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Dear Dr.dana,

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.

Answer
Dear Poorvi

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:

http://www.bio.miami.edu/hare/ileus.html

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:

http://www.mayoclinic.org/symptoms/protein-in-urine/basics/causes/sym-20050656

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.

Dana  

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Dana Krempels, Ph.D.

Expertise

I've lived with companion rabbits for more than 35 years, and consider them members of my family. I can answer any questions about the biology and health of rabbits, from the commonplace to the unusual. But please note:

RULE #1:
THE INTERNET IS NOT THE PLACE TO SEEK HELP IN AN EMERGENCY.

...it is an EMERGENCY.

Find a rabbit vet at www.rabbit.org/vet for immediate help, and don't risk your bunny's life by spending time asking questions online! If you can't get in touch with your vet, read these Emergency Sick Bunny Instructions.

If you have found a wild baby rabbit, please read these EMERGENCY INSTRUCTIONS FOR WILD BABY RABBITS and then use this link to FIND A LOCAL WILDLIFE REHABILITATOR who can give you the right advice.


RULE #2:
Help me help you! Please make your subject line informative if you have an urgent question. then LET ME KNOW IN THE SUBJECT LINE so I can give your question highest priority over non-urgent questions. If you don't do this, then I can't guarantee timely assistance!

For all the best, most accurate rabbit health, care and behavior information, visit The House Rabbit Society.

Experience

I have been rescuing and rehabilitating domestic and wild rabbits for about 30 years. I have written articles for many rabbit rescue publications, as well as for the veterinary journal, Exotic DVM. I own EtherBun, the internet's largest listserve dedicated to health, care, and behavior of domestic rabbits.

Organizations
Houserabbit Adoption, Rescue, and Education, Inc. (H.A.R.E., Inc.) president National House Rabbit Society (Board member)

Publications
Exotic DVM
Warren Peace (Journal of the House Rabbit Society of Miami)
Various newsletters of the House Rabbit Society, nationwide

Education/Credentials
Ph.D - Biology
B.S. - Biology
B.A. - English

Awards and Honors
Lightspan Academic Excellence Award for web site on rabbit health and biology
(http://www.bio.miami.edu/hare)

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