Abstract
Proteinuria is a negative prognostic indicator for dogs and cats with chronic kidney disease. A normal dog or cat should excrete very little protein and have a urine protein:creatinine ratio that is less than 0.4 or less than 0.2, respectively; persistent proteinuria above this magnitude warrants attention. Administration of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers, blood pressure control and nutritional modification are considered a standard of care for renal proteinuria. Renal biopsy and administration of immunosuppressive agents should be considered in animals with glomerular proteinuria that have not responded to standard therapy. Targeted patient monitoring is essential when instituting management of proteinuria.
Highlights
In dogs and cats proteinuria is a negative prognostic for chronic kidney disease and is associated with degree of functional impairment as well as the risk of a uremic crisis, progressive worsening of azotemia or death
Telmisartan attenuated angiotensin I-induced blood pressure response to a greater degree than did benazepril in normal cats (Jenkins et al, 2015). If this is true in dogs and cats, telmisartan might be the initial renin-angiotensin-aldosterone system (RAAS) inhibitor of choice when proteinuria and systemic hypertension are both present
One to 2 weeks after an angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) is added or changed, the urine protein: creatinine ratio (UPC), serum creatinine, serum potassium and systemic blood pressure should be evaluated to verify that the recent change in therapy has not resulted in a severe worsening of renal function (i.e., >30% increase in serum creatinine), a concerning increase in serum potassium concentrations, or hypotension
Summary
DISCLOSURE STATEMENT Vaden: I have acted as a paid consultant for Heska Corporation and Idexx LTD. Elliot: I have acted as a paid consultant for Bayer Animal Health, Boehringer Ingelheim, Elanco Animal Health, Idexx Ltd, CEVA Animal Health, Orion Inc, Nextvet Ltd., Waltham Centre for Pet Nutrition. KEY WORDS Urine protein: creatinine ratio, proteinuria, hypertension, angiotensin, aldosterone, glomerular, chronic kidney disease
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