Do cats have 9 lives? Successful treatment and long follow-up of a young cat with FIP and renal lymphoma

Do cats have 9 lives? 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Successful treatment and long follow-up of a young cat with FIP and renal lymphoma Ilse Beekhuis, Goncalos Serrano, Angel Almendros, Antonio Giuliano This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5672158/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract A 3.9-year-old male neutered cat presented with hyporexia and lethargy present for a few days. An abdominal mass was palpated on clinical examination and confirmed to be a renal mass on a computed tomography angiography (CTA) scan. Ultrasound-guided fine needle aspirates were performed, and cytological evaluation revealed a large-cell renal lymphoma. A modified COP protocol with the addition of vinblastine (COVP protocol) was started resulting in a complete response. Twenty weeks after starting chemotherapy, the cat developed, anorexia, fever, and pleural effusion. Feline infectious peritonitis (FIP) was diagnosed based on a positive RT RNA PCR test from the pleural effusion. Subcutaneous GS441524 administration led to FIP resolution. The cat did not receive any further treatment for both FIP and lymphoma and almost 5 years after the diagnosis of renal lymphoma, the cat is still alive and in remission of lymphoma and FIP. Renal lymphoma FIP remsidivir CHOP protocol Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Feline infectious peritonitis (FIP) has been long regarded as a fatal disease affecting most commonly young cats in multi-cat environments. 1 , 2 Although its pathogenesis is not entirely understood, the virulent biotype (FIPV) is caused by a mutation of the feline enteric coronavirus (FCoV) with changes in-cell tropism from enterocyte to monocyte. 2 , 3 Immunohistochemistry is considered the gold standard for diagnosis, 7 however, a combination of clinical signs and effusion analysis, if present, including cytology, biochemistry and FCoV RNA PCR testing would strongly support the diagnosis of FIP. 3 , 8 Due to immune-mediate vasculitis, typical of the wet form, abdominal effusion, lymphadenopathy and abnormal kidneys with subcapsular effusion have been common findings reported in infected cats. 2 , 9 Although less common, chest involvement alone with pathological lesions including pleuritis, vasculitis, perivascular parenchymal injury and pneumonia can occur and lead to pleural effusion, and dyspnea without the typical systemic signs of FIP. 10 Abdominal effusions, lymphadenopathy, pyogranulomatous lesions affecting abdominal organs, eyes and central nervous system are some of the common findings in wet and dry forms. 3 , 11 , 12 Renal abnormalities are reported to be common in younger cats including renomegaly, bilateral or unilateral, cortical hyperechogenicity, medullary rim sign, pyelectasia, and loss of corticomedullary differentiation. 2 , 11 , 12 , 13 , Poor prognosis and high fatality rate historically associated with FIP have improved considerably in recent years due to the novel use of nucleoside analogues, which have been successful in achieving clearance and complete long-term resolution of clinical signs. 4 – 6 However long-term assessment and follow-up of these patients treated with this new drug is lacking. Lymphoma is a hematopoietic neoplasia which occurs due to the proliferation of malignant lymphocytes 28 . It originates from DNA mutations which occur during primary differentiation of secondary lymphoid tissues 29 . Lymphomas themselves are categorized according to the topography 30 . There are alimentary, mediastinal, multicentric and extranodal lymphoma’s 30 , in which extranodal lymphoma refers to a disease confined to locations other than alimentary, mediastinal or multicentric sites and includes the nasal, central nervous system, cutaneous, ocular, laryngeal and renal lymphoma 29 . Renal lymphoma can be primary or be associated with gastrointestinal or multicentric involment 28 . The clinical signs are widely variable and unspecific since they are associated with the affected organ 28 . Cats diagnosed with renal lymphoma often have signs of chronic kidney disease, such as polyuria, polydipsia, azotemia and nonregenerative anemie 31 . For the diagnosis of renal lymphoma ultrasound can be used, it is also used to guide fine needle aspiration (FNA). Cytology is highly sensitive and specific for diagnosis 31 . The prognosis is reserved and must be considered with the stage, anatomical location, histological grade and comorbidities associated with the patient 31 . The treatment of choice is chemotherapy 31 . Long-term follow-up of more than 2–3 years for patients treated for renal lymphoma is only rarely reported 15 . In this report, we present a case of FIP infection in a young cat following the treatment of chemotherapy for renal lymphoma. The cat achieved a complete response to both treatments for FIP and lymphoma and he is currently free of both diseases for almost 5 years. Case presentation and investigations A 3.9-year-old domestic short-haired male neutered cat was referred for further investigation of a large mass in the cranial abdomen. At presentation, hyporexia and lethargy with a duration of a couple of weeks were reported. On physical examination, besides a very large mass palpable in the mid-cranial abdomen, occupying two-third of the abdomen, no other abnormalities were present. Haematology (table 1), full biochemistry profile (table 2) and urinalysis including a urine protein to creatinine ratio (UPC) (table 3), showed no significant abnormalities. Feline immunodeficiency virus and feline leukemia virus were both negative on an ELISA test (SNAP 4Dx Plus, IDEXX Laboratories, Westbrook, ME). Thoracic and abdominal CTA scans revealed an 8-centimetre mass arising from the left kidney and a small nodule in the right kidney (figure 1 and 2). The rest of the CT exam was unremarkable. Ultrasound-guided fine needle aspirates of the mass arising from the left kidney revealed a cell population consistent with large-cell lymphoma (figure 3 and 4). A COVP protocol was started. This consistent of a modified COP protocol with the addition of vinblastine. Complete remission was achieved after the second week of the COVP protocol. No significant adverse events attributed to the chemotherapy were reported during the chemotherapy course. Figure 1 and 2 left coronal and right axial, soft tissue window CT scan: The left kidney is markedly enlarged and measures approximately 80 mm in width, 65 mm in height, and 90 mm in length. It has a markedly deformed structure with no cortical medullary definition and a large lobulated expansile appearance. The cortex and medullary show reduced contrast enhancement while an irregular peripheral rim of tissue shows increased contrast enhancement. It retains a central area resembling a renal pelvis, where the left renal artery and vein are seen to enter, however, no accumulation of contrast medium is seen. The left kidney has a mass effect with severe lateral displacement of the intestines into the right abdomen, it also causes craniolateral displacement of the spleen which is curled in the left cranial abdomen. The right kidney is mildly enlarged measuring approximately 5 cm in length. It has several expansile rounded lesions within the cortex and medulla, these lesions mildly deformed the external contour of the kidney. They are similar in attenuation to the medulla pre-contrast (approximately 40 HU), but show markedly reduced contrast enhancement. Table 1, heamatology RBC 7.37 X 10 12 /L 6.54-12.20 HCT 34.0% 30.3-52.3 HGB 11.3 g/dL 9.8-16.2 MCV 46.1 fL 35.9-53.1 MCH 15.3 pg 11.8-17.3 MCHC 33.2 g/dL 28.1-35.8 RDW 22.9% 15.0-27.0 %RETIC 1.0% RETIC 70.8 K/ m L 3.0-50.0 RETIC-HGB 17.3 pg 13.2-20.8 WBC 25.24 x 10 9 /L 2.87-17.02 %NEU 79.9% %LYM 10.7% %MONO 5.7% %EOS 3.6% %BASO 0.1% NEU 20.17 10x 9 /L 2.30-10.29 LYM 2.69x10 9 /L 0.92-6.88 MONO 1.44x10 9 /L 0.05-0.67 EOS 0,92x10 9 /L 0.17-1.57 BASO 0,02x10 9 /L 0.01-0.26 PLT 608 K// m L 151-600 MPV 15.6 fL 11.4-21.6 PCT 0.95% 0.17-0.86 Table 2, biochemistry GLU 6.53 mmol/L 4.11-8.84 CREA 157 m mol/L 71-212 UREA 13.9 mmol/L 5.7-12.9 BUN/CREA 22 PHOS 1.50 mmol/L 1.00-2.42 CA 2.42 mmol/L 1.95-2.83 TP 72 g/L 57-89 ALB 30 g/L 22-40 GLOB 42 g/L 28-51 ALB/GLOB 0.7 ALT 47 U/L 12-130 ALKP 12 U/L 14-111 GGT 0 U/L 0-4 TBIL 11 m mol/L 0-15 CHOL 2.34 mmol/L 1.68-5.81 AMYL 1362 U/L 500-1500 LIPA 457 U/L 100-1400 Na 160 mmol/L 150-165 K 3.8 mmol/L 3.5-5.8 Na/K 42 Cl 116 mmol/L 112-129 Osm Calc 325 mmol/kg Table 3, urine analysis including UPC Test Result Reference Range Units Physical Examination Color Light