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We took in a stray, unclaimed, male (appears to be German pincher) pup about 1 1/2 years ago, who seemed to be healthy, but was afraid of men and had a spot of blood under the white of his eye. We've had him nutered about a year ago. Emotionally he has come a long way, but physically, so far he has been sick and recovered from parvo, and although he is housebroken and has a doggie door to our fenced yard, he has been having pee accidents in our home for the last 3 weeks-- when he's sleeping, or on the way to his door, and at other odd times, sometimes a sprinkle, sometimes a puddle. I noticed he is drinking a lot of water. I took him to our Animal Hospital/ vet and they ran some tests, and repeated some. They say he has an off the chart level of sugar in his urine and it is very diluted, yet there is no sugar at all in his blood. They first said he has diabetes and taught me how to administer shots-- practicing on my dog, and sent me home with insulin needles and a special food. 2 hours later they called and said he doesn.t have diabetes after all. They sent out bloodwork to foriegn labs testing for Leptospirosis and kidney levels and say everything came back normal. After 750.00 and no answers they say he doesn't have diabetes and don't know what it could be. There is no infection detected in any blood tests. They want me to take him 2 hours away to another emergency vet hospital for a Kidney biopsy. Upon calling for an appointment, and being curtly told a consultation where I can learn what the cost for a biopsy will be is 165.00, (I am not rich) I am at my wits end. I have asked if this could be cushings, or a spillover from having had parvo, or maybe even normal for this breed of dog, and am told no,no, and no. The dog may be eating a little less than normal or could it just be the heat. Do you have any idea how our dog could have so much sugar in his urine and none in his blood, and why the peeing problem? Thanks for your help.

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Age: 2; Male; Breed: German Pincer??

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You need to rule out infection in a lot of these cases, and the best way to do that is a urine culture. If that hasn't been done, it needs to be done first. Infection is the most common reason we see sugar in the urine without increase in the blood. Infections damage the kidney which leads to the sugar spilling into the urine, without a high blood sugar level. Treatment is antibiotics for several weeks.

Dogs can be born with birth defects to the kidneys, where the tubules are abnormal. Basenji's get a condition called Fanconi's syndrome. There are defects in the kidney tubules that lead to the sugar in the urine. Is it possible your dog is part Basenji? Insults to the kidney can damage the tubules also-leptospirosis (already ruled out I think you said), damage to the kidney from anesthetics, toxins (chemicals, heavy metals), etc, will also lead to these symptoms. If the parvo infection caused severe illness and dehydration, it is possible there could have been some damage done to the kidney tubules, thus creating this problem. Sometimes it is very difficult to determine the underlying cause of tubule damage, and it is only known that the damage is there.

Since your vet is not able to help further, I do suggest consulting with a specialist. Your dog may not need a biopsy, but I can't say for sure. If a recent complete blood test and urinalysis was done, that may be all that is needed to help make the diagnosis. However, you might expect the specialist to want to repeat some lab work or add more that hasn't been done. If you can afford the initial consultation, I think it might be worth it. I would suggest seeing a specialist in internal medicine. They should also be able to help with any treatment.

Here is a link where you can read more about Fanconi Syndrome: http://basenjicompanions.org/health/fanconi/syndrome.html

Edited by Dr. Vicky on August 5 2006 at 12:01 AM

Reply to Dr. Vicky Lamb's Post: Dear Dr. Lamb,
Since our dog didn't have a fever and our vet did a CBC that was "normal" would that proove that there isn't any infection going on? They also did urinalysis and repeated both these tests twice-- always showing high level of sugar in the urine and none in the blood, also very diluted urine was noticed and no infection found, through testing blood. You also mention toxins, is there a test for these toxins, how extensive is it and how costly in general. Would most vet/Animal Hospitals normally be able to do testing for toxins? It just dawned on me that since Rudy sometimes jumps our fence to explore the neighborhood, and sometimes barks at our neighbors when he's in their yard, someone might have attempted to poisoned him. We have a strict covenance where we live and can only have a certain kind of fence, at a certain height, also my husband bought and installed an electric fence that never worked and is now considering a invnsible fence as well, so we are having a time keeping Rudy where he belongs. As I said before he has a doggie door he uses to go to the bathroom outside, when we're at work. Would you look for "certain toxins" under such cercumstances. I am wondering about antifreeze? He did throw up all the contents of his stomach one day, which is another reason I took him to DR., and he has never thrown up before or since that I know of. If he has been exposed to toxins, what would the signs to look for be, how would he be treated for it, and what would the damage be to his body, and would it be permanent?
You mention taking him to an internist, but we have had such bad experiences with one in this area that we cringe at the thought, and the secretary in the second office I talked to was just as cold, aloof, unfriendly, unconcerned, and,unaccomodating as the first. They refuse to qoute a estimate of any kind for the procedure our vet was sending us there for, and insisted we pay 165.00 to get that information by coming for a consultation appointment,-- a 2 hr drive through the worst traffic in the country. PHULEEEZE!! I don't make a ton of money, I love my dog but I really think these places will use your vunerability, care and concern, and lack of knowledge, to run the bill up as high as possible. I mean, it's so in your face.
You mention the posability of Rudy being part basenji, and we cannot know completely, but he doesn't look and match the description of one. His tail is long and straight and he has no wrinkling around his ears or forehead. He really does look and match the description of a german pincher, markings and all, to a T.
As I mentioned before he has come through having parvo, around last September. You say he may have damage to the tubules to his kidneys and if so, we may never know what caused it. My question then, is by what tests or procedures, would a vet diagnose his tubules damage, and what would the the remedy? Will he ever stop having pee accidents?

