A 24.1 kg, 1.5-year-old intact male Labrador Retriever was presented to the North Carolina State University Veterinary Hospital (NC State VH) Emergency Service for a 3-day history of vomiting, hematochezia, fever, and generalized lymphadenopathy. The referring veterinarian treated the dog with a single dose of enrofloxacin 130 mg IV and discharged him with oral minocycline 10 mg/kg once daily. The dog vomited all oral medications. At NC State VH, CBC abnormalities included mild normocytic anemia (HCT 30.6%, reference interval [RI] 37-55%; MCV 69.9 fL, RI 60-72 fL) with mildly elevated MCHC (39.8 g/dL, RI 34-38 g/dL), marked leukocytosis (180,900/ lL, RI 4390-11,610/lL), characterized by marked monocytosis (103,113/lL, RI 75-840/lL), moderate neutrophilia (25,326/lL, RI 2840-9112/lL), marked left shift (12,663 band neutrophils), marked increase in intermediate-and late-stage myelomonocytic precursors (25,326/lL), moderate lymphocytosis (14,472/lL,, and thrombocytopenia (52,000/lL, RI 200,000-500,000/lL). In the absence of hemolysis, gross lipemia, and Heinz bodies, MCHC was considered falsely increased due to extreme leukocytosis. 1 Results of a biochemical panel including urea (17 mg/ dL, RI 7-25) and creatinine (1.0 mg/dL, RI 0.3-1.4) were within normal limits. Voided urinalysis included a sediment examination ( Figure 1). Acute leukemia was diagnosed and the dog was euthanized. Based on clinical signs, cytology of peripheral lymph node aspirates, microscopic blood smear review, peripheral blood flow cytometry, and necropsy, final diagnosis was acute monocytic (AML-M5) or acute myelomonocytic (AML-M4) leukemia. Figure 1. Urine sediment from a dog. Unstained wet mount, 910 objective. Urine sediment interpretation: Allantoin crystalluriaUrine was opaque, brown, with a specific gravity of 1.065, 3+ protein, 2+ bilirubin, 2+ blood, negative glucose, negative ketones, and undeterminable pH (Chemstrip 10; Roche Diagnostics, Indianapolis, IN, USA). The reason why pH was not determinable is unclear. Urine sediment examination revealed 2-5 fine granular casts/low-power field (9100), 0-5 RBC/high-power field (hpf, 9400), 0-5 WBC/hpf, and moderate numbers of long, needle-like, colorless to slightly yellow-brown crystals occurring singly and in bundles, sheaves, and fans (Figure 1). Sizes of crystals varied from 5 9 20 to 100 9 400 lm. Lignin test for sulfonamides was negative. Crystals did dissolve in 1N sodium hydroxide and were insoluble in 5% acetic acid. Sediment was submitted to the Minnesota Urolith Center for further evaluation and crystalline material was 100% allantoin. DiscussionSimilar to xanthine and uric acid, allantoin is a renally excreted, terminal metabolite of purine metabolism derived from nucleic acid break down. 2 In contrast to people, the vast majority of urine purine metabolites in dogs are comprised of allantoin. People and higher nonhuman primates lack functional urate oxidase, the enzyme that converts uric acid into allantoin. 3,4 Allantoin is 5-10 times more soluble than uric acid 2 , and the re...
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