Yellow N/A - Turbidity Clear N/A - Specific Gravity 1.041 N/A - Dipstick PH 6.5 6-7 - Protein 2+ (1.0 g/L) N/A - Glucose Negative Negative - Heme Negative Negative - Bilirubin Negative N/A - Ketones Negative Negative - Microscopic Examination RBC None seen <5 /HPF WBC <5 <5 /HPF Bacteria None seen N/A /HPF Epithelial Cells None seen N/A /HPF Crystals None seen N/A /LPF Casts None seen N/A /LPF Others Few-Debris, Few-Fat Drops N/A - BIOCHEMISTRY Result Reference Range Units Urine Protein/creatinine ratio (UPC) 0.39 <0,50 - Figures 3 and 4 100X magnification of the fine needle aspirate of the are the slides originating of theleft kidney mass. The sample is highly cellular and contains large numbers of large lymphocytes,2-3 times the size of a neutrophil. The lymphoid population is predominated by large lymphocytes with scant of dark blue cytoplasm. A few punctate clear cytoplasmic vacuoles are present in some cells. Nuclei are round and have fine reticular chromatin and one or more prominent nucleoli. Normal renal tissue is not seen. There is no evidence of inflammation or infection. The finding of a predominance of larger lymphocytes in the tissue is consistent with large cell lymphoma. Twenty weeks after the chemotherapy started after the penultimate triweekly maintenance injection protocol of vincristine and cyclophosphamide, anorexia and lethargy were reported by the owner. Physical examination revealed moderate dyspnea with paradoxical breathing and a fever of 40 degrees Celsius. Bloodwork revealed mild non-regenerative anaemia 25,3% (30.3-52,3), neutrophilia 22.35x10 9 /L (2.30-10.29), and mild hyperglobulinemia 54 g/L (28-51). Table 5 shows the bloodwork from that time. Thoracic radiographs revealed the presence of a large amount of pleural effusion. Therapeutic thoracocentesis was performed and the fluid was submitted for evaluation. Fluid analysis showed an exudate with a high protein count and cytology revealed a proteinaceous background with neutrophilic and macrophage inflammation, aerobic culture was negative for bacteria (figure 5). The mechanism of the effusion appeared to be that of exudation/inflammation. A PCR test for feline coronavirus was performed on the fluid and a positive result was requested, table 6. Echocardiography and abdominal ultrasonography performed at this point revealed no signs of cardiomyopathy that could have led to congestive heart failure or other abnormalities suggestive of lymphoma recurrence. Dexamethasone given intravenously at 0,2 mg/kg q 24h was started while the FeCoV PCR test result was pending. After a short initial clinical improvement, the pleural effusion reoccurred 2 days later and therapeutic thoracocentesis was repeated. After the PCR result confirmed FIP, daily subcutaneous GS441524 subcutaneous (SQ) injections were administered for 12 weeks and the dexamethasone was stopped. Marked clinical improvement was noticed after GS441524 started with no clinical or bloodwork abnormalities detected at 1-3-6-12 months rechecks. Currently, almost 5 years after the initial diagnosis of large-cell renal lymphoma, the cat is doing well without any clinical signs of lymphoma or FIP recurrence. Table 5. Bloodwork from the cat when FIP was suspected. RBC 6.03 X 10 12 /L 6.54-12.20 HCT 25.3% 30.3-52.3 HGB 8.5 g/dL 9.8-16.2 MCV 42.0 fL 35.9-53.1 MCH 14.1 pg 11.8-17.3 MCHC 33.6g/dL 28.1-35.8 RDW 27.1% 15.0-27.0 %RETIC 0.5% RETIC 28.3 K/ m L 3.0-50.0 RETIC-HGB 15.6 pg 13.2-20.8 WBC 24.84 x 10 9 /L 2.87-17.02 %NEU *89.9% %LYM *8.0% %MONO *1.8% %EOS 0.2% %BASO 0.1% NEU *22.35x10 9 /L 2.30-10.29 BAND *Suspected LYM *8.00x10 9 /L 0.92-6.88 MONO *1.98x10 9 /L 0.05-0.67 EOS *0.44x10 9 /L 0.17-1.57 BASO 0.05x10 9 /L 0.01-0.26 PLT 427 K// m L 151-600 MPV 16.5 fL 11.4-21.6 PCT 0,70% 0.17-0.86 GLU 8.42 mmol/L 4.11-8.84 CREA 135 m mol/L 71-212 UREA 5.7 mmol/L 5.7-12.9 BUN/CREA 10 TP 80 g/L 57-89 ALB 26 g/L 22-40 GLOB 54 g/L 28-51 ALB/GLOB 0.5 ALT 61 U/L 12-130 ALKP <10 U/L 14-111 Table 6, results from the examinations from the fluid collected from the thorax. Test Specimen Specimen Site Result Reference range Feline Coronavirus Fluid Thorax Positive Not applicable Thoracic fluid, cat Result Reference Interval Gross appearance Light yellow, slightly cloudy Clear RBCC 1.04 0 x 10 9 /L Nucleated cell count 8.44 < 1.5 x 10 9 /L Total protein 58 < 20 g/L Discussion Lymphoma is the most common cancer affecting domestic cats with an average age of 11 years 1 . Pediatric or juvenile lymphoma is rare in cats, but it has been previously reported. 14 , 15 Recently it has been shown that young cats with lymphoma tend to have mediastinal or disseminated forms with only 15% being of renal origin. 14 In the paper by Williams et al., the hospital incidence of renal lymphoma was 3.6% of all lymphoma cases, and patients as young as 1 year old were also reported to be affected. 15 Rogato reports that young cats tend to have similar or slightly better outcomes than those published for cats with lymphomas that develop at older ages 14 . While age difference was not assessed in Williams et al. paper as a prognostic factor, cats with renal lymphoma treated with chemotherapy lived a median of 203 days, with 3 of 27 cats surviving longer than 2 years and two cases living around 6 years. 15 This suggests that some cats could be cured of renal lymphoma. Unfortunately, the age of these long-surviving cats was not reported, making it impossible to assess the relationship between young age and long-term survival. Nevertheless, in one large study using CHOP-based chemotherapy, independently of the anatomical form of lymphoma, around 30% of cats that achieved a complete response were reported to live for 2 or more years, however renal lymphoma tended to have the shortest survival compared to other forms 16 . The cat reported here is still alive over 4 years after its renal lymphoma diagnosis without a reported relapse. As suggested by Williams et al. and Collette et al., studies, a cure is a possibility in cases that achieve a long-term, durable complete response. Although multiagent chemotherapy is the choice therapy for renal lymphoma, studies comparing the most commonly used chemotherapy protocols such as COP (vincristine, cyclophosphamide, and prednisolone) and CHOP (vincristine, cyclophosphamide, and doxorubicin) are inexistent. Nonetheless, it appears that cats that achieve complete response tend to live long independently of the protocol used 17 . In this case, a modified COP protocol with the addition of vinblastine (COVP protocol) was used. This is routinely used by the lead author’s clinic (article in press). Feline infectious peritonitis is an immune-mediated disease secondary to the systemic infection of macrophages by a mutant feline coronavirus strain 18 . Before the use of nucleoside analogues such as remdesivir (GS5734) or GS441524, a median survival of 9 days was expected in cats suffering from FIP 19 . Treatment with GS441524 proved to be effective against FIP in both, the short and long term, with no confirmed relapses during a 12-month follow-up period and a 96% survival rate at 6 months in cats that survive past the first 48 hours 4 , 20 . In the present report, subcutaneous GS441524 was used. Although very effective, subcutaneous weekly injections of nucleoside analogues have been associated with pain, vocalization and injection site reactions making its administration challenging at times. 5 , 21 , 22 Subcutaneous GS441524 administration in the present case was elected due to the lack of availability both of oral form and of information at the time of diagnosis regarding the efficacy of oral GS441524. Oral administration is widely available now and is the treatment of choice used by the authors as has also been shown to be efficacious by long-term follow-up of cats remission. 23 , 24 Stressful events during a young age including surgical procedures like spaying and neutering have been associated with the development of FIP. 25 Stress suppresses the immune system and increases the risk of FIP via a higher rate of viral replication and the risk of mutation 26 . A positive FCoV result from ascites fluid has been reported anecdotally in a young cat following chemotherapy treatment for jejunal lymphoblastic lymphosarcoma. 