Treatment
Treatment of renal amyloidosis requires management of protein loss in the urine, uremia (toxin buildup in the blood secondary to kidney disease), treatment of high blood pressure if present, and nutritional and fluid management.
Frequent rechecks of their blood and UP/C values is important (see monitoring below).
For many dogs affected by amyloidosis, massive protein loss in the urine can be life threatening and is a source of significant symptoms and ultimate cause of death. Management of proteinuria is very important.
- Standard treatment recommendations for protein losing kidney disease in dogs as a consensus statement from the International Renal Interest Society. In my experience, telmisartan is superior than ACE inhibitors to treat proteinuria in Bracco Italiano dogs with suspected amyloidosis, and I will use it as first-line therapy (even for dogs that are not also hypertensive). Here is additional information for veterinarians on the use of telmisartan to treat protein loss in the urine and a retrospective study evaluating its use. Medications are often also prescribed to reduce the risk of thromboembolic disease in cases of protein losing nephropathy.
- Management of chronic kidney disease for owners and veterinarians.
- While conclusive evidence of the efficacy of colchicine in amyloidosis in dogs is limited, I often prescribe it as adjunctive therapy for Bracchi with presumed or confirmed amyloidosis. It is important to discuss potential side effects and risk/benefits with your veterinarian.
- Use of omega-3 fatty acid supplementation.
- Nutritional management for protein losing kidney disease is very important.
It is critical to avoid excessive dietary protein restriction, which may contribute to loss of lean body mass.
Focus on nutrition: Nutritional management of protein-losing nephropathy in dogs
Monitoring
After diagnosis, frequent monitoring is needed. Even stable patients, whose disease is well controlled, should have their bloodwork, urine testing (including UP/C), and blood pressure measured at a minimum of every 6 months.
This disease can change course rapidly. In my experience with this disease, I have seen dogs change from a UP/C of 2 (mild-moderate proteinuria) to 11 (severe, life threatening proteinuria) in two months. While undergoing treatment, I have had a dog go from a UP/C of 3 to 9 in two weeks (which was corrected with medication adjustments). Frequent monitoring and rechecks, especially when any symptoms are noted, are vital to allow for intervention.
It is important to follow the recommendations of your veterinarian. Some basic guidelines are below:
Newly diagnosed Bracchi with kidney disease: Because of the rapid progression that is possible with amyloidosis, newly confirmed proteinuria or azotemia should be investigated thoroughly as soon as possible. This may include additional tests such as urine culture, blood pressure, infectious disease testing, x-rays and/or ultrasound. Additional diagnostics to confirm the presence of persistent protein loss in the urine and/or bloodwork changes should be done within 2 weeks. If the dog is concurrently moderately to severely hypoalbuminemic (low blood albumin), further investigation should occur on an emergency basis.
Unstable cases: Dogs with nephrotic range (UP/C >2) or newly diagnosed proteinuria (especially when found concurrently with low blood albumin), newly diagnosed or severe azotemia or clinically ill dogs. Rechecks should be performed on a 1-2 week basis until a response to treatment is seen, then rechecks can be spaced to once monthly, or once every 3-4 months until the dog is considered stable.
After Medication Adjustments: Bloodwork, blood pressure, and UP/C should be evaluated 1-2 weeks after medication adjustments.
Stable cases: Dogs with stable (medically managed, UP/C < 2) proteinuria and/or azotemia. These dogs are generally not symptomatic, or have chronic symptoms attributed to kidney disease. Stable dogs should still ideally be monitored every 3-4 months. For dogs with very mild (minimal azotemia, UP/C < 0.5), medically managed disease, rechecks may be performed every 4-6 months.
In a very informal sense, “do not trust this disease.” The absence of clinical signs does not mean that the disease is not progressing. As a chronic disease, many affected Bracchi do not show clinical signs until the disease is very advanced (often leading to euthanasia).