When our veteriarians do laboratory testing on pets of Alta Loma, Rancho Cucamonga, Upland, Ontario, Claremont, Fontana and the Inland Empire, our goal is to detect organ system problems at their earliest, most treatable stages. When it comes to early diagnosis of kidney disease, current blood tests are not very sensitive for early detection. Often, a pet must lose 50% or more of their kidney function before blood tests are elevated. Obviously, our veterinary team would like to detect kidney dysfunction earlier than that.
Recent research has shown that the presence of protein in the urine is a more sensitive indicator of early kidney dysfunction. The kidney is a blood filter. The microscopic filtration unit in the kidney is called the glomerulus. You can think of it as a colander you might use for straining spaghetti. Imagine that the “spaghetti” in this case is blood cells and proteins. The blood filters through the glomerulus and the blood cells and proteins are supposed to stay on the the inside of the body, while the fluid portions of the blood go through the filter, in the same way that the water you cooked the spaghetti in is allowed through the colander.
If your colander has too big a hole in it, the spaghetti will fall through into the sink. If the glomerulus is damaged, then proteins leak through into the urine. We can then detect the protein in the urine through routine testing.
If our veterinarians find protein in the urine where there is no sign of infection (red and white blood cells and/or bacteria), we must be suspicious of underlying kidney disease. However, a single sample does not reliably indicate kidney disease. Therefore our veterinary team usually check a 2nd sample 7-10 days from the first, after an all-night fast (since high protein in the diet can increase the amount of protein in the urine). If the protein is present at the second test, then we would want to find out exactly how much protein is in the urine to see if it is a significant amount. This is done with a test called the urine protein to creatinine ratio. Creatinine is a byproduct of muscle metabolism and is regularly excreted in the urine. If there is more protein than creatinine present, in the urine, then our veterinarians know that the kidney is damaged. Generally, we would like to repeat the test 2 weeks later and if the ratio is still high, we will start our diagnostic and therapeutic program.
There are many factors, which can lead to leaking of protein in the urine including, high blood pressure, excess of cortisone in the body (Cushing’s Syndrome), excessive protein in the diet, infections, kidney toxins, certain drugs, cancer and auto-immune disease.
If our veterianrians find that the urine protein creatinine ratio is elevated, we will usually want to look for any of the causes listed above as well as determining if there is primary structural damage to the kidneys. The tests that are typically recommended include (but are not limited to):
- Blood pressure measurement
- Kidney imaging via ultrasound
- Culture of the urine for infection
- Evaluation of the blood work for signs of Cushing’s Disease
If we find problems, we address them one at a time with additional diaganostics and/or therapy.
Treatment for Pets of Alta Loma, Rancho Cucamonga, Upland, Ontario, Claremont, Fontana, and the Inland Empire
If left untreated, the kidney damage will worsen, the protein loss will continue and the pet may lose weight and become clinically low in protein, which can lead to major problems. Therefore, we usually institute therapy, which may include any or all of the following:
- Blood pressure lowering medication if the blood pressure is high.
- Diet change to lower protein, kidney sparing diets
- Antibiotics if a bacterial infection is found through the culture.
- Drugs that reduce the pressure in the kidneys (Angiotensin Converting Enzyme Inhibitors) such as Benazepril
Once we institute therapy, we will monitor our progress with the following tests:
- Urine protein creatinine ratio test to see if the protein loss is improving.
- Blood pressure testing if there was hypertension.
- Urine culture if there was a bacterial infection detected
- Blood tests to evaluate the kidney function and electrolyte disturbances.
With early detection and treatment, we have a much better chance of slowing or stopping the deterioration of the kidneys and hence prolong your pet’s life as well as the quality of their life.
If you have questions about this, or any other aspect of your pet’s health care, feel free to discuss it with our veterinarians by calling (909) 980-3575.