6/27/23, 1:23 AM Insights into Veterinary Endocrinology: Diagnostic Approach to PU/PD: Urine Specific Gravity

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Monday, January 10, 2011 Dr. Mark E. Peterson

Diagnostic Approach to PU/PD: Urine Specific

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Urinalysis is a major key in determining the presence of a water balance About Insights into Veterinary
problem and the disorder causing the polyuria and polydipsia. The most Endocrinology
important features of urinalysis are: the SG or osmolality; the presence or This blog is written specifically
absence of glucose, protein or bacteria; and the cellularity of the sample. to serve veterinarians and
veterinary technicians. I've
A urine SG less than 1.030 in dogs and divided the posts into 3 types:
1.035 in cats suggests a concentrating (1) my insights into specific
defect and supports the complaint of endocrine issues, (2) Q & A
polyuria. Persistent glycosuria is diagnostic posts that deal with questions
I've gotten from veterinarians,
for primary renal glycosuria or, more
and (3) reviews of current
commonly, diabetes mellitus. Significant
endocrine publications (with my
proteinuria in the presence of an inactive
comments and "insights").
urinary sediment and dilute urine can be
associated with hyperadrenocorticism, Please also read my Animal
pyelonephritis, pyometra, glomerulonephritis or other glomerulopathy. Endocrine blog for pet owners.

An active urine sediment (pyuria, hematuria or bacteriuria) in a sample

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obtained by catheterization or cystocentesis supports urinary tract infection
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and possible pyelonephritis. Because urine sediment examination may be
misleading in an extremely dilute urine sample, a urine culture should always
be done to rule out pyelonephritis, regardless of sediment examination Subscribe
findings.
Endocrine Disorders
If the results of the above tests are unhelpful the direction of further
diagnostic work-up can often be based on the urine SG (see Table below). For Acromegaly
example, dogs and cats with a SG greater than 1.030--1.035 without Diabetes insipidus
glycosuria, are probably not polyuric and need no further work-up, at least Diabetes mellitus
for polyuria and polydipsia. Hyperadrenocorticism
(Cushing's syndrome)
Hyperaldosteronism (Conn's
Differential diagnosis based on urine specific gravity (SG) syndrome)
determination in animals with normal results of initial tests (CBC, Hypercalcemia
serum biochemical profile and urinalysis). Hyperlipidemia
Hyperparathyroidism
Urine SG of 1.001--1.007 Hypertension
Atypical hyperadrenocorticism (most common; always rule out Hyperthyroidism
first!) Hypoadrenocorticism
Atypical leptospirosis (Addison's disease)

Psychogenic polydipsia Hypocalcemia

Hypoglycemia
Diabetes insipidus (complete)
Hypoparathyroidism
Urine SG of 1.008--1.029
Hypothyroidism
Atypical hyperadrenocorticism (most common!) Pheochromocytoma
Atypical leptospirosis Polyuria/Polydipsia (PU/PD)
Early renal disease Thyroid carcinoma
Typical and occult pyelonephritis
Hyperthyroidism (cats) Endocrine Glands / Organs
Psychogenic polydipsia
Thyroid (101)
Diabetes insipidus (partial)
Pancreas (81)
Urine SG greater than 1.030 (without glycosuria) Adrenal (71)
probably No further work-up for polyuria and polydipsia needed. Pituitary (26)
Parathyroid (23)
Urine SG less than 1.008 A urine SG consistently less than 1.008 in a Gonads (Testes/Ovaries) (13)
middle-aged to older dog is usually associated with diabetes insipidus,

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6/27/23, 1:23 AM Insights into Veterinary Endocrinology: Diagnostic Approach to PU/PD: Urine Specific Gravity
psychogenic polydipsia, atypical hyperadrenocorticism or atypical Diet & Nutrition

leptospirosis. nutrition (40)

y/d diet (18)
In these dogs with atypical hyperadrenocorticism, polyuria and polydipsia are
major clinical signs but other characteristic clinical signs are mild or absent.
In addition, these dogs with atypical disease may lack the serum Radiation
biochemistry abnormalities commonly associated with hyperadrenocorticism Radioiodine (I-131) (19)
(i.e. elevated serum alkaline phosphatase activity and
Radiation Safety (5)
hypercholesterolaemia). Results of adrenal function tests in these dogs are
Nuclear Imaging
usually consistent with mild hyperadrenocorticism. (Scintigraphy) (2)

