kennel Club Dog Show from the start of the First Annual Masters Agility Championship until the moment GCH After All Painting the Sky captured the 138th Westminster Kennel Club Best in Show. Our doctors happily donated their time and skills to ensure the health and welfare of these beautiful animals.
Animal Medical Center Doggy Dash at the NYC Triathlon
For the past seven years The Animal Medical Center has been the title sponsor of the Animal Medical Center Doggy Dash. Doggy Dash gives a runner and their best canine friend the chance to compete in tandem over a 5 mile course through Central Park, finishing at the NYC Triathlon finish line. Twenty-nine dogs and their human runners participated in 2014. To ensure the health and safety of the canine participants, seven AMC veterinarians and four licensed veterinary technicians volunteered to perform the pre-race health certification and monitor canine participants on the hot and steamy day of the race.
Emergency Medical Training for NYC First Responders
A new program for 2014, involving AMC veterinary volunteers, was a canine first aid and critical care workshop for first responders. AMC veterinarians and technicians provided training using canine dummies and cadavers to teach such practices as venipuncture, catheter placement, intubation, CPR, oxygen administration, and treatment of dogs in shock. Thirty-two medical operations personnel, including men and women from the FBI, undercover agents, fire department EMTs, paramedics, physicians, and even an Air Force para-rescue jumper benefited from the expertise and time of AMC volunteer instructors.
Partnering with Angel On A Leash
The AMC and Angel On A Leash are both champions of the human-animal bond and its role in enhancing human health and quality of life, believing in the positive role of therapy dogs in health care facilities, schools, rehabilitation, hospice, extended care, correctional facilities, and crisis intervention. Because of our shared missions, The AMC and Angel On A Leash again worked together this past September on the Ronald McDonald House Family Fun Walk held in Carl Schurz Park.
On #GivingTuesday, the global day dedicated to giving back, the staff of The AMC gave not of time, but of money when they participated in a raffle. The proceeds, nearly $1,000, were donated to SAVE – Seniors’ Animal Veterinary Effort – a community fund supporting pet care for New York City seniors’ pets.
The AMC wishes you and yours the best of the holiday season and a 2015 filled with healthy and happy pets.