27 The development of a debilitating condition such as renal lymphoma and/or immunosuppression caused by the chemotherapeutic agents might have played a role in the development of FIP in the present case. To the authors’ knowledge this is the first time concurrent FIP and renal lymphoma have been successfully treated leading to long-term remission or cure. Independently of the reason for the concurrent development of two potentially fatal pathologies, the current case report highlights that therapeutic options are available and that cure or extreme long-term remissions are possible if appropriate therapies and care are readily instituted. Declarations Ethical approval and consent to participate: This work involved the use of client-owned animals only and followed the internationally recognized high standards of individual veterinary clinical patient care. Ethical approval from a committee was not necessarily required. Consent for publication: Informed consent (either verbal or written) was obtained from the owner of the cat Competing interests: None declared Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Author Contribution I.B. wrote the main manuscript text and prepared figures 1-5 and table 1-6A.A. wrote aff 31-52 A.G. wrote aff 53-71A.G. wrote aff 153-171A.A. wrote aff 179-192All authors reviewed the manuscript Acknowledgements: The author thanks Antonio Giuliano for his help and knowledge of oncology, Angel Almendron for her help and knowledge of viral disease. Together with Goncalo Serrano, they provided inspiration and support. Availability of data and materials: There are no additional data available for this paper. References Pedersen NC, Perron M, Bannasch M, et al. Efficacy and safety of the nucleoside analog GS-441524 for treatment of cats with naturally occurring feline infectious peritonitis. J Feline Med Surg. 2019;21:271–81. Müller TR, Penninck DG, Webster CR, et al. Abdominal ultrasonographic findings of cats with feline infectious peritonitis: an update. J Feline Med Surg. 2023;25:1098612X231216000. Tasker S, Addie DD, Egberink H, et al. 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Viruses 2021;13. Zwicklbauer K, Krentz D, Bergmann M, et al. Long-term follow-up of cats in complete remission after treatment of feline infectious peritonitis with oral GS-441524. J Feline Med Surg. 2023;25:1098612X231183250. Pedersen NC. A review of feline infectious peritonitis virus infection: 1963–2008. J Feline Med Surg. 2009;11:225–58. Riemer F, Kuehner KA, Ritz S, et al. Clinical and laboratory features of cats with feline infectious peritonitis–a retrospective study of 231 confirmed cases (2000–2010). J Feline Med Surg. 2016;18:348–56. Borku MK, Kara E, Kurtdede A, et al. Chemotherapy application on a cat with lymphoblastic lymphosarcoma. Turkish J Veterinary Res. 2017;1:29–33. Ambrosini F, Garcia M, Gariba e Silva V, et al. Primary renal lymphoma in two cats: case report. Archives Veterinary Sci. 2021;26:107–16. Argyle DJ, Pecceu E. Canine and feline lymphoma: challenges and opportunities for creating a paradigm shift. Vet Comp Oncol 2016:14:1–7. Sato H, Fujino Y, Chino J, et al. Prognostic analyses on anatomical and morphological classification of feline lymphoma. J Vet Med Sci. 2014;76:807–11. Moore a. Extranodal lymphoma in the cat prognostic factors and treatment options. J Feline Med Surg. 2013;15:379–90. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5672158","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":394700698,"identity":"1165c007-7a9c-4f6d-a1dc-431945d9c68c","order_by":0,"name":"Ilse Beekhuis","email":"","orcid":"","institution":"MVetMed Anicura Haaglanden","correspondingAuthor":false,"prefix":"","firstName":"Ilse","middleName":"","lastName":"Beekhuis","suffix":""},{"id":394700699,"identity":"3546afb7-1a2c-4c77-bb14-c4301db6cffb","order_by":1,"name":"Goncalos Serrano","email":"","orcid":"","institution":"Ghent University","correspondingAuthor":false,"prefix":"","firstName":"Goncalos","middleName":"","lastName":"Serrano","suffix":""},{"id":394700700,"identity":"0253d85f-c86d-4112-84e5-0a35d43f8649","order_by":2,"name":"Angel Almendros","email":"","orcid":"","institution":"Department of Veterinary Clinical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Angel","middleName":"","lastName":"Almendros","suffix":""},{"id":394700701,"identity":"46898de7-4810-4383-a428-91d5f594c645","order_by":3,"name":"Antonio Giuliano","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYFACxgaGBwYMDPwgBhgcYGCDMXFrSQBqkWxgbGwgUgsQJACxwQGYNYS08PcvbpNIKLDLMz5+uP0xbxuDHN+NBLaHM/BokbjxEKjFILnY7ExiYzNQi7HkjQR2ww34HHXjIEgLc+K2G4xgLYkbgLZIPsCjQx6ipT5x8wyIlnqCWgzON4K0HE7cIAHRkmAA0oLPYYY3GJstEgyOJ84A+mXmnHMShjPPPGyTxOd9ufPHH9748Kc6sb/9+IMPb8ps5PmOJx+T7MHnfYkEBJuJh0GCgYGBUETyH0CwGX/gVzsKRsEoGAUjFAAAI+lWzRaIht4AAAAASUVORK5CYII=","orcid":"","institution":"Harvest Veterinary Oncology Center","correspondingAuthor":true,"prefix":"","firstName":"Antonio","middleName":"","lastName":"Giuliano","suffix":""}],"badges":[],"createdAt":"2024-12-18 21:23:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5672158/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5672158/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72610172,"identity":"b1b302df-dec6-49e7-a4dc-883ad2909648","added_by":"auto","created_at":"2024-12-30 10:18:27","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28204,"visible":true,"origin":"","legend":"\u003cp\u003ecoronal soft tissue window CT-scan\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5672158/v1/7bf23abcfdd2957057d60dbb.jpg"},{"id":72610171,"identity":"9d28caf2-bcbe-47e9-a3a7-fb38c76cc00f","added_by":"auto","created_at":"2024-12-30 10:18:27","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":12896,"visible":true,"origin":"","legend":"\u003cp\u003erigth axial soft tissue window CT scan\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5672158/v1/8c490b216e5cb0626954648e.jpg"},{"id":72610176,"identity":"ac6b4a1f-e676-4638-9279-b25a68ddac41","added_by":"auto","created_at":"2024-12-30 10:18:27","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":35185,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5672158/v1/c8ddcb5b14643506ca6ccc93.jpg"},{"id":72610173,"identity":"3a69b3e7-dd40-4f53-ad70-8e645d643b91","added_by":"auto","created_at":"2024-12-30 10:18:27","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":36538,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5672158/v1/a0624686c60b6ed5007b58fa.jpg"},{"id":72612670,"identity":"50956e22-fdd3-4c19-a6bf-5ea9e808e78f","added_by":"auto","created_at":"2024-12-30 10:34:27","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":54961,"visible":true,"origin":"","legend":"\u003cp\u003ecytology of the pleural effusion: large nember of segmenteed neutrophils with moderate amount of activated macrophages and occasional small to intermediate lymphocytes. Suggestive of Pyogranulomatous inflammation\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5672158/v1/437138d52e31e46a9547886a.jpg"},{"id":73055225,"identity":"13e12001-4c20-4432-b4fd-f97d0103ab45","added_by":"auto","created_at":"2025-01-06 10:02:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":841280,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5672158/v1/a775c446-4a57-4a31-b77c-67addc72e144.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Do cats have 9 lives? Successful treatment and long follow-up of a young cat with FIP and renal lymphoma","fulltext":[{"header":"Background","content":"\u003cp\u003eFeline infectious peritonitis (FIP) has been long regarded as a fatal disease affecting most commonly young cats in multi-cat environments. \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Although its pathogenesis is not entirely understood, the virulent biotype (FIPV) is caused by a mutation of the feline enteric coronavirus (FCoV) with changes in-cell tropism from enterocyte to monocyte.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Immunohistochemistry is considered the gold standard for diagnosis,\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e however, a combination of clinical signs and effusion analysis, if present, including cytology, biochemistry and FCoV RNA PCR testing would strongly support the diagnosis of FIP.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Due to immune-mediate vasculitis, typical of the wet form, abdominal effusion, lymphadenopathy and abnormal kidneys with subcapsular effusion have been common findings reported in infected cats.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Although less common, chest involvement alone with pathological lesions including pleuritis, vasculitis, perivascular parenchymal injury and pneumonia can occur and lead to pleural effusion, and dyspnea without the typical systemic signs of FIP.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Abdominal effusions, lymphadenopathy, pyogranulomatous lesions affecting abdominal organs, eyes and central nervous system are some of the common findings in wet and dry forms.