Canine proteinuria is not only a marker of kidney disease, but also an important prognostic factor. Progression of kidney disease is faster in dogs showing high levels of proteinuria than in dogs who have little amount of proteins in urines or in patients who have a good response to treatment of proteinuria. With the same creatinine levels, dogs with UP/C greater than 1 have a risk of uremic crises three times higher than dogs with UP/C less than 1 within a year from diagnosis of CKD.
In December 2015, the International Renal Interest Society (www.iris-kidney.com) amended the recommendations for the treatment of proteinuria previously published in 2006, suggesting to treat all dogs with UP/C higher than 0.5, regardless of the value of blood creatinine.
Treatment of proteinuria involves:
1. CONCOMITANT DISEASES - if the dog is affected from diseases that can cause proteinuria, they should be treated before the therapy for proteinuria is started. For example, the patient may be suffering from leishmaniasis and if the patient is classified as sick according to the staging of the Canine Leishmaniasis Working Group (www.gruppoleishmania.org), it will be re-evaluated between 2 and 4 weeks after the leishmanicidal therapy. It’s been demonstrated that many patients reduce proteinuria after they have treated the underlying pathology and a high percentage of dogs will have no need to treat proteinuria. If the PATIENT REMAINS PROTEINURIIC after treating the underlying disease, therapy based on renal diet and Omega-3 fatty acids will be set.
2. RENAL DIET and OMEGA3s – It’s certainly valuable the administration of a renal diet in combination with Omega-3 fatty acids and some dogs show a reduction in proteinuria with this treatment, without drugs. EPA are the Omega3 fatty acids useful in case of canine chronic kidney disease, to be administered as a supplement to the renal diet. The dosage of about 80 mg / kg daily of EPA, should be added to the amount of Omega3s administered with the renal diet thus allowing to reach a total quantity of about 0.8-1 g / day every 4.5 kg of patient weight. EPA are most effective if they are administered together with antioxidants such as mixed tocopherols content in some products based on fish oil. Administration of ALA (cheaper than EPA) is not effective, as in dogs their conversion to EPA is extremely reduced. If after a month with renal diet and EPA the dog remains proteinuric (UP/C > 0.5), ACE inhibitors and/or sartans will then be recommended.
3. ACE-inhibitor (enalapril) - SARTANS. ACE inhibitors and sartans are useful in the management of proteinuric disease. The effectiveness of DRUG THERAPY should be evaluated by UP/C after 30 days of therapy.
The therapy of proteinuria is considered EFFECTIVE when
1. The proteinuric patient reduces UP/C below 0.5
2. If, at follow-up, UP/C is at least the half compared to baseline.
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