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692 Nerve Sheath Tumors

If plasma volume is normal, spirono- • Warfarin is avoided in the face of
■ PEARLS & CONSIDERATIONS
hypoalbuminemia.
lactone 1-2 mg/kg PO q 12h may • Heparin is an ineffective anticoagulant when Comments
VetBooks.ir and provide benefit of inhibiting Possible Complications • Nephrotic syndrome is pathognomonic for
help delay return of third-space fluid
antithrombin is depleted.
glomerular disease.
aldosterone.
○ Low-level exercise may help mobilize
edema. • Hypotension from ACE inhibitor and ○ The clinical condition can deteriorate
rapidly, and prompt intervention is
• Address components of uremia if present calcium channel blocker or severe reduction warranted.
(p. 169). in plasma oncotic pressure • Nephrotic syndrome is a predisposing factor
• Initiate aspirin 2 mg/kg PO q 12h • Hyperkalemia from ACE inhibitor for thromboembolic disease.
or clopidogrel 1.1 mg/kg PO q 24h • Bleeding tendency from aspirin or clopidogrel
therapy as anticoagulant to reduce risk of (rare at recommended dose) Prevention
thromboembolism. • Worsening azotemia as a result of ACE • Urinalysis screening during routine health
• Add additional medications as needed to inhibition or calcium channel blockade (rare) evaluations may allow early detection of
control systemic hypertension (p. 501). • Worsening of ascites/edema after parenteral protein-losing nephropathy.
• Address concurrent/underlying disease when fluid administration • Early intervention when proteinuria is first
possible. detected might prevent the development of
• Uremic crisis may require colloid support Recommended Monitoring nephrotic syndrome.
for appropriate diuresis. The UPC, urinalysis, blood pressure, serum
albumin and creatinine, body weight, and body Technician Tips
Chronic Treatment condition score should be monitored regularly, Affected dogs need frequent evaluation because
• Disease-specific treatment is indicated on weekly to monthly initially and after therapeutic they can destabilize rapidly.
basis of renal biopsy and other test results. adjustments. Once stable, re-evaluate every 3
• If proteinuria is not reduced by > 50% with months unless changes in therapy are initiated Client Education
an ACE inhibitor or telmisartan, another or changes are noted in clinical condition. Urine Rapid deterioration is possible; frequent
inhibitor of the renin-angiotensin-aldosterone culture indicated at least twice per year. Ideally, rechecks are necessary.
system (RAAS) should be added. UPC should be evaluated in several samples
• Consider immunosuppressive therapy. collected over a few days. Alternatively, equal SUGGESTED READING
aliquots from several samples can be pooled Klosternam ES, et al: Comparison of signalment,
Nutrition/Diet for UPC evaluation. clinicopathologic findings, histologic diagnosis, and
Diet formulated for renal disease prognosis in dogs with glomerular disease with or
PROGNOSIS & OUTCOME without nephrotic syndrome. J Vet Intern Med
Behavior/Exercise 25:206, 2011.
Moderate, comfortable physical activity is • Varies but usually guarded AUTHOR: Shelly Vaden, DVM, PhD, DACVIM
encouraged; inactivity may worsen peripheral • Prognosis improves if underlying disease EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
edema. causing proteinuria can be identified and
corrected.
Drug Interactions • Azotemia, systemic hypertension, and marked
• Hypoalbuminemia increases the unbound tubulointerstitial lesions on biopsy may be
(often active) fraction of highly protein- negative prognostic indicators.
bound drugs; dosages may need to be • Nephrotic syndrome due to Lyme nephritis
adjusted. has a poor prognosis.

Nerve Sheath Tumors Client Education
Sheet

Epidemiology
BASIC INFORMATION ○ Benign peripheral nerve sheath
SPECIES, AGE, SEX tumors (schwannoma, neurofibroma,
Definition • Common in medium-sized to large-breed perineuroma)
Benign or malignant tumors arising from cells of dogs, less common in cats ○ Malignant peripheral nerve sheath tumors
the peripheral nerve sheath, nerve sheath tumors • Reported age range is 3-13 years (dogs) and (malignant schwannoma, neurofibrosar-
can affect peripheral nerves, spinal nerve roots, 8-19 years (cats). coma)
or cranial nerves. About 80% of nerve sheath Clinical Presentation
tumors occur in the brachial plexus region. HISTORY, CHIEF COMPLAINT
The remaining ≈20% involve cranial nerves DISEASE FORMS/SUBTYPES • Chronic, progressive lameness
(most commonly, the trigeminal nerve) or other Nerve sheath tumors include • Pain or paresthesia
spinal nerve roots. • Ganglioneuroma • Muscle atrophy
• Peripheral neuroblastoma • Weakness
Synonyms • Paraganglioma • Ataxia
Peripheral nerve sheath tumor (PNST), malig- • Peripheral nerve sheath tumors
nant nerve sheath tumor (MNST)

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