Diagnostic Plan

Diagnostic plan

A chemistry panel, including the IDEXX SDMA Test; complete urinalysis; the SNAP 4Dx Plus Test; and a fecal ova and parasites test were recommended.

Mary Jane’s CBC came back within normal limits, and her SNAP 4Dx Plus Test results were all negative.

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Diagnostic review

The implications of an incomplete patient workup given today’s diagnostic capabilities:

  • Better information yields better patient outcomes and appropriate pet owner conversations—Innovations in diagnostics afford us the opportunity to more specifically identify disease conditions, investigate underlying causes and complications, and plan treatment and follow-up supportive care.

  • While SDMA* and creatinine are inversely proportional to glomerular filtration rate (GFR), they vary in reliability for assessing kidney function—SDMA has not been shown to be influenced by medications,      advanced age, breed, or muscle mass like creatinine can be.1,2
Treatment Plan and Follow Up

Diagnosis

Mary Jane’s kidney function was normal. Creatinine is not specific for kidney function, and it was likely increased because of Mary Jane’s muscle mass.

Discussion

Creatinine is a breakdown product of muscle and, as such, blood creatinine concentration is highly influenced by muscle condition of patients.

SDMA is a more reliable indicator of kidney function than creatinine.1–5 Mary Jane’s case is an example of how a healthy pet can have a creatinine that is increased above the reference interval while other commonly evaluated kidney disease parameters (e.g.,SDMA, urine specific gravity) are within normal limits. SDMA should always be assessed first alongside creatinine to more reliably determine kidney health and response to treatment.

Diagnostic Reports

Patient reports

Previous laboratory results
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*Symmetric dimethylarginine.

References

  1. Hall JA, Yerramilli M, Obare E, Yerramilli M, Yu S, Jewell DE. Comparison of serum concentrations of symmetric dimethylarginine and creatinine as kidney function biomarkers in healthy geriatric cats fed reduced protein foods enriched with fish oil, L-carnitine, and medium-chain triglycerides. Vet J. 2014;202(3):588–596.
  2. Hall JA, Yerramilli M, Obare E, Yerramilli M, Melendez LD, Jewell DE. Relationship between lean body mass and serum renal biomarkers in healthy dogs. J Vet Intern Med. 2015;29(3):808–814.
  3. Nabity MB, Lees GE, Boggess M, et al. Symmetric dimethylarginine assay validation, stability, and evaluation as a marker for early detection of chronic kidney disease in dogs. J Vet Intern Med. 2015;29(4):1036–1044.
  4. Hall JA, Yerramilli M, Obare E, Yerramilli M, Jewell DE. Comparison of serum concentrations of symmetric dimethylarginine and creatinine as kidney function biomarkers in cats with chronic kidney disease. J Vet Intern Med. 2014;28(6):1676–1683.
  5. Hall JA, Yerramilli M, Obare E, Yerramilli M, Almes K, Jewell DE. Serum concentrations of symmetric dimethylarginine and creatinine in dogs with naturally occurring chronic kidney disease. J Vet Intern Med. 2016;30(3):794–802.