greyhound glomerulonephropathy

Re: greyhound glomerulonephropathy

Stephen Courtney — Tue, 16 Jun 2015 14:33:44 GMT

Totally agree, do what works so long as the medicine isn't worse than the disease!

Re: greyhound glomerulonephropathy

Martin Atkinson — Tue, 16 Jun 2015 09:57:35 GMT

[quote user="Stephen Courtney"]

^^ that doesn't mean it is ineffective, and a phaeo is a far more aggressive cause of hypertension than the usual idiopathic or overt or manifest renal causes of hyopertension

[/quote]I guess you use what works best for you under given circumstances. The dog with the (suspected - the owner has opted out of surgery) phaeo actually started on phenoxybenzamine which is much more specific for the condition until it became unavailable but we seem to be able to control the BP better with a combination of benazeprl, prazocin and amlodipine.

Re: greyhound glomerulonephropathy

Stephen Courtney — Mon, 15 Jun 2015 22:35:39 GMT

Sorry mean to say occult or manifest renal causes - for some reason I seem unable to edit any of my numerous and occasionally memorable autocorrects....

Re: greyhound glomerulonephropathy

Stephen Courtney — Mon, 15 Jun 2015 22:33:58 GMT

^^ that doesn't mean it is ineffective, and a phaeo is a far more aggressive cause of hypertension than the usual idiopathic or overt or manifest renal causes of hyopertension

Re: greyhound glomerulonephropathy

Martin Atkinson — Mon, 15 Jun 2015 12:14:57 GMT

[quote user="Stephen Courtney"]Amlodipine works well enough in the two dogs i give it to[/quote]Until a couple of months ago I would I have agreed but my assistant 4 years graduated maintains that she was taught that benazepril is a better drug to use in dogs as does the referral vet at the QMH I recently referred a hypertensive dog with a suspected phaechromocytoma. Indeed I was struggling to control its hypertension with amlodipine alone and it needed a combination of benazepril and prazocin to get it normo-tensive. Plus the BSAVA Formulary states: "It is a less effective anti-hypertensive in dogs than cats".

Re: greyhound glomerulonephropathy

Stephen Courtney — Sat, 13 Jun 2015 18:45:16 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Stephen Courtney"] was fairly nasty military dermatitis[/quote]

Ah, the rough male kiss of khaki serge?

[/quote]

I do seem to have regular issues with an autocorrect function....

Though i'm afraid i have none of your obviously wider life experiences to bring to this discussion!

Re: greyhound glomerulonephropathy

Evelyn Barbour-Hill — Sat, 13 Jun 2015 17:17:10 GMT

[quote user="Stephen Courtney"] was fairly nasty military dermatitis[/quote]

Ah, the rough male kiss of khaki serge?

Re: greyhound glomerulonephropathy

Stephen Courtney — Sat, 13 Jun 2015 12:54:17 GMT

Amlodipine works well enough in the two dogs i give it to...but the dose / response seems variable, perhaps more so than in cats, but as with cats i treat, measure and adjust dose depending on results. I only ever once had a problem with amlodipine, a cat developed some sort of skin eruption which may have been due to the drug - was fairly nasty military dermatitis which had apparently never happened before.

Benazeptril will drop BP by about 5%, semintra by slightly more, so of late i am using it in preference in my new feline cases with renal disease and proteinuria.

As ace inhibitors and semintra block different parts of the RAS, there is good theoretical reason to use both if need be. Admittedly no studies done and no drug company will give you the nod, so i guess extravagances of that nature are probably best reserved for referral medics!

Re: greyhound glomerulonephropathy

Martin Atkinson — Fri, 12 Jun 2015 09:09:45 GMT

[quote user="Stephen Courtney"]Amlodipine for blood pressure. ACE inhibitors and seminar won't do enough on their own, or even in combination.[/quote]Well this was once my approach but I've since learned that amlodypine does not work as well in dogs as cats and benazepril would be my first line for hypertension in a dog then add in prazocin and/or amlodypine if it wasn't effective enough on its own. I don't think there is any evidence to show Semintra in addition to ACEi is beneficial.

Re: greyhound glomerulonephropathy

Stephen Courtney — Thu, 11 Jun 2015 23:52:47 GMT

Amlodipine for blood pressure. ACE inhibitors and seminar won't do enough on their own, or even in combination.

I had one of these ( still do in fact) on amlodipine and fortekor, and renal diet, and he is doing great at the ripe age of 15 years. diagnosed 2 years ago, and after 2-3 BP measurements decided he wouldn't allow another one....still doing OK anyway. I weight him and check his urine every few months, and he is as stable clinically as you could hope for.

Re: greyhound glomerulonephropathy

Kerry Peak — Thu, 11 Jun 2015 20:12:34 GMT

Thanks for the replies everyone. I will definitely consider Semintra in this case.

I believe that originally we performed bloods, urinalysis including culture and blood pressure measurement. I think an abdominal ultrasound to asses adrenal size may be beyond our expertise and referral is not an option.

I will definitely try and re check his blood pressure again, and he is already on aspirin to try and reduce the risk of TE.

Re: greyhound glomerulonephropathy

Sarah Keir — Thu, 11 Jun 2015 13:51:20 GMT

These PLN patients are also at risk of thromboembolism - do you have him on asprin or clopridogrel?

Sarah

Re: greyhound glomerulonephropathy

Martin Atkinson — Thu, 11 Jun 2015 10:08:03 GMT

In answer to the question in the OP I would start on benazepril but as has already been mentioned Semintra may be a better bet as it has been shown, admittedly by Boehringer's own data, to control proteinuria better than ACEi.

I would also want to control the BP better so would add in some amlodypine, although this doesn't work as well as in cats, and/or prazocin (Hypovase).

I would also ask what investigations have lead to the diagnosis and maybe revisit these, the glomerulopathy may be secondary to the hypertension rather than vice-versa. One cause of persistent hypertension could be phaechromoctoma

Re: greyhound glomerulonephropathy

Kate Richardson — Thu, 11 Jun 2015 07:59:38 GMT

Speak to boehringer about semintra (telmisartin) and ace escape- off licence in dogs but there has been some use but they will have more info

Re: greyhound glomerulonephropathy

Kara Gibson — Thu, 11 Jun 2015 07:55:07 GMT

Hi,

I would be a bit worried about ongoing hypertension and you might find if you start an antihypertensive then his UPC will reduce. 200mmHg does sound high for a dog even if it is stressed. If his blood pressure is normal consider starting an angiotensin receptor blocker like telmisartan if you have maxed out the ACE inhibitor dose but as with an ACE inhibitor check urea and creatinine a week or so after. Studies show proteniuria is a negative prognostic indicator so trying to get on top of it is important.