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Renal abnormalities are reported to be common in younger cats including renomegaly, bilateral or unilateral, cortical hyperechogenicity, medullary rim sign, pyelectasia, and loss of corticomedullary differentiation.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003c/sup\u003e Poor prognosis and high fatality rate historically associated with FIP have improved considerably in recent years due to the novel use of nucleoside analogues, which have been successful in achieving clearance and complete long-term resolution of clinical signs.\u003csup\u003e\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHowever long-term assessment and follow-up of these patients treated with this new drug is lacking.\u003c/p\u003e \u003cp\u003eLymphoma is a hematopoietic neoplasia which occurs due to the proliferation of malignant lymphocytes\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. It originates from DNA mutations which occur during primary differentiation of secondary lymphoid tissues\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Lymphomas themselves are categorized according to the topography\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. There are alimentary, mediastinal, multicentric and extranodal lymphoma\u0026rsquo;s\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e, in which extranodal lymphoma refers to a disease confined to locations other than alimentary, mediastinal or multicentric sites and includes the nasal, central nervous system, cutaneous, ocular, laryngeal and renal lymphoma\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Renal lymphoma can be primary or be associated with gastrointestinal or multicentric involment\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. The clinical signs are widely variable and unspecific since they are associated with the affected organ\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Cats diagnosed with renal lymphoma often have signs of chronic kidney disease, such as polyuria, polydipsia, azotemia and nonregenerative anemie\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. For the diagnosis of renal lymphoma ultrasound can be used, it is also used to guide fine needle aspiration (FNA). Cytology is highly sensitive and specific for diagnosis\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. The prognosis is reserved and must be considered with the stage, anatomical location, histological grade and comorbidities associated with the patient\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. The treatment of choice is chemotherapy\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Long-term follow-up of more than 2\u0026ndash;3 years for patients treated for renal lymphoma is only rarely reported\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this report, we present a case of FIP infection in a young cat following the treatment of chemotherapy for renal lymphoma. The cat achieved a complete response to both treatments for FIP and lymphoma and he is currently free of both diseases for almost 5 years.\u003c/p\u003e"},{"header":"Case presentation and investigations","content":"\u003cp\u003eA 3.9-year-old domestic short-haired male neutered cat was referred for further investigation of a large mass in the cranial abdomen. At presentation, hyporexia and lethargy with a duration of a couple of weeks were reported. On physical examination, besides a very large mass palpable in the mid-cranial abdomen, occupying two-third of the abdomen, no other abnormalities were present. Haematology (table 1), full biochemistry profile (table 2) and urinalysis including a urine protein to creatinine ratio (UPC) (table 3), showed no significant abnormalities. Feline immunodeficiency virus and feline leukemia virus were both negative on an ELISA test (SNAP 4Dx Plus, IDEXX Laboratories, Westbrook, ME). Thoracic and abdominal CTA scans revealed an 8-centimetre mass arising from the left kidney and a small nodule in the right kidney (figure 1 and 2). The rest of the CT exam was unremarkable. Ultrasound-guided fine needle aspirates of the mass arising from the left kidney revealed a cell population consistent with large-cell lymphoma (figure 3 and 4). A COVP protocol was started. This consistent of a modified COP protocol with the addition of vinblastine. Complete remission was achieved after the second week of the COVP protocol. No significant adverse events attributed to the chemotherapy were reported during the chemotherapy course. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 1 and 2 left coronal and right axial, soft tissue window CT scan: The left kidney is markedly enlarged and measures approximately 80 mm in width, 65 mm in height, and 90 mm in length. It has a markedly deformed structure with no cortical medullary definition and a large lobulated expansile appearance. The cortex and medullary show reduced contrast enhancement while an irregular peripheral rim of tissue shows increased contrast enhancement. It retains a central area resembling a renal pelvis, where the left renal artery and vein are seen to enter, however, no accumulation of contrast medium is seen. The left kidney has a mass effect with severe lateral displacement of the intestines into the right abdomen, it also causes craniolateral displacement of the spleen which is curled in the left cranial abdomen. The right kidney is mildly enlarged measuring approximately 5 cm in length. It has several expansile rounded lesions within the cortex and medulla, these lesions mildly deformed the external contour of the kidney. They are similar in attenuation to the medulla pre-contrast (approximately 40 HU), but show markedly reduced contrast enhancement.\u003c/p\u003e\n\u003cp\u003eTable 1, heamatology\u0026nbsp;\u003c/p\u003e\n\u003ctable style=\"border: none;border-collapse: collapse;width: 417px;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eRBC\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e7.37 X 10\u003csup\u003e12\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e6.54-12.20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eHCT\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e34.0%\u003c/span\u003e\u003c/p\u003e\n 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\u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e9.8-16.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eMCV\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e46.1 fL\u003c/span\u003e\u003c/p\u003e\n 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style=\"font-size:13px;font-family:Symbol;color:red;\"\u003em\u003c/span\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003eL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e3.0-50.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eRETIC-HGB\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e17.3 pg\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e13.2-20.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003eWBC\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n 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5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e79.9%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e%LYM\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e10.7%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e%MONO\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e5.7%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e%EOS\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.6%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e%BASO\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.1%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003eNEU\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e20.17 10x\u003csup\u003e9\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e2.30-10.29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eLYM\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.69x10\u003csup\u003e9\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.92-6.88\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003eMONO\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e1.44x10\u003csup\u003e9\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e0.05-0.67\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eEOS\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0,92x10\u003csup\u003e9\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.17-1.57\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eBASO\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0,02x10\u003csup\u003e9\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.01-0.26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003ePLT\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e608 K//\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Symbol;color:red;\"\u003em\u003c/span\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003eL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e151-600\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eMPV\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e15.6 fL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e11.4-21.