Sable was not quite a year old when I first met her. She had been adopted from a local rescue a couple of weeks before.
Sable was a beagle and something bigger mix, but at 32 pounds, she wasn’t too big.
Her parents were a young, intelligent couple with their first pet. They knew the rescue didn’t quite do all the vaccines that she needed and were here to get them done.
Her spay incision was enlarged and inflamed, a result of cheap suture or tissue handling issues. She had been given a pain medicine associated with death in some Labrador Retrievers.
I advised that she didn’t need anymore, but she looked bright and alert and very happy to have a good home. I saw Sable again in three weeks for her booster vaccines and she was happy.
Three months later, Sable was not as happy.
The young couple brought Sable in on a Wednesday emergency. She had been lethargic for a week. The busy young couple had taken Sable to a closer veterinarian on Monday.
That vet had given an injection to stop vomiting and said everything would be okay. With an MD and a lab tech in the family, they knew this wasn’t quite right, but blood work or hospitalization was not offered and it was a quite busy day.
By Wednesday, it was obvious that more was needed. By the time I saw her, she had lost 10-percent of her body weight, her mucous membranes were pale and she seemed a little off. We drew blood for testing. Then we started IV fluids, IV antibiotics and vitamins.
The CBC, a complete blood count: white blood cells, red blood cells and platelets, came back first. Sable’s total white blood cell count was okay, but her neutrophils (the white blood cells that fight off bacteria) were low. Low white blood cell counts can be cause by viral infections (disrupting the bone marrow’s production), bone marrow defects and autoimmune disorders. Nothing pointed to any of these over other causes.
The red blood cell count was increased. This is almost always dehydration in our pets. It is not that there are too many red blood cells, but rather there is too little fluid.
Then the bombshell hit.
Sable’s blood chemistry was very off. The chemistry looks at liver, kidney, pancreas and electrolytes.
With other factors, it can tell us something about heart disease. While Sable’s liver enzymes were good, the BUN (blood urea nitrogen), Creatine and phosphorus were all very, very high.
This is indicative of kidney failure, which can lead to decrease in bone marrow activity also.
Hoping for some sort of acute cause that could be fixed, we did radiographs and an ultrasound.
On the radiographs, the abdomen had a general lack of detail which can be inflammation, free fluid or lack of fat. The liver and spleen were normal.
No specific abnormalities seen with the kidneys, however the lack of detail interfered. The urinary bladder did appear distended, but not abnormally so and no stones were seen.
The stomach had a mixture of “heterogeneous soft tissue material” (often food) surrounded by air and fluid. The small intestines were mostly fluid filled with some intraluminal air. No obvious evidence of intestinal over distention or obstruction was present. The colon had mostly air.
On the ultrasound, there was no help either.
The spleen was normal.
The liver was hypoechoic and coarse in texture, yet appeared homogenous with no obvious nodular lesions.
The left kidney is normal in size and shape.
There was no renal pelvis dilation. (Like a stone was or had been blocking the outflow.) The cortical medullary definition is normal.
The bladder wall is normal in thickness with anechoic urine.
No calculi (stones) seen. (Normal kidney and bladder.) The omentum appeared somewhat hyperechoic. (Like fluid or inflammation.) There is no evidence of abdominal effusion. (Not fluid and probably not inflammation.)
The small intestines were normal in overall diameter and distribution.
The individual wall layering was normal.
Then the specialist’s notes: “there is no recognizable normal renal tissue noted on the image labeled as the right kidney.”
The radiologist concluded that the right kidney was abnormal with no recognizable normal renal parenchyma, which meant a degenerative right kidney is probable.
The left kidney is normal with no obvious evidence of compensatory hypertrophy.
The urinary bladder distention could be associated with polyuria. (There is too much urine being made.)
The liver signs were deemed nonspecific and could be a variation of normal.
Sable’s parents visited and spent time with her, but with one kidney not working and the other kidney unable to work well enough for two, Sable did not survive kidney failure.
She was never stable enough to even discuss removing the non-working kidney. Three days later after a brief rally, Sable was dead in her cage at Sunday first morning checks.
Saturday night at night checks, she had been resting peacefully.
Reminding myself that I wished, hoped and prayed for what was best and not necessarily what I wanted, I got a cup of coffee before I called the owners.
I advised they move past the guilt of the other vet first, it may not have changed the outcome, and then requested permission for a necropsy.
That Sunday morning necropsy showed that the right kidney destroyed.
Nothing was normal. Samples were sent for histopathology.
The pathologist report did not come until much later.
The spleen was within normal limits.
Liver sections had marked congestion of the sinusoids.
There were a few small infiltrates of neutrophils with mononuclear cells in the sinusoids.
Two arterioles in the section were surrounded by edema.
Hepatocytes were vacuolated, but not necrotic. (The liver was stressed, but okay.)
Kidney sections have marked congestion of the interstitial region.
No evidence of inflammation. Random tubules show early necrosis and degeneration.
Both proximal and distal tubules appear involved. There was no evidence of crystals. (Not antifreeze.) Intestines were within normal limits.
Pathologist’s diagnosis: Moderate acute renal tubular degeneration.
Congestion in the tissues was indicative of shock. Changes in the kidney could have been shock or ischemia, but are not specific for a particular etiology (cause).
All in all, a frustrating case.
Young dogs are not supposed to die from kidney failure unless they get into antifreeze or something.
Radiographs, ultrasound or at least necropsy should have pointed to a specific diagnosis.
Genetics, a clot, a rare toxin, whatever, we will never know.
But Sable is dead and I and her parents will not forget her.
Closure would have been quicker and easier with something to blame.
Rest in peace, Sable.

MJ Wixsom, DVM MS is a best-selling Amazon author who practices at Guardian Animal Medical Center in Flatwoods, Ky. GuardianAnimal.com 606-928-6566