Case Study 7: Spike, Amyloid Kidney Biopsy and Hematoma. **

History: This 12-year-old MN Cairn terrier presented for a geriatric screening. The physical exam was uneventful. The CBC was normal. Blood chemistry revealed mildly depressed total protein and magnesium and moderately depressed albumin levels. Mildly elevated amylase was also present. Urinalysis: PH 7.0, USG 1.045, Appearance cloudy, Protein 3+, Blood 1+, epithelia rare. The urine protein creatinine ratio was moderately elevated, and progressively increased over a 2 month period. Urine culture and Leptospirosis titers were negative and the patient had been vaccinated for Lyme's disease.

Clinical Differential Diagnosis: Protein losing nephropathy: glomerulonephritis, interstitial nephritis, amyloidosis, other chronic renal disease, and neoplasia.

Sonographic Interpretation: See images.

Sonographic Differential Diagnosis: Glomerulonephritis, pyelonephritis, interstitial nephritis, amyloidosis, other immune mediated renal disease.

Sampling: After a normal PT and APTT were tested, US-guided 18g Tru-cut biopsy of the cranial left renal cortex revealed extensive glomerular amyloidosis with mild interstitial fibrosis and secondary inflammation.

Comments: The patient was clinically stable 8 months post sonogram.

Referring Practitioner: Barbara Guy DVM, Whitehouse Veterinary Hospital, Whitehouse, NJ, USA.