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003ePCT\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.95%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.5pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;height: 14.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.17-0.86\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2, biochemistry\u003c/p\u003e\n\u003ctable style=\"border: none;border-collapse: collapse;width: 603px;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eGLU\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e6.53 mmol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e4.11-8.84\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eCREA\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e157\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Symbol;color:black;\"\u003em\u003c/span\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003emol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e71-212\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003eUREA\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e13.9 mmol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e5.7-12.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eBUN/CREA\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003ePHOS\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.50 mmol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.00-2.42\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eCA\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.42 mmol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.95-2.83\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eTP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e72 g/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e57-89\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eALB\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e30 g/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e22-40\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eGLOB\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e42 g/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e28-51\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eALB/GLOB\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eALT\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e47 U/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e12-130\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003eALKP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e12 U/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e14-111\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eGGT\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0 U/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0-4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eTBIL\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e11\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Symbol;color:black;\"\u003em\u003c/span\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003emol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0-15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eCHOL\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.34 mmol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1.68-5.81\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eAMYL\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1362 U/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e500-1500\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eLIPA\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e457 U/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e100-1400\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eNa\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e160 mmol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e150-165\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eK\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.8 mmol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.5-5.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eNa/K\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e42\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eCl\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e116 mmol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e112-129\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eOsm Calc\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e325 mmol/kg\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3, urine analysis including UPC\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical Examination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eColor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eLight Yellow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTurbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eClear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecific Gravity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e1.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDipstick\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e6-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProtein\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e2+ (1.0 g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGlucose\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilirubin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKetones\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMicroscopic Examination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRBC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNone seen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026lt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e/HPF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWBC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026lt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026lt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e/HPF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBacteria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNone seen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e/HPF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpithelial Cells\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNone seen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e/HPF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrystals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNone seen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e/LPF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCasts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNone seen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e/LPF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOthers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eFew-Debris, Few-Fat Drops\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.0265%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBIOCHEMISTRY\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2123%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8706%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.8905%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.0265%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrine Protein/creatinine ratio (UPC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2123%;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8706%;\"\u003e\n \u003cp\u003e\u0026lt;0,50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.8905%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFigures 3 and 4 100X magnification of the fine needle aspirate of the are the slides originating of theleft kidney mass. The sample is highly cellular and contains large numbers of large lymphocytes,2-3 times the size of a neutrophil. The lymphoid population is predominated by large lymphocytes with scant of dark blue cytoplasm. A few punctate clear cytoplasmic vacuoles are present in some cells. Nuclei are round and have fine reticular chromatin and one or more prominent nucleoli. Normal renal tissue is not seen. There is no evidence of inflammation or infection. The finding of a predominance of larger lymphocytes in the tissue is consistent with large cell lymphoma.