More recently an atypical form of leptospirosis has been recognized. These

dogs present with an acute onset polyuria and polydipsia, hyposthenuria or Species

isosthenuria, but no other laboratory abnormalities. Diagnosis of leptospira Dog (canine) (185)
infection can be confirmed by positive leptospirosis serology or use of
Cat (feline) (179)
molecular detection of leptospiral DNA by polymerase chain reaction (PCR)
testing performed on urine samples.
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In general, when considering polyuric dogs with a urine SG less than 1.008, Go!
hyperadrenocorticism and atypical leptospirosis should be ruled out first
before testing for central diabetes insipidus and primary polydipsia. There are
several reasons for making this recommendation: the latter two disorders of This blog sponsored by:

water metabolism are much less common than hyperadrenocorticism (see

Table below); the diagnostic tests of choice to differentiate these disorders –
the water deprivation test or a therapeutic trial with the AVP-analogue
desmopressin – are time-consuming and expensive. Also, dogs with
hyperadrenocorticism may respond to these tests in a manner similar to dogs
with central diabetes insipidus, resulting in a misdiagnosis. Moreover, water
deprivation testing a dog with leptospirosis would be a major contraindication
because of the possibility of causing significant patient morbidity.

Differential rule outs for polyuria and polydipsia in dogs and cats,
listed from most to least common. Dogs
Hyperadrenocorticism
Diabetes mellitus
Chronic renal failure
Pyelonephritis
Pyometra
Hypercalcaemia
Atypical leptospirosis
Psychogenic polydipsia Followers (137) Next

Diabetes insipidus
Liver disease
Hypoadrenocorticism
Acromegaly
Cats
Chronic renal failure
Diabetes mellitus
Hyperthyroidism
Hypercalcaemia
Pyelonephritis Follow
Hypokalaemia
Acromegaly
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Postobstructive diuresis
Hyperadrenocorticism Posts

Hypoadrenocorticism Comments
Diabetes insipidus

In cats, a urine SG consistently less than 1.008 is associated with either

diabetes insipidus or hyperthyroidism. Obviously, hyperthyroidism should be
ruled out first before initiating testing procedures for diabetes insipidus. It is
also important to realize that the finding of a urine SG less than 1.008 in a
cat or dog excludes mild (occult) renal disease, so precautions associated
with the water deprivation test are not necessary.

Urine SG between 1.008 and 1.029

A urine SG of 1.008--1.012 or greater (but less than 1.030) can be

associated with hyperadrenocorticism (dogs), hyperthyroidism (cats), or

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6/27/23, 1:23 AM Insights into Veterinary Endocrinology: Diagnostic Approach to PU/PD: Urine Specific Gravity
stage 1 renal insufficiency (including atypical leptospirosis) or pyelonephritis,
as well as psychogenic polydipsia and partial forms of diabetes insipidus. 

Again, when considering animals with a urine SG greater than 1.008

hyperadrenocorticism and hyperthyroidism should first be ruled out. With this
group of disorders, pyelonephritis and early renal insufficiency should next be
ruled out before evaluating the animal for psychogenic polydipsia and
diabetes insipidus with a water deprivation test. Performing a water
deprivation test as a diagnostic tool in the face of unsuspected renal
insufficiency or pyelonephritis could induce overt renal failure or urosepsis. To
avoid this complication, a sensible approach is to do the following:

1. Perform a urine culture to help exclude pyelonephritis and associated

urinary tract infection.
2. Consider leptospirosis serology and urine PCR testing.
3. Evaluate renal size and architecture by abdominal radiography or,
preferably, renal ultrasonography. The ultrasonographic appearance of
renal parenchymal disease (chronic renal failure) includes increased
cortical echogenicity and loss of a distinct corticomedullary junction.
The kidneys may appear smaller than normal and have an ill-defined or
irregular border. Similar sonographic findings, in addition to a dilated
renal pelvis, are characteristic of pyelonephritis.

