Hypertension and its correlation with renal lesions in dogs with leishmaniosis

Abstract

To evaluate the prevalence of hypertension and its correlation with the severity of renal injury and proteinuria in dogs with leishmaniosis, sixty-six dogs were divided into two groups. Group 1 (G1) was composed of 54 dogs included in stage 1 of chronic kidney disease (CKD), and group 2 (G2) of twelve dogs in stages 2 and 3 of CKD. Prevalence of hypertension was 28.8%, comprising 22.2% of the dogs from G1 and 58.3% from G2 (P=0.011). The mean arterial blood pressure (BP) of dogs from G1 (135.7 ± 20.5) was lower than from G2 (170.0 ± 26.3) (P <0.001). Urine proteincreatinine ratio (UP/C) revealed values above 0.5 in 75.7% of the dogs, with 34% presenting hypertension. All dogs with hypertension had histopathological and laboratory evidence of glomerular disease. Although there was no statistically significant correlation between elevated BP and the severity of glomerular lesions (P=0.408), there was a statistically significant correlation between elevated BP and increased UP/C in the studied population (P=0.002). Thus, dogs with leishmaniosis and renal disease must be screened for the presence of hypertension so that treatment may be instituted as early as possible, in countries where treatment is allowed, to prevent the progression of renal damage.Keywords: Histopathology, kidney, Leishmania infantum chagasi, systolic blood pressure. ResumoPara avaliar a prevalência de hipertensão arterial e sua correlação com a severidade da lesão renal e proteinúria em cães com leishmaniose, 66 cães foram divididos em dois grupos. O grupo 1 (G1), composto por 54 cães em estágio 1 de doença renal crônica (DRC), e o grupo 2 (G2) por 12 cães em estágios 2 e 3 de DRC. A prevalência de hipertensão foi de 28,8%, compreendendo 22,2% dos cães de G1 e 58,3% dos cães de G2 (p = 0,011). A pressão arterial média (PA) de G1 (135,7 ± 20,5) foi inferior a de G2 (170,0 ± 26,3) (P <0,001). A relação proteína creatinina urinária (P/C U) foi maior que 0,5 em 75,7% dos cães, dos quais 34% possuíam hipertensão. Todos os cães com hipertensão apresentavam doença glomerular. Embora não tenha sido observada correlação estatisticamente significativa entre elevação da PA e severidade das lesões glomerulares (P =0,408), houve uma correlação significativa entre PA elevada e aumento da UP/C (P = 0,002). Portanto, cães com leishmaniose e doença renal devem ser pesquisados quanto à presença de hipertensão, para que o tratamento possa ser instituído o mais precocemente possível em países onde ele é permitido, para evitar a progressão da lesão renal.Palavras-chave: Histopatologia, rim, Leishmania infantum chagasi, pressão arterial sistólica.

Laboratory tests for diagnosing and monitoring canine leishmaniasis

“…The resulting chronic kidney disease (CKD) is characterized by glomerulosclerosis, renal hypertension, and tubulointerstitial nephritis . Advanced stages of CKD are characterized by azotemia and may be associated with systemic hypertension, both factors contributing to comorbidity in dogs with leishmaniasis . Therefore, the clinical and laboratory approach to leishmaniotic dogs with proteinuric nephropathy is the same as the one recommended by the International Renal Interest Society (IRIS) for any type of CKD.…”

“…61,62 Advanced stages of CKD are characterized by azotemia and may be associated with systemic hypertension, both factors contributing to comorbidity in dogs with leishmaniasis. 62,63 Therefore, the clinical and laboratory approach to leishmaniotic dogs with proteinuric nephropathy is the same as the one recommended by the International Renal Interest Society (IRIS) 64 for any type of CKD. This approach is based on a thorough clinical evaluation including the measurement of arterial pressure, and on the quantification of urinary proteins and of markers of renal function such as the urine specific gravity and the serum concentration of creatinine.…”

Blood pressure and renal injury in dogs with visceral leishmaniasis

“…Another study by Cortadellas et al (2008) investigating 26 dogs with visceral leishmaniasis and microalbuminuria, an early surrogate of glomerular lesion, documented 34.7% (9/26) of hypertension, which is also similar to our results, but contrasted with a very recent study, in which only 8.8% of Leishmania spp. infected dogs were diagnosed with systemic arterial hypertension, even though an UPC >0.5 were identified in 83.3% of them (Braga et al 2015).…”

“…Although the studies by Cortadellas et al (2006) and Cortadellas et al (2008) classified the animals as hypertensive only when documenting either a SAP ≥180mmHg or a SAP between 150 and 179mmHg with overt clinical manifestations attributable to systemic hypertension, and Braga et al (2015) considered a SAP cut-off of ≥160mmHg, the consensus statement on systemic hypertension in small animals defined such condition as a sustained increase in blood pressure, even though target organ lesions, including the reduction in glomerular filtration rate, ocular lesions, and hypertensive encephalopathy, are only likely to occur when a SAP >160 mmHg is identified (Brown et al 2007). Actually, some dogs recruited for this investigation were classified as hypertensive because the SAP was greater than the normal reference range proposed by two large systematic investigations (Bodey & Michell 1992, Mishina et al 1997, but the majority of these animals were undoubtedly at minimal to mild risk of target organ damage.…”

“…A recent study showed interstitial nephritis with a lymphoplasmacytic infiltrate in 70.6% (48/68) of the infected animals. However, membranoproliferative glomerulonephritis (39/68), glomerular fibrosis (30/68), membranous glomerulonephritis (22/68), and hyaline casts (39/68) were also identified (Braga et al 2015). In dogs with leishmaniasis, glomerulonephritis and tubulointerstitial nephritis are the most common renal pathologic findings, whereas amyloidosis is considered rare (Lopez et al 1996, Costa et al 2003, Zatelli et al 2003.…”