Section: Veterinary Care In-depth
Diagnosis
Complete blood count and chemistry panel. These tests do not diagnose amyloidosis directly; however, they give information that may be suggest excessive protein loss from the body, as well as information as to other body systems. Complete blood counts may show changes expected for kidney failure, such as anemia. The chemistry panel usually shows low total protein, low albumin, and often, elevated kidney parameters. High cholesterol is often seen.
Urinalysis. Excessive protein detected on a urinalysis is the hallmark of kidney amyloidosis. Further tests to document the magnitude of the protein loss will be necessary.
Urine protein/creatinine ratio. This test confirms that the amount of protein lost in the urine is truly excessive.
X-rays. Kidney size on radiographs can vary in cases of amyloidosis. In dogs, kidney size may be small, normal, or larger than normal, making this test not very informative.
Biopsy of the kidney. A kidney biopsy is necessary to make a definitive diagnosis of amyloidosis and distinguish it from other disorders of the kidney that can lead to excessive urinary protein loss.
Therapy
Treatment of kidney amyloidosis is difficult and often unrewarding, especially if kidney failure has already begun to develop. The principles of therapy are as follows:
Identify and treat any underlying infectious or inflammatory condition that may have led to the amyloidosis.
Manage any concurrent kidney failure – this may require hospitalization and intravenous fluids, or may only require outpatient care. Prescription diets, hormonal supplements, and other dietary supplements may be necessary for treatment.
Experimental therapy such as DMSO or colchicine. Administration of the drug dimethylsulfoxide (DMSO) during the very early stages of the disease has been shown to be an effective treatment; however, most dogs present much later in the course of their disease, when DMSO is much less effective.
Colchicine may be beneficial for humans with the disorder in certain circumstances, but it has yet to be studied well in dogs.
Follow-up
Optimal treatment for your dog requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your dog does not rapidly improve.
Administer all prescribed medication(s) as directed. Alert your veterinarian if you are experiencing problems treating your dog.
Feed special low protein prescription diets as recommended.
Return for frequent re-examination. If therapy has been attempted, your veterinarian will want to monitor the urinary protein loss by performing serial urine protein/creatinine ratios to see if the magnitude of the protein loss is decreasing, as well as serial chemistry panels to see if the circulating protein and albumin levels are rising toward the normal range.
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