Urinalysis increased bilirubin / protein

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daveandtiff

Post   » Fri Apr 24, 2015 5:47 pm


Our little boy (4.75 yo) went in for an ultrasound of bladder Wednesday morning as we believe he had blood in urine 3 times Monday night through very early Tues am. What is odd is that one of the blood spots on his blanket is still red (usually blood turns brown over time. On two of the blankets, appears they turned brown, and peroxide bubbled when pouring onto these spots, so we are assuming blood). Is it true that bilirubin can cause blood not to turn brown? Or is this not true?

The ultrasound was neg for bladder stones (could not look at urethra without an xray, however). No apparent sludge and he is peeing and has not had blood since.

I ran two urinalysis tests at home, Wed early evening and this morning (Fri) around 1:50a. Each showed no blood in urine, but did show increased levels of bilirubin and protein. I have been concerned about this, but was told these are often increased in guinea pigs and are not a concern at this time anyway. Urine was not gritty to the touch and was pale yellow with slight bit of cloudiness.

Does anyone have thought on this? Foods, herbs, etc beneficial for liver and kidney (incase there is a chance of stone in urethra)? Will try to attach photos of the test strips and parameter from bottle.

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Delaine
Supporter in '14

Post   » Fri Apr 24, 2015 8:14 pm


I always get high protein levels when I test my sows urine for blood. I have Chemstrip 5 test strips that test for Glucose, Leukocytes, Nitrite, Protein and Blood.

I asked the vet about this and she told me unless you take a sterile sample right from the bladder it is not unusual to see high protein levels. My test strips don't include a square for bilirubin so I am not sure about that one.

Talishan
You can quote me

Post   » Fri Apr 24, 2015 10:37 pm


Is he having any pain when he urinates or defecates?

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daveandtiff

Post   » Sat Apr 25, 2015 2:08 am


We are not sure, Talishan. I have heard deep grunts from him on occasion over the past few months, but have not been able to place them. He will pee/poop without the grunts, and does have output very frequently. I wondered when I had first heard these if stones, or gas even. Right after hearing the sound, I will look and he is watching me, eating, moving around without a care, so does not seem to be affecting his disposition. In fact, he's gained wait since his last dr's vst last year.

Delaine, I considered contamination of the sample, but i did wash the skin around his penis and removed excess poopie, washed tray I sat him in and then used alcohol to sterilize. the pee did go down at an angle to side he had not been sitting on, so should have been a clean sample in general, but cannot rule out that pee may have moved past any parts of him picking up fecal matter along the way, probably not very much at all if so. so bilirubin in urine was very concerning to me.

Talishan
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Post   » Sat Apr 25, 2015 2:19 am


Bpatters, if you see this, what does bilirubin mean?

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daveandtiff

Post   » Sat Apr 25, 2015 3:26 am


Talishan, I had picked up this info from urinalysis detail, for humans, but not far off from what should be expected in guinea pigs (and other animals), via labtestsonline.org ~
"Bilirubin is not present in the urine of normal, healthy individuals. Bilirubin is a waste product that is produced by the liver from the hemoglobin of RBCs that are removed from circulation. It becomes a component of bile, a fluid that is secreted into the intestines to aid in food digestion.

In certain liver diseases, such as biliary obstruction or hepatitis, bilirubin leaks back into the blood stream and is excreted in urine. The presence of bilirubin in urine is an early indicator of liver disease and can occur before clinical symptoms such as jaundice develop."

Also, grabbed this info on normal urine test parameters for guinea pigs ~ http://www.mediphos.com/.../urinestrips_vet_analyticon.pdf Parameter (Ideal) - Guinea pig Bilirubin neg. Blood neg. Glucose neg. Ketones neg. Leucocytes neg. Nitrite neg. pH 8,0 – 9,0 Protein neg. Specifi c gravity 1,000 – 1,040 Urobilinogen neg. – weak pos. Color Yellow Turbidity Clear – slightly turbid

Bilirubin is present in feces, so very slight possibility of contamination of urine sample, but i was careful to try to avoid this.

Also, found this via Mayo Clinic ~ "Bilirubin is a tetrapyrrole created by the normal breakdown of heme. Most bilirubin is produced during the breakdown of hemoglobin and other hemoproteins." ... "The kidneys do not filter unconjugated bilirubin because of its avid binding to albumin. For this reason, the presence of bilirubin in the urine indicates the presence of conjugated hyperbilirubinemia."

bpatters
And got the T-shirt

Post   » Sat Apr 25, 2015 9:49 am


Daveandtiff's info on bilirubin is good. Usually the only time you hear anything about it is if a baby is born with jaundice because the liver is not functioning properly yet.

