Proteinuria in the elderly: evaluation and management

Verma, Vipin; Kant, Ravi; Sunnoqrot, Naseem; Gambert, Steven

doi:10.1007/s11255-012-0252-7

Cited by 21 publications

(23 citation statements)

References 17 publications

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“…28,76 Proteinuria affects up to 25% of elderly people and is not considered a physiologic age-related change, but the consequence of an underlying pathology. 78,79 In 18.6% of these dogs, renal proteinuria was detected (7 overt, 11 borderline). 33 The reader is referred to Marynissen et al for more information regarding proteinuria in this population.…”

Section: Discussionmentioning

confidence: 97%

Results of Screening of Apparently Healthy Senior and Geriatric Dogs

Willems

Paepe

Marynissen

et al. 2016

Veterinary Internal Medicne

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BackgroundThere is a growing interest in health care of elderly dogs; however, scientific information about physical and laboratory examination findings in this age group is limited.ObjectivesTo describe systolic blood pressure (SBP), and results of physical examination and laboratory tests in senior and geriatric dogs that were judged by the owner to be healthy.AnimalsHundred client‐owned dogs.MethodsDogs were prospectively recruited. Owners completed a questionnaire. SBP measurement, physical, orthopedic and neurologic examination, direct fundoscopy and Schirmer tear test were performed. Complete blood count, serum biochemistry, and urinalysis were evaluated.ResultsForty‐one senior and 59 geriatric dogs were included. Mean SBP was 170 ± 38 mmHg, and 53 dogs had SBP > 160 mmHg. Thirty‐nine animals were overweight. A heart murmur was detected in 22, severe calculus in 21 and 1 or more (sub)cutaneous masses in 56 dogs. Thirty‐two dogs had increased serum creatinine, 29 hypophosphatemia, 27 increased ALP, 25 increased ALT, and 23 leukopenia. Crystalluria, mostly amorphous crystals, was commonly detected (62/96). Overt proteinuria and borderline proteinuria were detected in 13 and 18 of 97 dogs, respectively. Four dogs had a positive urine bacterial culture. Frequency of orthopedic problems, frequency of (sub)cutaneous masses, and platelet count were significantly higher in geriatric compared with senior dogs. Body temperature, hematocrit, serum albumin, and serum total thyroxine concentration were significantly lower in geriatric compared with senior dogs.Conclusions and Clinical ImportancePhysical and laboratory abnormalities are common in apparently healthy elderly dogs. Veterinarians play a key role in implementing health screening and improving health care for elderly pets.

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Section: Discussionmentioning

confidence: 97%

Results of Screening of Apparently Healthy Senior and Geriatric Dogs

Willems

Paepe

Marynissen

et al. 2016

Veterinary Internal Medicne

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“…Second, no further diagnostics (thoracic radiographs, abdominal ultrasonography, serology for vector borne diseases, renal biopsies) were performed in dogs with persistent overt renal proteinuria. This did not allow to exclude underlying pathologies, often described in human medicine . Third, no follow‐up of blood pressure measurement was performed.…”

Section: Discussionmentioning

confidence: 99%

“…Proteinuria, that affects up to 25% of elderly humans, is often associated with an underlying disease such as systemic hypertension, chronic kidney disease (CKD), diabetes mellitus, amyloidosis, or multiple myeloma. Proteinuria is not considered a physiologic age‐related change in human medicine . Twenty‐five percent of middle‐aged to old, apparently healthy cats have borderline proteinuria .…”

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confidence: 99%

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Proteinuria in Apparently Healthy Elderly Dogs: Persistency and Comparison Between Free Catch and Cystocentesis Urine

