protein losing nephropathy

Re: protein losing nephropathy

nikki — Sat, 20 Mar 2010 21:57:25 GMT

he is on benazepril - started at 0.25mg/kg SID, then 0.5mg/kg SID now on 0.5mg/kg BID!

Re: protein losing nephropathy

Jon Bray — Sat, 20 Mar 2010 20:35:44 GMT

Hi Laurence!

A poster (certificate holder I believe) on eVets recently stated that oral albumin supplementation did not help plasma [albumin] - although one would have thought that if this was the case then reducing the dietary protein content wouldn't do much to reduce it either.

I also think remember reading somewhere that benezapril could be used to reduce proteinuria in dogs - might be worthwhile giving Novartis a ring.

Re: protein losing nephropathy

nikki — Sat, 27 Feb 2010 21:49:07 GMT

dog has never travelled abroad. no clinical signs other than PUPD.

Re: protein losing nephropathy

jose targa — Sat, 27 Feb 2010 21:46:55 GMT

Hi.

Only one thing...

Does the dog travel to any country with Leishmania infantum (Spain, France, Italy...)????? We have lots of cases of this dissease every month and all end with glomerulonephritis if the treatment is not at time.

In that cases we use high corticosteroid for get down the inmune response (the real cause of the problem) and of course the treatment for Leishmania.

[quote user="Laurence Webb"]

Yes, I'd be a bit wary of a water deprivation test, especially as you should only consider it in an animal where renal pathology has been ruled out. DI should not be associated with a raised UPC and certainly not as high as you've seen.

[/quote]

Re: protein losing nephropathy

Laurence Webb — Fri, 05 Feb 2010 22:30:15 GMT

Re: protein losing nephropathy

nikki — Fri, 05 Feb 2010 21:56:51 GMT

all lab tests were done at Axiom labs.

he is truly polydipsic - o's have measured. bit scared of water deprivation tests. he's on Royal Canin renal diet so I know it's not his diet causing the prob now. have sent another urine sample for UPC ratio again today - now 4wks since started tx so will be interesting to see results.

Re: protein losing nephropathy

Emily Nightingale — Fri, 05 Feb 2010 14:43:46 GMT

Hi.. just skimmed through the case.

Have you ruled out diabetes insipidus? Would measuring 24hour water intake be useful to see if is truly polydipsic? (100ml/kg/24hours is polydipsia threshold).

I had similar case where clients ran a food mill, and they could analyse the sodium content of the dog food pellets they were using. It turned out to be over double the amount on the packet and once off the food the dog was fine. (and the clients much poorer as went down same road as you... ACTH etc. ) Water deprivation tests is one method to investigate the D.I.

Also am interested to know how you have measured fibrinogen levels? Is that in house?

Best of luck with the case.

Re: protein losing nephropathy

nikki — Thu, 04 Feb 2010 21:09:34 GMT

no change in urea/creat so far. urea remains around 5, creat around 70.

Re: protein losing nephropathy

listhestar — Thu, 04 Feb 2010 12:58:58 GMT

[quote user="Laurence Webb"]

Only once less than 33% remain.

[/quote]

Thank you- migraine brain scrambled things up!

lisa

Re: protein losing nephropathy

Laurence Webb — Wed, 03 Feb 2010 23:29:07 GMT

[quote user="listhestar"]

[quote user="nikki"]would the urea/creat start to rise [/quote]

They would evetually but only after is it 33% have been damaged (someone correct me if numbers are wrong)?

lisa

[/quote]

Only once less than 33% remain.

A rising trend (but still within normal limits may be detected. The IRIS guidelines for interpreting creat and phos in light of isothenuria may be useful to look at, though they're aimed at animals with CRF rather than active glomerulonephritis or neoplasia

Re: protein losing nephropathy

listhestar — Wed, 03 Feb 2010 22:23:27 GMT

[quote user="nikki"]would the urea/creat start to rise [/quote]

They would evetually but only after is it 33% have been damaged (someone correct me if numbers are wrong)?

lisa

Re: protein losing nephropathy

nikki — Wed, 03 Feb 2010 22:18:11 GMT

globulins were normal. did look into Lepto testing but worked out about £150 to check for all the different types and we elected to leave it for the time being.