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTwenty weeks after the\u0026nbsp;chemotherapy started after the penultimate triweekly maintenance injection protocol of vincristine and cyclophosphamide, anorexia and lethargy were reported by the owner. Physical examination revealed moderate dyspnea with paradoxical breathing and a fever of 40 degrees Celsius. Bloodwork revealed mild non-regenerative anaemia 25,3% (30.3-52,3), neutrophilia 22.35x10\u003csup\u003e9\u003c/sup\u003e/L (2.30-10.29), and mild hyperglobulinemia 54 g/L (28-51). Table 5 shows the bloodwork from that time. Thoracic radiographs revealed the presence of a large amount of pleural effusion. Therapeutic thoracocentesis was performed and the fluid was submitted for evaluation. Fluid analysis showed an exudate with a high protein count and cytology revealed a proteinaceous background with neutrophilic and macrophage inflammation, aerobic culture was negative for bacteria (figure 5). The mechanism of the effusion appeared to be that of exudation/inflammation. A PCR test for feline coronavirus was performed on the fluid and a positive result was requested, table 6.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEchocardiography and abdominal ultrasonography performed at this point revealed no signs of cardiomyopathy that could have led to congestive heart failure or other abnormalities suggestive of lymphoma recurrence.\u003c/p\u003e\n\u003cp\u003eDexamethasone given intravenously at 0,2 mg/kg q 24h was started while the FeCoV PCR test result was pending. After a short initial clinical improvement, the pleural effusion reoccurred 2 days later and therapeutic thoracocentesis was repeated. After the PCR result confirmed FIP, daily subcutaneous GS441524 subcutaneous (SQ) injections were administered for 12 weeks and the dexamethasone was stopped.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMarked clinical improvement was noticed after GS441524 started with no clinical or bloodwork abnormalities detected at 1-3-6-12 months rechecks. Currently, almost 5 years after the initial diagnosis of large-cell renal lymphoma, the cat is doing well without any clinical signs of lymphoma or FIP recurrence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5. Bloodwork from the cat when FIP was suspected.\u0026nbsp;\u003c/p\u003e\n\u003ctable style=\"border: none;border-collapse: collapse;width: 603px;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003eRBC\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003e6.03 X 10\u003csup\u003e12\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003e6.54-12.20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003eHCT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003e25.3%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003e30.3-52.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003eHGB\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003e8.5 g/dL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003e9.8-16.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eMCV\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e42.0 fL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e35.9-53.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eMCH\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e14.1 pg\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e11.8-17.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eMCHC\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e33.6g/dL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e28.1-35.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003eRDW\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e27.1%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e15.0-27.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e%RETIC\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.5%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eRETIC\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e28.3 K/\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Symbol;color:black;\"\u003em\u003c/span\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.0-50.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eRETIC-HGB\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e15.6 pg\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e13.2-20.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003eWBC\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e24.84 x 10\u003csup\u003e9\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e2.87-17.02\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e%NEU\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e*89.9%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e%LYM\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e*8.0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e%MONO\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e*1.8%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e%EOS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.2%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e%BASO\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.1%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003eNEU\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e*22.35x10\u003csup\u003e9\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e2.30-10.29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eBAND\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e*Suspected\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eLYM\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e*8.00x10\u003csup\u003e9\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.92-6.88\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eMONO\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e*1.98x10\u003csup\u003e9\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.05-0.67\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003eEOS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003e*0.44x10\u003csup\u003e9\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003e0.17-1.57\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eBASO\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.05x10\u003csup\u003e9\u003c/sup\u003e/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.01-0.26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003ePLT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e427 K//\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Symbol;color:black;\"\u003em\u003c/span\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e151-600\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eMPV\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e16.5 fL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e11.4-21.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003ePCT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0,70%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.17-0.86\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eGLU\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003e8.42 mmol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003e4.11-8.84\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eCREA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e135\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Symbol;color:black;\"\u003em\u003c/span\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003emol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e71-212\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eUREA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003e5.7 mmol/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003e5.7-12.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eBUN/CREA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eTP\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003e80 g/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003e57-89\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eALB\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e26 g/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e22-40\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003eGLOB\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e54 g/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:red;\"\u003e28-51\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eALB/GLOB\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003eALT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003e61 U/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003e12-130\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150.9pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003eALKP\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003e\u0026lt;10 U/L\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150.95pt;background: rgb(242, 242, 242);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:13px;color:#0070C0;\"\u003e14-111\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 6, results from the examinations from the fluid collected from