Rabbits/High protein in urine- renal failure?
I have been in touch with you for sometime now. I'll first give a brief history so you can recall the situation. Ollie my 3 year old bun had started getting blood in her urine about a month ago.In her first ultrasound, bladder was extremely inflammed indicating cystisis, She was intact at that time, the urine analysis showed bacteria (Pseudomonas) in her urine and she was started on enroflaxacin for 5 days witht he first 2 days on high loading, which led to her losing her appetite completely, on the fifth day her intestine sounds stopped completely, and her medication had to be stopped. After which I put her on critical care for the next 3 4 days and she started eating again. the ultrasound and x-ray which were taken a week after the last ultrasound threw up nothing. Thus after consulting 5 vets, who all prescribed meds for UTI, we continued her treatment for a week or so with ciproflaxacin, but again she had a bad reaction, and diarrhoea started. All this while the blood in urine kept showing up which we tried to control with revisi inject-able. After about a month of treatment and 4 ultrasounds, when the blood still continued to come in pools (very large quantity), after consultation with you on this forum, we decided to get her spayed. Thus we contacted an experienced surgeon, though being in India, there are no experienced vets, we decided for surgery as her blood loss was too great, her haemoglobin levels were 11.1 before she had massive bleeds, even though she got out of spay surgery, the surgeon said that no cancer/tumor was found in the uterus, and on inspection nothing was seen in the bladder or other nearby organs. This was 3 days ago, now the trouble is she has been getting excessive amounts of protein in her urine though the visible blood has stopped. Even in the urine analysis taken at the time she was diagnosed with UTI she has a (+) of protein in her urine, another report showed a (+++) of protein. Now after surgery, its been 3 days, she has had no visible blood in her urine, unlike before when the stoppage of revisi was causing massive bleeds, but her urine shows an excessive amount of protein. We are worried she may be going into renal failure.
The meds she is on now are mostly ayurvedic, mainly a liver tonic, a kidney tonic for appetite stimulation, B-complex, Urikind (an alkaliser) and meloxicam/metacam and a dietary supplement for animals known as Renalof which has small amount of protein (0.1mg/100gm).
Her Blood urea is 38 and her creatinine is 0.75. calcium, phosphorus and NA levels are normal. Some level of ketone was found but glucose was not found even in trace amounts. Could it be the protein is because of the UTI present? Was the bleeding also cause of the UTI? But then why would the bleeding stop after the surgery?
Kindly advice what should be our next step? the vets here are completely clueless.
Thank you so much for your advice doctor. In a place like India, your help is much valued and appreciated.
It is very unlikely that the enrofloxacin or ciprofloxacin caused your bunny's GI problems, unless the formulations you have in India are completely different from those we have in the US. It is more likely that the pain and stress of the infection she has caused the GI stasis. That should be treated with the protocols here:
Her BUN levels are high, but not off the charts. Her creatinine is within the normal range. I would suggest trying subQ fluid therapy to help her kidneys flush any toxins and to avoid putting too much of a strain on them. Consult with the vet about the proper dosage for this therapy per day, and be careful not to overdo.
As for the protein in the urine, conditions other than renal disease *can* cause this:
If you can ensure that she is very well hydrated and *then* get blood values, they will be more accurate.
A urinary tract infection left untreated (or treated with ineffective antibiotics) can worsen and affect the kidneys. So it might also be wise to try another antibiotic (perhaps trimethoprim sulfadiazine?), or pair antibiotics to try to get broader coverage.
I hope this helps.