Could be hypertensive, but our doppler is broken and our anaesthetic machine gives such varied readings I cant rely on it. I tried and got systolic readings of between 140 and 200! The cuff has been replaced, the machine checked and yet still it gives dodgy readings and I cant persuade the boss to get a new Doppler. I hadn't thought of phaeochromocytoma.

urine sediment is inactive on repeated samples.

falling UPC due to running out of functioning nephrons sounds worrying! I was encouraged by the cholesterol falling along with the UPC, but the USG very much concerns me. would the urea/creat start to rise if we run out of nephrons? they have remained well within normal limts so far.

Re: protein losing nephropathy

Stephen Ashman — Wed, 03 Feb 2010 22:17:24 GMT

London vet school run a nutrition service, they may be helpful?

Re: protein losing nephropathy

listhestar — Wed, 03 Feb 2010 22:13:53 GMT

[quote user="Laurence Webb"]Is it hypertensive[/quote]

Damn it- always forget something when replying :)

lisa

Re: protein losing nephropathy

Laurence Webb — Wed, 03 Feb 2010 22:08:35 GMT

You could check it for lepto and do a SPE incase it's got multiple myeloma, but you've not mentioned globulins being high.

Is it hypertensive? Might be something obscure like a phaeochromocytoma which would be exciting.

To further the investigation into renal problems you're going to biopsy ideally. You could consider intravenous urography to check clearence through each kidney although there is a risk of causing further renal damage. Mind you renal biopsy isn't exactly risk free either though. If nothing else an IVU may tell you if it's 1 or both kidneys or if there are any lower urinary tract lesions not evident on ultrasound. You've not mentioned what urine sediment was like - - it could still be post-renal

If you the owners don't go for further investigation and the UPC is falling you could just monitor how it goes, although you should warn the owners that a falling UPC may be due to either improvement in the condition or because it's rapidly running out of functioning nephrons to leak protein (which would tie in with the falling USG). The first makes you look like a God, the seconds doesn't!

A low protein diet would be preferable for management to chappie etc as high UPC is associated with a shorter survivial time so I'd try Hills, Royal Canine, Purina or anything else you can find. If they want to use 'normal' food then I'd monitor its phosphorus and add in a phos binder if required. I'd avoid red meat as the phos intake will be higher. There's also Rubenal to consider which may reduce renal fibrosis. Monitor its albumin too in case if goes hypoalbuminaemic - if can be given cooked agg white if required.

I've run out of ideas now.

Re: protein losing nephropathy

nikki — Wed, 03 Feb 2010 22:07:47 GMT

thanks. o is very understanding thankfully - just wanted to make sure I wasn't missing anything obvious.

Re: protein losing nephropathy

listhestar — Wed, 03 Feb 2010 22:01:04 GMT

[quote user="nikki"]

what i read suggested steroids contra-indicated in glomerulonephritis in dogs so have steered clear at present.

[/quote]

Always changing I guess :)

[quote user="nikki"]neoplasia was def high on my list hence the abdo scan[/quote]

You may not ever see the tumour if diffuse and sutble.

I guess warn them may never get a true answer without a biopsy and even then it could be missed.

Lisa

Re: protein losing nephropathy

nikki — Wed, 03 Feb 2010 21:54:20 GMT

what i read suggested steroids contra-indicated in glomerulonephritis in dogs so have steered clear at present.

haematology fine - no anaemia. haven't checked clotting - could certainly do that. neoplasia was def high on my list hence the abdo scan, multiple rads but nothing seen. could repeat kidney scan though. dog is very good and owner is luckily extremely understanding about the multitude of tests i have had to run! am currently verging on the £2000 mark though and no answer yet!

Re: protein losing nephropathy

listhestar — Wed, 03 Feb 2010 21:47:20 GMT

Hey

Only thing I can think of is identifying what protein is in urine- I know likely albumin but worth checking not Benz Jones proteins as well?

There is in Nelson and Couto internal medicine textbook a self made renal diet- I do believe some of the ingredients are hard to come by but may be worth looking at?

Like you say without a biopsy it's going to be harder to Id the cause but in an 11 year old some worry of a tumour would worry me eg renal lymphoma. May be worth re ultrasounding later in case the leaky kidneys proceed any structural abnormalities.

Other thought is checking clotting function in case antithrombin low, haematology ok- no anaemia?

Other thought is steroids (if aspirin stopped) as some benefit I thought in nephrotic syndrome (used in humans I know).

Good luck

Lisa