One caution about those strips. While they'll accurately measure what's in the urine, the normal values may be WAY off, so you'll need to look them up rather than depending on the "right" color. For example, human urine is acidic, herbivore urine is basic, so what shows the right color for either one is dead wrong for the other.

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daveandtiff

Post   » Sat Apr 25, 2015 10:14 am


yes, bpatters...had taken care of a baby/child with kernicterus so elevated bilirubin in babies has been familiar to me.

the values i had looked up and posted here were specific to guinea pigs. unless this particular brand of urine test strip was inaccurate twice, that there was not just mild elevation but middle of the road elevation (when should be neg) concerned me. perhaps another test strip or blood test (though the blood test would be traumatic for him as he gets nervous enough to shake, so i hesitate unless would be necessary). his energy level and appetite are good, he is bright, but hoping there is nothing underlying.

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daveandtiff

Post   » Sat Apr 25, 2015 10:24 am


So if there is an underlying liver condition, am thinking of foods/herbs that would be helpful to serve to keep liver function healthy. Any advice?

There seems to be no sign of UTI, and possibly no stones (though we don't know if there were no stones in urethra, ultrasound only showed no stones in bladder), so thoughts on kidney foods might be helpful secondarily. I have been giving plenty of foods with fluids. Had tried extremely low dose cranberry concentrate (by gaia herbs, vegetarian, pesticide-free), just a drop 1/2 the size of a grape seed mixed with half teaspoon critical care (which he loves). Have also been offering corn silk, as had read this might be helpful, and doctor agreed. one of my clients uses shilintong and feels it is helpful. have read on hydrangea, gravel root and parsley piert - these three i have not heard confirming thoughts on.

bpatters
And got the T-shirt

Post   » Sat Apr 25, 2015 10:47 am


I don't know enough about abnormal liver function in guinea pigs to comment.

However, throw out the window nearly everything you know about urinary tract problems in humans, because it doesn't apply to guinea pigs. Cranberry juice, for example, is used to acidify urine in humans to make it less hospitable to bacteria. But herbivore urine is basic, and giving a bit of something acidic isn't going to acidify the urine. You'd have to give a ton of it, and it might not work even then, because the pig's body is going to neutralize it.

Shilintong might or might not help. As I understand it, it relaxes the urethra a little which would allow very small stones or sludge to pass, but if the issue is stones, it's useless.

The whole problem with herbal meds is that you have no idea how much active ingredient is in them. It depends on what growth cycle they were in when they were harvested, how they've stored, how old they are, etc. You may be getting good stuff, you may be getting nothing at all.

On top of that, some pigs are just prone to stones/sludge, no matter what you feed them or how you try to treat them. One member here has had a pig re-develop stones within two weeks of having one removed. Others have done well for several years after removal of a stone, while still others live their whole lives without any indication of them.

I have a sow that has had two stones, and in spite of a consistently low-calcium diet, I still see occasional dried white urine spots in the cage. But I'm pig-sitting for a six-year-old male, and in spite of a diet high in calcium, there's never a spot in his, and he's never had a stone/sludge problem.

I think the best thing you can do is to severely restrict calcium, cross your fingers, and hope for the best. That may mean no pellets at all. Oxbow is too high in calcium and uses calcium carbonate (limestone) as a source. KMS is lower and uses a different source, but my sow had been on KMS pellets for three years as well as a fairly low calcium diet before her stones developed. There aren't any other pellets out there that I'd consider feeding my pigs, and mine don't get any at all and haven't for about two years.

Some pigs excrete excess urinary calcium when eating romaine and cilantro, so my pigs get none of those. I aim for no more than .4% calcium in the diet, and less if I can manage it.

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daveandtiff

Post   » Sat Apr 25, 2015 11:02 am


thanks, bpatters. i was restricting the calcium and serving low calcium/oxalate foods (still am, goal for vegetation not greater than .3, and serving the lower calcium kibble, incl crit care which is lower in comparison), but we have actually never (knowingly) had an issue with stones with any of our boys since '06, thankfully. we had suspected stones in this little boy because of random grunting, but then ultrasound showed no stones in bladder or sign of sludge. no grit to the touch in urine, either. there have been points over the years we had seen some white on blankets, but we then would reduce oxalate foods. we are not sure if his brother is actually genetically his brother (we were told he was), but his brother seems clear of any issues so far.

where elevated bilirubin is the only confirmed finding, have been focused on liver now. in some info i have read, calcium may actually be useful for liver health (of course, i am here writing because some of the info I read is related to people. i am looking for information from cavy people for cavies). so i am playing it safe right now, keeping balance and fluids going, not too many changes at once, regular feedings/hay.

bpatters
And got the T-shirt

Post   » Sat Apr 25, 2015 11:35 am


Keep oxalate in the back of your mind, but I wouldn't worry about it much. Something in excess of 95% of all stones are calcium carbonate, not oxalate, so I'm not convinced it plays a major role.

