Comparison of Signalment, Clinicopathologic Findings, Histologic Diagnosis, and Prognosis in Dogs with Glomerular Disease with or without Nephrotic Syndrome

Abstract

Background: Nephrotic syndrome (NS) develops most commonly in people with glomerular diseases associated with marked albuminuria. Hypernatremia, hypertension, and progressive renal failure are more prevalent in nephrotic than nonnephrotic human patients.Hypothesis/Objectives: Dogs with NS have higher serum cholesterol, triglyceride, and sodium concentrations, higher urine protein:creatinine ratios (UPC) and systolic blood pressure, and lower serum albumin concentrations than dogs with nonnephrotic glomerular disease (NNGD). NS is associated with membranous glomerulopathy and amyloidosis. Affected dogs are more likely to be azotemic and have shorter survival times.Animals: Two hundred and thirty-four pet dogs (78 NS dogs, 156 NNGD dogs).Methods: Multicenter retrospective case-control study comparing time-matched NS and NNGD dogs. NS was defined as the concurrent presence of hypoalbuminemia, hypercholesterolemia, proteinuria, and extravascular fluid accumulation. Signalment, clinicopathologic variables, histopathologic diagnoses, and survival time were compared between groups.Results: Age, serum albumin, chloride, calcium, phosphate, creatinine, and cholesterol concentrations, and UPC differed significantly between NS and NNGD dogs. Both groups were equally likely to be azotemic at time of diagnosis, and NS was not associated with histologic diagnosis. Median survival was significantly shorter for NS (12.5 days) versus NNGD dogs (104.5 days). When subgrouped based on serum creatinine (o or !1.5 mg/dL), survival of NS versus NNGD dogs was only significantly different in nonazotemic dogs (51 versus 605 days, respectively).Conclusions and Clinical Importance: Presence of NS is associated with poorer prognosis in dogs with nonazotemic glomerular disease. Preventing development of NS is warranted; however, specific interventions were not evaluated in this study.

Proteinuria and lipoprotein lipase activity in Miniature Schnauzer dogs with and without hypertriglyceridemia

“…This cascade does not occur until proteinuria is moderate to severe; mild proteinuria does not cause increased triglyceride concentrations. There are minimal data available on HTG in dogs with glomerular disease, but disease appears to be mild, with median triglyceride concentrations of 79 mg/dL in nephrotic syndrome and 85 mg/dL in non-nephrotic glomerular disease (Klosterman et al, 2011). Alterations in relative proportions of lipoproteins are reported in dogs with chronic kidney disease (Behling-Kelly, 2014), but it is unknown whether they result in HTG.…”

Relationship between apolipoprotein E gene polymorphism with triglyceride level in patients with renal diseases

“…High serum TG level is an important characteristic for many renal diseases, such as NS, 35 glomerulonephritis, 36 chronic kidney disease with dialysis, 37 and so on. The increased level of TG might be an important risk factor for the onset susceptibility of renal diseases.…”

Consensus Guidelines for Immunosuppressive Treatment of Dogs with Glomerular Disease Absent a Pathologic Diagnosis

“…Although indirect evidence suggests that reactive amyloidosis in dogs is associated with a dysregulated immune response, immunosuppressive therapy in people and dogs is either of no benefit or may contribute to more rapid progression of disease . Although glomerular amyloidosis in dogs can be associated with very high UPC values, there is too much overlap in UPC values between dogs with amyloidosis and dogs with other glomerulopathies to reliably use the UPC value to predict histopathologic diagnosis . Renal amyloidosis may be more likely in dog with glomerular disease when (1) the affected dog is of a breed known to be predisposed to amyloidosis (eg, Shar Pei); (2) additional clinical signs associated with hereditary amyloidosis in Shar Peis are present, including cyclical fever or distal joint effusion; or (3) amyloid deposition has been confirmed in other organs, particularly the liver …”

“…Reported survival times for dogs with azotemia, nephrotic syndrome, or both as a result of glomerular disease are short, with a median of <60 days . However, survival of nonazotemic dogs without nephrotic syndrome can be substantially longer, with a reported median of 605 days .…”