Evaluation of the relationship between clinical variables and thromboelastographic findings in dogs with protein‐losing nephropathy

Background Proteinuria is a risk factor for progressive kidney injury in dogs. Enhanced understanding of potential associations between canine vector‐borne diseases (CVBD) and proteinuria is needed. Objectives To determine the proportion of evaluated proteinuric dogs exposed to ≥1 CVBD, including Babesia spp., Ehrlichia spp., spotted‐fever group Rickettsia, Bartonella spp., Anaplasma spp., hemotropic Mycoplasma spp., Borrelia burgdorferi, and Dirofilaria immitis, and to determine if demographic or clinicopathologic differences exist between proteinuric dogs exposed to CVBD versus proteinuric dogs with no evidence of CVBD exposure. Animals Two‐hundred nine proteinuric dogs, concurrently tested for CVBD, which were examined at a single academic veterinary hospital between January 2008 and December 2015. Methods Retrospective cross‐sectional study. Demographic, clinicopathologic, and CVBD test results were extracted from medical records. A multivariable logistic regression model was used to assess associations between CVBD and selected variables. Results Based on serology and polymerase chain reaction testing, 34% of proteinuric dogs (72/209) were exposed to ≥1 CVBD. Exposure to Rickettsia spp. (19%), Ehrlichia spp. (12%), and B. burgdorferi (9%) were most common. The CVBD exposure was lower in dogs tested in autumn or spring, higher in intact dogs, and higher in dogs with lower serum albumin and higher serum creatinine concentrations. Conclusions and Clinical Importance Exposure to CVBD, particularly exposure to Rickettsia spp., Ehrlichia spp., and B. burgdorferi was found in proteinuric dogs from the southeast United States. Additional controlled prospective studies examining a potential causal relationship between CVBD and proteinuria are warranted.

Section: Discussionmentioning

confidence: 99%

“…Proteinuria is an important clinical finding and is not only a marker of nephropathy but also a prognostic factor for progression of chronic kidney disease . Proteinuria is related to decreased survival in azotemic and non‐azotemic dogs, and decreasing proteinuria improves survival .…”

Section: Introductionmentioning

confidence: 99%

A retrospective study of vector‐borne disease prevalence in dogs with proteinuria: Southeastern United States

Purswell

Lashnits

Breitschwerdt

et al. 2020

“…Thromboemboli were found in up to 38% of dogs with renal amyloidosis with both arterial and venous locations with pulmonary arterial thrombi being the most common . The incidence of thromboembolic complications in people with nephrotic syndrome has been reported as high as 44% and a recent thromboelastography (TEG) study in dogs with PLN found 89% of dogs were hypercoagulable by TEG analysis . Dogs with nephrotic syndrome are thought to be hypercoagulable due to urinary loss of antithrombin, hyperfibrinogenemia as a result of ongoing inflammation, and platelet hyperaggregability secondary to hypoalbuminemia .…”

Section: Discussionmentioning

confidence: 99%

“…Hypovolemia leading to vascular stasis may also be a predisposing factor to thromboembolism in some PLN patients . In most dogs with PLN, the UPC ratio, serum albumin concentration, and plasma antithrombin activity are not predictive of thromboembolic complications and do not predict TEG‐based hypercoagulability . The lack of ability to identify one marker that predicts hypercoagulablity in dogs with PLN suggests the predisposition is multifactorial.…”

Section: Discussionmentioning

confidence: 99%

Concurrent renal amyloidosis and thymoma resulting in a fatal ventricular thrombus in a dog

Loewen

Cianciolo

Zhang

et al. 2018

Thymoma‐associated nephropathies have been reported in people but not in dogs. In this report, we describe a dog with thymoma and concurrent renal amyloidosis. A 7‐year‐old castrated male Weimaraner was presented for progressive anorexia, lethargy, and tachypnea. The dog was diagnosed with azotemia, marked proteinuria, and a thymoma that was surgically removed. Postoperatively, the dog developed a large left ventricular thrombus and was euthanized. Necropsy confirmed the presence of a left ventricular thrombus and histopathology revealed renal amyloidosis. We speculate that the renal amyloidosis occurred secondary to the thymoma, with amyloidosis in turn leading to nephrotic syndrome, hypercoagulability, and ventricular thrombosis. This case illustrates the potential for thymoma‐associated nephropathies to occur in dogs and that dogs suspected to have thymoma should have a urinalysis and urine protein creatinine ratio performed as part of the pre‐surgical database.

“…Protein‐losing nephropathy (PLN) in dogs is associated with a hypercoagulable state and thromboembolic risk . The true prevalence of thromboembolic complications in PLN dogs is difficult to ascertain but has been reported to be more than 40% in previous studies .…”

Section: Introductionmentioning

confidence: 99%

Platelet aggregometry testing during aspirin or clopidogrel treatment and measurement of clopidogrel metabolite concentrations in dogs with protein‐losing nephropathy

Shropshire

Johnson

Olver

2020

Background Dogs with protein‐losing nephropathy (PLN) are treated with antiplatelet drugs for thromboprophylaxis but no standardized method exists to measure drug response. It is also unknown if clopidogrel metabolite concentrations [CM] differ between healthy and PLN dogs. Objectives Assess response to aspirin or clopidogrel in PLN dogs using platelet aggregometry (PA) and compare [CM] between healthy and PLN dogs. Animals Six healthy and 14 PLN dogs. Methods Platelet aggregometry using adenosine diphosphate (ADP), arachidonic acid (AA), and saline was performed in healthy dogs at baseline and 1‐week postclopidogrel administration to identify responders or nonresponders. A decrease of ≥60% for ADP or ≥30% for AA at 1 or 3 hours postpill was used to define a responder. At 1 and 3 hours postclopidogrel, [CM] and PA were measured in healthy and PLN dogs. Platelet aggregometry was performed in PLN dogs at baseline, 1, 6, and 12 weeks after clopidogrel or aspirin administration. Results In PLN dogs receiving clopidogrel, PA differed from baseline at all time points for ADP but not for AA at any time point. Most dogs responded at 1 or both time points except for 1 dog that showed no response. For PLN dogs receiving aspirin, no differences from baseline were observed at any time point for either ADP or AA. No differences in [CM] were found at either time point between healthy and PLN dogs. Conclusions and Clinical Importance Platelet aggregometry may represent an objective method to evaluate response to clopidogrel or aspirin treatment and PLN dogs appear to metabolize clopidogrel similarly to healthy dogs.