The only way to rule out infection in the urine is to run a culture. Just because the CBC was normal, does not mean there isn't infection in the urine. In fact, in most cases of urinary tract infections, the CBC is normal. However, in cases of kidney infections, one would expect the WBC count to be elevated. I wouldn't simply rule an infection out just based on a CBC though. That is very presumptuous. If a urine culture has not been done, I don't see any harm in doing it.

There are numerous "toxins" that can cause kidney damage. Of course, antifreeze is the most common, and there is a test for that. If they ingest it, it is usually fatal, so I guess I wouldn't be leaning towards that. Unless you have an idea of what type of toxin your dog may have had contact with, it is very unlikely to be able to just run a "screening test" that checks for all the possible toxins that cause kidney damage. Dogs get into things that we are not aware of all the time. The best thing to do is look through your house at the chemicals you have that he might have had exposure to. Your vet may be able to help you research if any can cause kidney damage. A vet list I am on lists Lysol as one of the chemicals that can cause renal tubular damage. Lead poisoning, mercury poisoning can also cause this damage, but it is more rare in dogs to see this unless you have lead paint in your house. There are plants that cause kidney damage also, the most common one being lillies. I have seen many cats get ill and even die from ingesting a lily plant leaves, but I haven't met any dogs that have eaten lillies, but it is a possibility. Certain antibiotics and other drugs can damage the kidneys, and something he was on when he had parvo may have affected the kidneys. And yes, someone may have tried to poison him. But again, unless we know what we are looking for, there won't be a specific test to run, we simply find out when problems arise that damage has been done by the toxin. Most cases, the damage is permanent if the damage is done to the kidneys.

Fanconi's syndrome is most common in Basenji's, but it does occur in other breeds, but rarely. It is genetic in Basenji's. What I've described above--all the causes of renal tubular damage--could be described as "acquired" Fanconi's syndrome, and this can occur in any breed of dog.

You will need the help of an internist to diagnose this condition. There are several things that are recommended to be done, including urine cultures, kidney ultrasounds, measuring for electrolyte abnormalities in blood and urine. This site lists what is done for Basenji's: http://basenjicompanions.org/health/fanconi/suspect.html , and these tests will probably need to be done in your dog to diagnose tubular damage also. I understand you do not like the specialist near you. Is there anyone else you can go to? It just sounds like your vet isn't able to continue with the diagnostic tests, and unless a specialist gets involved, you might never know for sure what the diagnosis is. As a general practitioner myself, I would definately have to refer a case like this, it is just so rare a problem, and complicated to diagnose.

There are special diets and supplements that are recommended, but the symptoms like excessive urinations do persist, I believe.

Reply to Dr. Vicky Lamb's Post: Dear Dr. Lamb,
You have been more helpful than I ever imagined, and I must say this is the best money I ever spent for our pets. I am so glad to have found your site. Thank you so very much for your expert info and advice.
I don't know if there is a difference in a urinalysis, and a urine culture, as he has had two urinalysis. As you suggest, I will move forward with finding an internest, and look into the possability of kidney damage, Falconi's, and Toxins. (I wonder if some of the things we used on our lawn could be the culprit?)
In reference to future exchanges with this website, once I accept your answer, (after this reply) what are my chances of ever corresponding, with you for instance, regarding future inquires, and are you interested in learning the outcome of Rudy's situation?
Again, thank you so much for your extremely helpful input.

Bonnie,

I'm glad I could be of some help to you. I hope you are able to find a vet that you like and that is able to help Rudy. I would be very interested in finding out about his progress/outcome.

To answer your last question: yes, there is a difference in a urinalysis and a urine culture. A urinalysis checks the urine for blood, protein, sugar, pH, concentration, etc. It can give you a good idea of how the kidneys are functioning and if there is evidence of infection. A urine culture is used to see if bacteria are growing in the urine (there shouldn't be any), and what kind of bacteria, and what antibiotic they are sensitive to (in order to kill them). In a case like Rudy's, even though there is no evidence of infection in the urinalysis, this alone cannot rule out infection. That is why when investigating possible renal tubular damage, a culture MUST be done. Infection is the major cause of high sugar in the urine without a high sugar in the blood. That is why I think it must be done, even if there is a possibility it will be negative.

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Once you hit accept, if you have further questions, you can relist this particular question, or open a new question. You can even request to have me specifically answer your question if you like.

I hope you are able to get to the bottom of Rudy's problem, and find some therapy that will help him. Please keep me posted, as this is a very interesting case. I wish you all the best.

Dr. Vicky

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