Marynissen

Willems

Paepe

et al. 2016

Veterinary Internal Medicne

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BackgroundUp to 25% of elderly humans have proteinuria, often associated with underlying lesions. Data concerning the presence of proteinuria in elderly dogs is scarce.ObjectivesTo describe the presence and persistence of proteinuria and to compare urinary protein : creatinine ratio (UPC) between free catch and cystocentesis urine samples in apparently healthy elderly dogs.AnimalsHundred apparently healthy elderly dogs.MethodsProspective study. Owners of 100 elderly dogs were asked to collect 2 free catch urine samples. Dogs were considered healthy based on owner's perception and an age chart, based on ideal bodyweight, was used to define dogs as senior or geriatric. UPC of urine collected by free catch and cystocentesis were compared. Overt proteinuria and borderline proteinuria were defined as UPC >0.5 and between 0.2 and 0.5, respectively, if examination of sediment did not explain proteinuria. Proteinuria was considered persistent if present at both sampling times.ResultsAt baseline, 71 owners succeeded in collecting urine. Eleven percent of dogs had overt proteinuria, 14% were borderline proteinuric, and 75% nonproteinuric. Thirty‐seven repeated urine samples, with a median time interval of 31 days (range 10–90), were available. Nineteen percent of dogs had a persistently increased UPC (>0.2), with persistent overt proteinuria present in 8%. A strong correlation (ρ = 0.88) was found between UPC of urine collected by free catch and cystocentesis.Conclusions and Clinical ImportanceAs 19% of study dogs had persistent proteinuria, our findings emphasize that measurement of proteinuria should be part of geriatric health screening. For UPC in dogs, free catch urine provides a good alternative to cystocentesis.

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“…13–15 Although thought to be part of the “normal” aging process, the resultant reduction in GFR that occurs with aging is a true loss of GFR and physiologically indistinguishable to that produced by pathologic reductions in GFR. 9,16 As a result, if the adverse outcomes associated with RD stem from the reduction in GFR, it should be irrelevant whether the low GFR is the result of a “benign” cause such as the aging process or a pathologic process such as HF-induced RD. However, if RD is primarily acting as an indicator of otherwise unmeasured disease severity, the risk for mortality attributable to RD should be much greater in patients that have a reduction in GFR primarily as a result of a pathologic cause.…”

Section: Introductionmentioning

confidence: 99%

Influence of Age-Related Versus Non–Age-Related Renal Dysfunction on Survival in Patients With Left Ventricular Dysfunction

Testani

Brisco

Han

et al. 2014

The American Journal of Cardiology

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Normal aging results in a predictable decline in glomerular filtration rate (GFR) and low GFR is associated with worsened survival. If this survival disadvantage is directly caused by the low GFR, as opposed to the disease causing the low GFR, the risk should be similar regardless of the underlying mechanism. Our objective was to determine if age related declines in estimated GFR (eGFR) carry the same prognostic importance as disease attributable losses in patients with ventricular dysfunction. We analyzed the Studies Of Left Ventricular Dysfunction (SOLVD) limited data set (n=6337). The primary analysis focused on determining if the eGFR mortality relationship differed by the extent the eGFR was consistent with normal ageing. Mean eGFR was 65.7 ± 19.0ml/min/1.73m2. Across the range of age in the population (27 to 80 years), baseline eGFR decreased by 0.67 ml/min/1.73m2 per year (95% CI 0.63 to 0.71). The risk of death associated with eGFR was strongly modified by the degree to which the low eGFR could be explained by aging (p interaction <0.0001). For example, in a model incorporating the interaction, uncorrected eGFR was no longer significantly related to mortality (adjusted HR=1.0 per 10 ml/min/1.73m2, 95% CI 0.97–1.1, p=0.53) whereas a disease attributable decrease in eGFR above the median carried significant risk (adjusted HR=2.8, 95% CI 1.6–4.7, p<0.001). In conclusion, in the setting of LV dysfunction, renal dysfunction attributable to normal aging had a limited risk for mortality, suggesting that the mechanism underlying renal dysfunction is critical in determining prognosis.

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Proteinuria in the elderly: evaluation and management

Cited by 21 publications

References 17 publications

Results of Screening of Apparently Healthy Senior and Geriatric Dogs

Results of Screening of Apparently Healthy Senior and Geriatric Dogs

Proteinuria in Apparently Healthy Elderly Dogs: Persistency and Comparison Between Free Catch and Cystocentesis Urine

Influence of Age-Related Versus Non–Age-Related Renal Dysfunction on Survival in Patients With Left Ventricular Dysfunction

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