the thorax. \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19.9341%;\"\u003e\n \u003cp\u003eTest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7694%;\"\u003e\n \u003cp\u003eSpecimen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7694%;\"\u003e\n \u003cp\u003eSpecimen Site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7694%;\"\u003e\n \u003cp\u003eResult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.6079%;\"\u003e\n \u003cp\u003eReference range\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19.9341%;\"\u003e\n \u003cp\u003e\u003cem\u003eFeline Coronavirus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7694%;\"\u003e\n \u003cp\u003eFluid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7694%;\"\u003e\n \u003cp\u003eThorax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7694%;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7694%;\"\u003e\n \u003cp\u003eNot applicable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThoracic fluid, cat\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference Interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGross appearance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eLight yellow, slightly cloudy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eClear\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRBCC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0 x 10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNucleated cell count\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e8.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026lt; 1.5 x 10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal protein\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026lt; 20 g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eLymphoma is the most common cancer affecting domestic cats with an average age of 11 years\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Pediatric or juvenile lymphoma is rare in cats, but it has been previously reported.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Recently it has been shown that young cats with lymphoma tend to have mediastinal or disseminated forms with only 15% being of renal origin.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e In the paper by Williams et al., the hospital incidence of renal lymphoma was 3.6% of all lymphoma cases, and patients as young as 1 year old were also reported to be affected.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Rogato reports that young cats tend to have similar or slightly better outcomes than those published for cats with lymphomas that develop at older ages \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. While age difference was not assessed in Williams et al. paper as a prognostic factor, cats with renal lymphoma treated with chemotherapy lived a median of 203 days, with 3 of 27 cats surviving longer than 2 years and two cases living around 6 years.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e This suggests that some cats could be cured of renal lymphoma. Unfortunately, the age of these long-surviving cats was not reported, making it impossible to assess the relationship between young age and long-term survival. Nevertheless, in one large study using CHOP-based chemotherapy, independently of the anatomical form of lymphoma, around 30% of cats that achieved a complete response were reported to live for 2 or more years, however renal lymphoma tended to have the shortest survival compared to other forms \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. The cat reported here is still alive over 4 years after its renal lymphoma diagnosis without a reported relapse. As suggested by Williams et al. and Collette et al., studies, a cure is a possibility in cases that achieve a long-term, durable complete response.\u003c/p\u003e \u003cp\u003eAlthough multiagent chemotherapy is the choice therapy for renal lymphoma, studies comparing the most commonly used chemotherapy protocols such as COP (vincristine, cyclophosphamide, and prednisolone) and CHOP (vincristine, cyclophosphamide, and doxorubicin) are inexistent. Nonetheless, it appears that cats that achieve complete response tend to live long independently of the protocol used \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. In this case, a modified COP protocol with the addition of vinblastine (COVP protocol) was used. This is routinely used by the lead author\u0026rsquo;s clinic (article in press).\u003c/p\u003e \u003cp\u003eFeline infectious peritonitis is an immune-mediated disease secondary to the systemic infection of macrophages by a mutant feline coronavirus strain \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Before the use of nucleoside analogues such as remdesivir (GS5734) or GS441524, a median survival of 9 days was expected in cats suffering from FIP \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Treatment with GS441524 proved to be effective against FIP in both, the short and long term, with no confirmed relapses during a 12-month follow-up period and a 96% survival rate at 6 months in cats that survive past the first 48 hours \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. In the present report, subcutaneous GS441524 was used. Although very effective, subcutaneous weekly injections of nucleoside analogues have been associated with pain, vocalization and injection site reactions making its administration challenging at times.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Subcutaneous GS441524 administration in the present case was elected due to the lack of availability both of oral form and of information at the time of diagnosis regarding the efficacy of oral GS441524. Oral administration is widely available now and is the treatment of choice used by the authors as has also been shown to be efficacious by long-term follow-up of cats remission.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eStressful events during a young age including surgical procedures like spaying and neutering have been associated with the development of FIP.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Stress suppresses the immune system and increases the risk of FIP via a higher rate of viral replication and the risk of mutation\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. A positive FCoV result from ascites fluid has been reported anecdotally in a young cat following chemotherapy treatment for jejunal lymphoblastic lymphosarcoma.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e The development of a debilitating condition such as renal lymphoma and/or immunosuppression caused by the chemotherapeutic agents might have played a role in the development of FIP in the present case.\u003c/p\u003e \u003cp\u003eTo the authors\u0026rsquo; knowledge this is the first time concurrent FIP and renal lymphoma have been successfully treated leading to long-term remission or cure. Independently of the reason for the concurrent development of two potentially fatal pathologies, the current case report highlights that therapeutic options are available and that cure or extreme long-term remissions are possible if appropriate therapies and care are readily instituted.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical approval and consent to participate:\u003c/strong\u003e \u003cp\u003eThis work involved the use of client-owned animals only and followed the internationally recognized high standards of individual veterinary clinical patient care. Ethical approval from a committee was not necessarily required.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eInformed consent (either verbal or written) was obtained from the owner of the cat\u003c/p\u003e \u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eNone declared\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eI.B. wrote the main manuscript text and prepared figures 1-5 and table 1-6A.A. wrote aff 31-52 A.G. wrote aff 53-71A.G. wrote aff 153-171A.A. wrote aff 179-192All authors reviewed the manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eThe author thanks Antonio Giuliano for his help and knowledge of oncology, Angel Almendron for her help and knowledge of viral disease. Together with Goncalo Serrano, they provided inspiration and support.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials:\u003c/h2\u003e \u003cp\u003eThere are no additional data available for this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePedersen NC, Perron M, Bannasch M, et al. Efficacy and safety of the nucleoside analog GS-441524 for treatment of cats with naturally occurring feline infectious peritonitis. J Feline Med Surg. 2019;21:271\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM\u0026uuml;ller TR, Penninck DG, Webster CR, et al. Abdominal ultrasonographic findings of cats with feline infectious peritonitis: an update. J Feline Med Surg. 2023;25:1098612X231216000.