Protein-losing enteropathy and protein-losing nephropathy in a mixed breed dog

Abstract

Case History: Sassie, a 3 year old female spayed mixed breed dog, was presented to the Cornell University Hospital for Animals for a 3 week history of abdominal distention, vomiting, and lethargy. Clinical Findings: The dog presented with a body condition score of 2/9 and ascites. Diagnostic Findings: Urine analysis disclosed proteinuria and a urine protein: creatinine ratio (UP/C) of 13.5. Ultrasonography confirmed pleural effusion and ascites and ruled down a portosystemic shunt and gastro-intestinal perforation. Analysis of Sassie’s blood by the referring veterinarian disclosed hypoalbuminemia, increased blood urea nitrogen (BUN), and increased serum bile acids. When additional blood tests were performed at Cornell, a disseminated intravascular coagulation (DIC) panel established a mild coagulopathy; folate, cobalamine, and trypsin-like immunoreactivity (TLI) levels ruled down endocrine pancreatic insufficiency and pancreatitis; protein C assay ruled down portosystemic shunt; and baseline cortisol and ACTH stimulation tests ruled down Addison's Disease. Exploratory laparotomy and surgical biopsy disclosed lymphocytic-plasmacytic enteritis in the gastro-intestinal tract and membranoproliferative glomerulonephritis in the kidney. Problem list: Sassie's major problems were proteinuria, hypoalbuminemia, diarrhea, vomiting, and hypoglycemia. Treatment: Sassie was treated with corticosteroids, anti-thrombotics, antimicrobials, dietary modification, parasiticides, glucose supplement, appetite stimulant, diuretics, and an immuno-suppressant (Mycophenolate).