Questions regarding Nephritis in Labrador Retrievers

Factual Questions
1

Calling all vets…

I’m looking for information on nephritis and other complications brought on by Lyme Disease in Labrador Retrievers. Specifically, information on therapies, long term prognosis etc.

My fiancee’s Chocolate Lab (Luna) has been in Veterinary ER/ICU since Sunday with systemic inflammation, a heart murmur, extreme lethargy, very low albumin and exceptionally high protein levels in the urine. Also, platelets were significantly off normal. Further testing has revealed it’s most likely mid-stage Lyme Disease. (She had Lyme several years ago but responded well to treatment - the presence of antibodies evidently confuses results) Last night in the wee hours she had a kidney biopsy and bone marrow extraction as well

After a liter of plasma, IV antibiotics and human albumin therapy, she’s shown marked improvement but we won’t know more until some time as passed - her albumin is up but still only 2.1 (from a high of 2.6 with the therapy) She is generally a very healthy dog - 80 lbs, not overweight, and active.

The hospital is cautiously optimistic, but warned that in addition to general concerns, there are additional breed specific issues with nephritis. We are looking for info on what to expect, and any longterm therapeutic options.

Thanks in advance!

  • Luna and her people
2

While I have very little experience with Borrelia, a friend of mine (a veterinarian) does. Her comment:

A link with some info: (PDF)
http://ecommons.library.cornell.edu/bitstream/1813/2581/1/2003+Emery.pdf

3

Thanks, vetbridge

That’s not terrible encouraging, but we’d rather have all the information we can get at this point.

Couple Q’s:
Is Borreliosis a specific type of nephritis, or just the specific term for the condition?

Is the age of the dog a factor in the outcome, or is it just more common to younger dogs? (Luna is 7)

Thanks again

4

Borreliosis is the name I would use for a disease caused by Borrelia burgdorferi, the organism that causes “Lyme disease”. The term “Lyme disease” was used before the causative organism was identified.

The age has to do with one specific manifestation of Borreliosis, specifically nephritis. It tends to occur in young setters. I do not know if there is a correlation between age and outcome, however.

Although I do not see many cases of Borreliosis, my understanding in general is that dogs with nephritis have a very poor prognosis.

ETA: maybe Pullet has some more recent information.

5

I see. While we very much wish the situation were different, at the very least forewarned is forearmed.

Thanks for the information, vetbridge

Pullet, anything to add?

6

IANAV, but Gavi, my Border Collie, went through almost the exact same thing about a month and a half ago. Albumin, which was chronically low anyhow, dropped to 1.1, platelets to 23,000, BUN and Creatinine high. Blood and protien in the urine. Poor girl was immobile…

Tick titers came out as high for Lyme, possible for Anaplasma (was called Erhlichia a while ago). They kept her on supportive fluids, and high doses of both Doxy and Cephalexin. They kept her at the ICU in case she needed plasma, but she didn’t start bleeding.

Upshot is: She is fine, now. Her platelets were back up to 250,000, no sign of nephritis, kidney levels back to normal, her muscle mass is starting to return. Her albumin levels are back up to 1.4, and as soon as I can afford the endoscopy, we will try to figure out what the reason for that is.

Just wanted to let you know that the first two vets that saw her, (an overnight ER and the next day my own vet) believed she was in kidney failure. The internist that took over says no - and that permanent kidney damage is often over diagnosed with Lyme and Anaplasma.

Good luck with her - and hopefully the antibiotics will start showing their effect soon!

7

Sorry for being late to the party. (and personal invites, too! I feel so special!)

Small animals aren’t quite my bag, so I’m going to have to dig up my notes. Will do as soon as I get home. In the mean time, I’ve got an EPB out to my classmates. Between the hundred of us, we make a fairly good vet :smiley:

Will have info directly.

Pullet

8

Ok, more info filtering in.

Like the link VetBridge provided says, Lyme nephrosis is believed to be an immune-mediated attack on the kidneys. The proposed way it works is like this: the dog’s immune system over-reacts to proteins in the lyme disease and makes a bunch of antibodies. The antibodies then mistakenly glom on to the tissues in the kidneys putting holes in the kidney’s filtering tissues. Normally, the kidney’s filters would prevent the natural proteins in the blood stream from being lost into the urine. But, with all the holes caused by the mistaken antibodies, the kidneys can’t hold on to the blood’s proteins and everything goes out into the urine.

The reason your vet is suspicious that this might be the case for you is the fact that your dog had a low blood albumen (albumen is the major protein present in the blood) and high urine protein.

In my diggings so far, there doesn’t seem to be a lot of good information on how smoothly these dogs recover from lyme nephritis. One site I found (here) suggests that the mortality rate for dogs with this complication is 50%. If that’s true, and given how rarely this occurs anyhow, than that would explain why there isn’t a lot of good information: just not a lot of recovered dogs to study.

I’m checking now with a researcher here who works on lyme disease to see if he has any unpublished info.

Let us know what the vet found on the kidney biopsy. Should have results by late Monday, I’d imagine.

9

Update?

10

Hey folks

Sorry about the delay in updating - it’s been a wild and exhausting couple of weeks.

First, Luna appears to be on the road to a (fairly) complete recovery, although the Chief of Staff at the Animal ER/ICU and her regular vet are both at a loss to explain why she’s alive. Apparently, it’s nothing short of a miracle, although several days of intensive care support didn’t hurt (except for the pocketbook, ouch)

She did in fact test positive for Lyme and Lepto, and has been on Doxycycline, plus Danozol (sp?), an anti-emetic, a GI protectant plus a couple of other meds I can’t recall offhand (13 pills a day right)

Her albumen stabilized after about a week and a half. Kidney biopsy showed some Lyme damage, but not through and through, and some indications point to some other type of auto-immune illness being the primary driver in her illness.

She’s slightly anemic and has slightly elevated creatinine levels. Evidently, she will always be on prescription food (k-d or the like) but all signs point to a recovery.

Color me confused, but grateful…we were at the clinic on the lawn ready to put her down, and her bed was laying on the grass with the tray of euthanasia chemicals next to it, and she started just acting normal - running, jumping, found a ball and was trying to get us to throw it, etc.

The vet was amazed, and we decided to hold off, run some more blood work, and see how she did over the weekend. And here we are. Personally, I think she saw the tray and decided to straighten up and fly right, but I’m no vet…

Anyway, thanks for all the helpful info and kind thoughts. Katie, Luna and myself really appreciate it.

P

11

Wow, miracle dog. Congratulations!

12

Do you know the specific type of test that was run for each problem? The in-house (ELISA) Lyme test is worthless. If the positive result and diagnosis of Lyme nephritis was not based on a polymerase chain reaction (PCR) test, then I would asume the diagnosis of Lyme disease to be incorrect.

Leptospirosis is usually diagnosed by dark field microscopy. A diagnosis of leptospirosis would adequately explain all that was going on with the dog.

Regardless, you received good news. Keep in mind that leptospirosis is a zoonotic concern and you should avoid exposure to your dog’s urine.