Page 1169 - Clinical Small Animal Internal Medicine

121 Glomerular Disease 1107

a therapeutic response. Dogs should be thoroughly eval- therapy should be discontinued following appropriate
VetBooks.ir uated 1–2 weeks after starting therapy and every two drug tapering.
weeks after for the first 4–6 weeks of treatment, then
every four weeks for the next three months and then
quarterly until disease resolution. Prognosis
A therapeutic response is viewed as a reduction in the
magnitude of proteinuria with improvement or stabiliza- The prognosis for dogs and cats with glomerular disease is
tion of renal function and increases in serum albumin variable and probably based on a combination of factors.
concentration. A reduction in proteinuria is as described The prognosis is expected to differ with the various dis-
earlier (see Inhibition of RAAS). Improvement or stabili- eases. Although progressive disease can be expected to
zation in renal function is defined as a sustained reduc- occur in a large percentage of animals with glomerular dis-
tion in serum creatinine to less than 1.4 mg/dL (complete ease, spontaneous remission and response to specific ther-
response) or by >25% of baseline (partial response). A apy can also be expected. Furthermore, disease progression
meaningful increase in serum albumin is defined as a can be slow enough for the animals to lead relatively nor-
sustained increase to >2.5 mg/dL (complete response) or mal lives, especially when the diagnosis is established early
either to 2.0–2.5 mg/dL or by >50% of baseline (partial in the disease process. In humans, azotemia, severe pro-
response). Secondary goals include improved blood teinuria, systemic hypertension, and marked tubulointer-
pressure regulation, resolution of edema, and stabiliza- stitial lesions at presentation are the most significant
tion of body weight. If there are no unacceptable adverse predictors of an unfavorable outcome in most forms of
drug effects, treatment should be continued for 8–12 glomerular disease. In dogs, the presence of nephrotic
weeks before changing the regimen or discontinuing syndrome or azotemia is a negative prognostic indicator.
treatment. Those demonstrating a partial or complete Median survival time for dogs with nephrotic syndrome
response should have therapy continued for at least was only 12.5 days versus 104.5 days for dogs without
12–16 weeks. If partial or complete responses are not nephrotic syndrome. When only nonazotemic dogs were
evident by the end of 8–12 weeks, the immunosuppres- considered, (i.e., serum creatinine <1.5 g/dL), the median
sive protocol should be changed or discontinued. If there survival for those with nephrotic syndrome was 51 days
is no response by 3–4 months, all immunosuppressive versus 605 days for those without nephrotic syndrome.

Further Reading

Brown S, Elliot J, Francey T, Polzin D, Vaden S. Consensus with suspected glomerular disease. J Vet Intern Med
recommendations for standard therapy of glomerular 2013; 27: S19–S26.
disease in dogs. J Vet Intern Med 2013; 27: S27–S43. Pressler B, Vaden S, Gerber B, Langston C, Polzin D.
Cianciolo RE, Brown CA, Mohr FC, et al. Pathologic Consensus recommendations for immunosuppressive
features of canine renal biopsies: methods for treatment of dogs with glomerular disease absent a
identifying features that differentiate immune‐ pathologic diagnosis. J Vet Intern Med 2013; 27:
mediated glomerulonephritides from other categories S55–S59.
of glomerular disease. J Vet Intern Med 2013; 27: Segev G, Cowgill LD, Heiene R, Labato MA, Polzin DJ.
S10–S18. Consensus recommendations for immunosuppressive
Klosterman ES, Moore GE, de Brito Galvao JF, et al. treatment of dogs with glomerular disease based on
Comparison of signalment, clinicopathologic findings, established pathology. J Vet Intern Med 2013; 27:
histologic diagnosis, and prognosis in dogs with S44–S54.
glomerular disease with or without nephrotic syndrome. Schneider SM, Cianciolo RE, Nabity MB, et al. Prevalence
J Vet Intern Med 2011; 25: 206–14. of immune‐complex glomerulonephritidies in dogs
Littman MP, Daminet S, Grauer GF, et al. Consensus biopsied for suspected glomerular disease: 501 cases
recommendations for diagnostic investigation of dogs (2007–2012). J Vet Intern Med 2013; 27: S67–S75.