If urine culture results are negative, leptopirosis serology and urine PCR
testing are negative, and radiographic or ultrasonographic findings are
equivocal, a creatinine or iohexol clearance test or renal biopsy may be
indicated. In rare cases, the urine culture may be negative even if
pyelonephritis is present. If clinical or ultrasonographic findings suggest
occult pyelonephritis, a therapeutic trial with an appropriate antibiotic (e.g.
enrofloxacin) should be instituted.

In the next post, I will talk about when water deprivation testing is needed in
the workup of dogs and cats with PU/PD.

Labels: Adrenal, Cat (feline), Diabetes insipidus, Diabetes mellitus, Dog (canine),
Hyperadrenocorticism (Cushing's syndrome), Hypercalcemia, Hypoadrenocorticism
(Addison's disease), Hypokalemia, Leptospirosis, Pancreas, Pituitary, Pituitary tumors,
Polyuria/Polydipsia (PU/PD), Pyelonephritis, Pyometra, renal disease

4 comments:
scrivereconlaluce said...
Hello, I'm an Italian anesthesiologist working in Switzerland. My dog Stella, a
golden retriever aged 7, no past medical history, had surgery in Italy for a
stage-2 mast cell cancer on november 12th. A huge hematoma developed
immediately after surgery but vet said he didn't think she needed a surgical
revision immediately... I was very disappointed but hey, I'm into human
medicine so I trusted the guy..

On 4th day postop, black-red urines: hemoglobinuria (was it autoimmune

hemolysis? was hematoma resorption? they told me they don't know). She
was put on fluids for 72 hours, the urine got back to a clear yellow.

On 7th day postop, fever, anorexia, septic blood count + wound oozing old
blood from the hematoma: she had a second surgery and they cleaned the
whole thing. At the same time they found that the infection had somehow
spread to the other leg where she had a TPLO years ago, so they took a
metal plate and screw off her contralateral tibia.

For the first ten days, she was on cephalexin and metronidazol.

On 11th day postop (Always counting from first surgery), polyuria+polydipsia

+ fever. (USG 1020; UP:UC 0.2). I suggest we switch antibiotics to
pradofloxacin + amoxicillin/clav and the vet accepts. Fever goes away in 48
hours, but PU/PD is still here today after a whole week; she burps a lot and
has lots of lip-smacking.

My vet was vague to say the least on the diagnosis-prognosis... I don't trust
his judgement too much anymore after all these complications, honestly.

Is it pyelonephritis? Is it renal failure? No urine culture was ever performed.

Only lots of blood counts, biochemistry and a couple of urine samples.
If the kidney damage is not permanent, in how many weeks should the
PU/PD disappear?

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6/27/23, 1:23 AM Insights into Veterinary Endocrinology: Diagnostic Approach to PU/PD: Urine Specific Gravity

Any suggestion is GREATLY appreciated.

Thanks
Irene Tosetti, MD
Anesthesiologist
University Hospitals of Geneva.
November 29, 2012 at 6:15 PM

Dr. Mark E. Peterson said...

Your dog certainly could have pyelonephritis, which could lead to renal
failure. This is a complicated case, but urine cultures and renal ultrasound
certainly are indicated.

If pyelonephritis is present, the renal damage may or may not be

permanent. It depends on the progression of the damage and if the infection
can be cured.

Sounds like you need to get another opinion, and you should probably take
your dog to a veterinary university hospital where they will have many
specialists to help in the diagnostic workup.
December 3, 2012 at 8:08 AM

Laura said...
My dog was very recently diagnosed with diabetes insipidus. My vet wrote
me a prescription for nasal drops (to be given into the eye). Based on what I
have read I would rather administer this via injection. My vet hasnt heard of
doing this before and is hesitant. What information can I provide him with to
show that it is more effective and less expensive to give the "eye drops"
subcutaniously? Also in order to this I just want to verify that it can be
prepared by a compounding pharmacy safely to be used in this manner.
June 7, 2015 at 1:09 PM

Dr. Mark E. Peterson said...

I'd show your vet my pertinent blog posts. If he doesn't believe me, then I'd
find another vet! I order my injectable compounded desmopressin product
from http://www.wedgewoodpharmacy.com.
June 7, 2015 at 1:52 PM
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