Replying to Talia C. 21/10/2024 - 12:17
Hi Talia,
Thank you for your kind words and for sharing your thoughts on Molly’s case!
Your approach is quite thorough, especially with your inclusion of ionized calcium (iCa) in Pu/Pd evaluations, which can be pivotal in differentiating primary causes. I agree that an abdominal ultrasound can be helpful, both for ruling out other potential causes and for adrenal evaluation, particularly given the mild ALP increase and hypercholesterolemia in Molly’s case.
I would tend to use the Urine Cortisol
Ratio (UCCR) in cases where the index of suspicion for hyperadrenocorticism is lower, as it serves well as a rule-out test. When suspicion is higher, a more definitive test like the Low-Dose Dexamethasone Suppression Test (LDDST) or the ACTH Stimulation Test would be considered, though as we know, no test is perfect.
Regarding urine culture, I align with your approach. I often reserve it for cases with sediment abnormalities or a clinical suspicion of infection, using cystocentesis as needed to ensure accuracy.
The paper you referenced is indeed interesting. The persistence of subclinical bacteriuria in older dogs without progression raises questions about the necessity of aggressive intervention in such cases. We will chat lots more about this in the UTI lesson. I find urinary tract infections and the significance of bacteria in the urinary tract fascinating!
Looking forward to catching up more on these topics.
Warm regards,
Scott