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTasker S, Addie DD, Egberink H, et al. Feline infectious peritonitis: European advisory board on cat diseases guidelines. Viruses. 2023;15:1847.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoggins SJ, Norris JM, Malik R, et al. Outcomes of treatment of cats with feline infectious peritonitis using parenterally administered remdesivir, with or without transition to orally administered GS-441524. J Vet Intern Med. 2023;37:1772\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreen J, Syme H, Tayler S. Thirty-two cats with effusive or non-effusive feline infectious peritonitis treated with a combination of remdesivir and GS-441524. J Vet Intern Med. 2023;37:1784\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDickinson PJ, Bannasch M, Thomasy SM, et al. Antiviral treatment using the adenosine nucleoside analogue GS-441524 in cats with clinically diagnosed neurological feline infectious peritonitis. J Vet Intern Med. 2020;34:1587\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFelten S, Hartmann K. Diagnosis of feline infectious peritonitis: a review of the current literature. Viruses. 2019;11:1068.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThayer V, Gogolski S, Felten S, et al. 2022 AAFP/EveryCat feline infectious peritonitis diagnosis guidelines. J Feline Med Surg. 2022;24:905\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLewis KM, O\u0026rsquo;Brien RT. Abdominal ultrasonographic findings associated with feline infectious peritonitis: a retrospective review of 16 cases. J Am Anim Hosp Assoc. 2010;46:152\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSlaviero M, Cony FG, da Silva RC, et al. Pathological findings and patterns of feline infectious peritonitis in the respiratory tract of cats. J Comp Pathol. 2024;210:15\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTasker S. Diagnosis of feline infectious peritonitis: Update on evidence supporting available tests. J Feline Med Surg. 2018;20:228\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKipar A, May H, Menger S, et al. Morphologic features and development of granulomatous vasculitis in feline infectious peritonitis. Vet Pathol. 2005;42:321\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eG\u0026uuml;lersoy E, Balık\u0026ccedil;ı C, Kısmet E, et al. Renal Ultrasonography Findings in Cats with Feline Infectious Peritonitis. Van Veterinary J. 2023;34:63\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRogato F, Tanis JB, Pons Gil B, et al. Clinical characterisation and long-term survival of paediatric and juvenile lymphoma in cats: 33 cases (2008\u0026ndash;2022). J Small Anim Pract. 2023;64:788\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams AG, Hohenhaus AE, Lamb KE. Incidence and treatment of feline renal lymphoma: 27 cases. J Feline Med Surg. 2021;23:936\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCollette SA, Allstadt SD, Chon EM, et al. Treatment of feline intermediate- to high-grade lymphoma with a modified university of Wisconsin-Madison protocol: 119 cases (2004\u0026ndash;2012). Vet Comp Oncol. 2016;14(Suppl 1):136\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernardo Marques G, Ponce F, Beaudu-Lange C, et al. Feline high-grade and large granular lymphocyte alimentary lymphomas treated with COP- or CHOP-based chemotherapy: A multi-centric retrospective study of 57 cases. Vet Comp Oncol. 2024;22:186\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThayer V, Gogolski S, Felten S, et al. 2022 AAFP/EveryCat Feline Infectious Peritonitis Diagnosis Guidelines. J Feline Med Surg. 2022;24:905\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRitz S, Egberink H, Hartmann K. Effect of feline interferon-omega on the survival time and quality of life of cats with feline infectious peritonitis. J Vet Intern Med. 2007;21:1193\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZwicklbauer K, Krentz D, Bergmann M, et al. Long-term follow-up of cats in complete remission after treatment of feline infectious peritonitis with oral GS-441524. J Feline Med Surg. 2023;25:1098612X231183250.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaylor SS, Coggins S, Barker EN, et al. Retrospective study and outcome of 307 cats with feline infectious peritonitis treated with legally sourced veterinary compounded preparations of remdesivir and GS-441524 (2020\u0026ndash;2022). J Feline Med Surg. 2023;25:1098612X231194460.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNegash R, Li E, Jacque N, et al. Owner experience and veterinary involvement with unlicensed GS-441524 treatment of feline infectious peritonitis: A prospective cohort study. Front Veterinary Sci. 2024;11:1377207.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrentz D, Zenger K, Alberer M et al. Curing Cats with Feline Infectious Peritonitis with an Oral Multi-Component Drug Containing GS-441524. Viruses 2021;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZwicklbauer K, Krentz D, Bergmann M, et al. Long-term follow-up of cats in complete remission after treatment of feline infectious peritonitis with oral GS-441524. J Feline Med Surg. 2023;25:1098612X231183250.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePedersen NC. A review of feline infectious peritonitis virus infection: 1963\u0026ndash;2008. J Feline Med Surg. 2009;11:225\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRiemer F, Kuehner KA, Ritz S, et al. Clinical and laboratory features of cats with feline infectious peritonitis\u0026ndash;a retrospective study of 231 confirmed cases (2000\u0026ndash;2010). J Feline Med Surg. 2016;18:348\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorku MK, Kara E, Kurtdede A, et al. Chemotherapy application on a cat with lymphoblastic lymphosarcoma. Turkish J Veterinary Res. 2017;1:29\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmbrosini F, Garcia M, Gariba e Silva V, et al. Primary renal lymphoma in two cats: case report. Archives Veterinary Sci. 2021;26:107\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArgyle DJ, Pecceu E. Canine and feline lymphoma: challenges and opportunities for creating a paradigm shift. Vet Comp Oncol 2016:14:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSato H, Fujino Y, Chino J, et al. Prognostic analyses on anatomical and morphological classification of feline lymphoma. J Vet Med Sci. 2014;76:807\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore a. Extranodal lymphoma in the cat prognostic factors and treatment options. J Feline Med Surg. 2013;15:379\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Renal lymphoma, FIP, remsidivir, CHOP protocol","lastPublishedDoi":"10.21203/rs.3.rs-5672158/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5672158/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA 3.9-year-old male neutered cat presented with hyporexia and lethargy present for a few days. An abdominal mass was palpated on clinical examination and confirmed to be a renal mass on a computed tomography angiography (CTA) scan. Ultrasound-guided fine needle aspirates were performed, and cytological evaluation revealed a large-cell renal lymphoma. A modified COP protocol with the addition of vinblastine (COVP protocol) was started resulting in a complete response. Twenty weeks after starting chemotherapy, the cat developed, anorexia, fever, and pleural effusion. Feline infectious peritonitis (FIP) was diagnosed based on a positive RT RNA PCR test from the pleural effusion. Subcutaneous GS441524 administration led to FIP resolution. The cat did not receive any further treatment for both FIP and lymphoma and almost 5 years after the diagnosis of renal lymphoma, the cat is still alive and in remission of lymphoma and FIP.\u003c/p\u003e","manuscriptTitle":"Do cats have 9 lives? Successful treatment and long follow-up of a young cat with FIP and renal lymphoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-30 10:18:22","doi":"10.21203/rs.3.rs-5672158/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bb7b1830-f05a-4a5a-9e98-c251e327967e","owner":[],"postedDate":"December 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-06T09:54:00+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-30 10:18:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5672158","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5672158","identity":"rs-5672158","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}