Abstract
BackgroundRenal disease is considered the main cause of natural mortality in dogs with canine leishmaniosis. The pathological mechanisms associated with kidney injury in canine leishmaniosis include immune complex glomerulonephritis, tubulointerstitial nephritis and occasionally renal amyloidosis. Proteinuria is a frequent finding in canine leishmaniosis and its quantification by the urine protein-creatinine ratio (UPC) is an important parameter in the staging of canine lesihmaniosis as presented by the LeishVet group.ResultsA 4.5 year-old spayed female Belgian Malinois dog was presented to the Hebrew University Veterinary Teaching hospital with epistaxis and rhinitis and diagnosed also with proteinuria and acute kidney injury (AKI IRIS grade V) associated with canine leishmaniosis that developed to LeishVet stage III with chronic kidney disease (CKD) after stabilization. Clinicopathologic abnormalities included azotemia with a peak creatinine concentration of 7.76 mg/dl (reference interval, 0.3–1.2 ng/dl), hypoalbuminemia (1.76 g/dl, reference interval 3-4.4 g/dl), hyperglobulinemia (4.54 g/dl, reference interval 1.8–3.9 g/dl) and proteinuria (urine protein/creatinine ratio 15.6, normal < 0.2). Serology by the enzyme-linked immunosorbent assay (ELISA) for Leishmania infantum was positive with high antibody levels. The dog was hospitalized and treated with intermittent hemodialysis, feeding through an esophageal feeding tube, medical treatment for protein losing nephropathy and antileishmanial treatment with allopurinol. Kidney function gradually improved and the dog’s creatinine levels and proteinuria decreased until complete normalization two years after the acute insult. However, rhinitis and sneezing persisted and although the anti-leishmanial antibodies decreased over time, the dog remains constantly seropositive.ConclusionsTo our knowledge, this is the first report of hemodialysis management of AKI associated with canine leishmaniosis. Hemodialysis was imperative in stabilizing the dog’s renal disease and controlling its azotemia. It demostrates that hemodialysis can be beneficial in the management of acute deterioration of kidney disease in canine leishmaniosis.
Highlights
Renal disease is considered the main cause of natural mortality in dogs with canine leishmaniosis
Two years after hemodialysis, when writing this report, the dog is still being monitored and treated medically for chronic kidney disease (CKD) and is currently at International Renal Interst Society (IRIS) CKD Stage I, non-proteinuruic, non-hypertensive [11]. It remains seropositive for L. infantum antigen by enzyme-linked immunosorbent assay (ELISA), with a lower antibody level compared to its initial testing (0.73 optical density (OD) 21 months after allopurinol treatment initiation), despite continuous treatment with allopurinol and a course of miltefosine (Virbac, Carros, France) at 2 mg/kg q 24 h Per os (PO) for 28 days, administered five months after discharge from hospital when the ELISA serology result was 1.32 OD
This study describes the treatment and management of a dog with canine leishmaniosis associated with kidney disease
Summary
Renal disease is considered the main cause of natural mortality in dogs with canine leishmaniosis. Renal injury is common in canine leishmaniosis and ranges from sub-clinical to severe and fatal end-stage kidney disease. Dermal manifestations and lymphadenomegally are the most common manifestations of canine leishmaniosis, renal disease is considered the main cause of mortality in dogs with this disease and it occasionally presents without typical skin abnormalities [1, 2]. Acute kidney injury (AKI) leading to severe uremia, regardless of its underlying cause, is associated with high morbidity and mortality [7,8,9]. Hemodialysis, initially developed for management of human kidney disease, is an advanced extracorporeal renal replacement therapy for uremic and overhydrated patients that has been adapted to canine and feline medicine. Hemodialysis requires specialized equipment and expertise during and in-between treatments and is currently carried out mainly in major veterinary referral centers by specially trained staff
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