One of the problems is that there is so little research done on this, and the whole calcium metabolism mechanism in guinea pigs is not well understood by anybody.

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Delaine
Supporter in '14

Post   » Sat Apr 25, 2015 12:45 pm


What did your vet say about the high bilirubin result?

I have to be careful because I always get into trouble when I start messing with my girls' diet. I would be weary of adding too many supplements to the diet and if you do try only one thing at a time. If you make more than one change you won't know what did good and what did harm.

My vet and I have talked about diet more than once and she says "Keep it simple, consistent, and focus on the hay." Her thoughts are guinea pigs don't do well with too many dietary changes.

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daveandtiff

Post   » Sat Apr 25, 2015 3:02 pm


hi Delaine, in first post I wrote word for word what our dr said, that the elevated bilirubin is seen in guinea pigs and not a problem at this point anyway. and re diet, as mentioned we keep balance with few changes at once, but have lowered the number of calcium-rich foods, and those with oxalate as well (though bpatters mentions oxalate may not be so much a concern). increased water foods (like melon, lettuce, cuke) for filtering organs, and they have always chosen what they want out of the pile, they seem to know what they need and leave the rest behind. they are served fresh hay upwards of 15-20 times a day, and they do love their hays (we have three, timothy as primary ordered from KMS Hayloft, and bluegrass (KMS Hayloft) and Timothy Hay (Sweet Meadow) as secondaries. we focus on hay for the fiber for intestinal health and for keeping teeth filed down (we've had malocclusion in two of our boys, one who was older and one who we adopted with the problem, so we are particularly keen on hay consumption).

I think what we are going to do is get urine test strips from a reputable company and test our other boys as well as our boy we are concerned about, in order to compare. If there is elevated bilirubin again in him or any of them, I would want to figure out the cause. It might be necessary to run bloods (check wbc's to be sure not an infection, verify the serum bilirubin, etc). It's important to me to keep them from unnecessary stress, and also important to try to mitigate a problem as early as possible to prevent worsening health. So am really focused on the nutritional affects on liver right now so that we might be able to think preventatively.

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daveandtiff

Post   » Sat Apr 25, 2015 3:14 pm


on a side note, while on topic of stones, one of my clients had xrays/ultrasound to confirm large and small stones in her girl and is scheduled for surgery this week to remove them. is there anyone who performs an ultrasonic breaking of the stones in order for them to be able to be moved through urethra more easily, to make for a less invasive surgery? EDIT: for her guinea pig

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Lynx
RESIST

Post   » Sat Apr 25, 2015 7:31 pm


From what I understand, it cannot be done in guinea pigs due to the heat generated when they would be broken up.

Talishan
You can quote me

Post   » Sat Apr 25, 2015 8:37 pm


Ditto Lynx. As far as I have heard, that technique cannot be used (yet, anyway) in guinea pigs.

Liver support: silymarin or milk thistle:

http://www.guinealynx.info/forums/viewtopic.php?p=902279#902279

From Carpenter's 4e: 4-15 mg/kg by mouth every 8 to 12 hours.

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daveandtiff

Post   » Sat Apr 25, 2015 8:56 pm


Okay, thanks for that information, Lynx. I hope it, or something similar that is safer, will become possible.

Thanks for this info on milk thistle, Talishan. I will read up...

Talishan
You can quote me

Post   » Sat Apr 25, 2015 9:08 pm


They will sometimes grunt or squeal when bending to retrieve a cecotrope, too. The key to that is the "dive" they do at the end. If I see the "dive" and don't hear or see evidence of discomfort when peeing or pooping otherwise, I'm less worried.

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daveandtiff

Post   » Sat Apr 25, 2015 9:23 pm


I'll watch for this, Talishan. It's a deep and somewhat muted loud sound, it sounds like pain, but other indications are not there that might be with pain (hunched, teeth chattering...). it could be that the pain is more transient? i rush to get there to see him and what may be going on when i hear him, and cannot confirm (could be as he's passing a stool, but they are not ever dry, and even this possibility i haven't been able to pinpoint as cannot tell how recent stool near him is). have never had anyone make this sound before. We may try simethicone to see if it could be gas-related and the grunts decrease, maybe a longshot, but trying to think of any possibility. he is definitely motivated to eat (he's now 1110g, up from 1050g on 6/4/14).

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