An eight-year-old, intact, male Chihuahua presented to the Cornell University Hospital for Animals Emergency Service on referral for a week-long history of inappetence, vomiting, weight loss and increasing lethargy. Bloodwork performed at the primary veterinarian prior to referral was suggestive of acute kidney injury or acute-on-chronic renal failure. On presentation, the patient was depressed and underconditioned. Cardiovascular abnormalities included tachycardia, pale, tacky mucous membranes, hypertension, and a grade II/VI left apical systolic heart murmur. Oral examination revealed uremic halitosis. The patient was tense during abdominal palpation and questionably painful. Initial blood work revealed a nonregenerative anemia, severe azotemia, hypoalbuminemia, and electrolyte derangements. His urinalysis revealed a specific gravity of 1.016, an active sediment, and urine protein creatinine ratio of 4.25 (Normal: <0.5). Supportive care was initiated, and the patient received a blood transfusion to address his worsening anemia. Based on the lack of toxin exposure, a negative Leptospirosis PCR/MAT, and positive 4Dx snap for Lyme, a tentative diagnosis of Lyme nephritis was made. After five days of aggressive fluid therapy, the patient began to develop pitting edema in his extremities and the renal values began to plateau. The following day he continued to decompensate and underwent two episodes of cardiopulmonary arrest, from which he was successfully resuscitated both times. Over the next 12 hours, the patient remained unresponsive and the anemia continued to worsen, so euthanasia was elected.

This senior seminar will cover the various causes of protein losing nephropathies, the clinical manifestation of Lyme nephritis as well as prognosis and treatment options.