Critical appraisal of medical and dietary treatments of proteinuria in dogs and cats

Authors: Leaver MR, Mansfield CS
Publication: Australian Veterinary Practitioner, Volume 50, Issue 3, pp 140-159, Sep 2020
Publisher: Australian Veterinary Association

Animal type: Cat, Dog
Subject Terms: Animal remedies/veterinary medicines, Clinical examination, Diet/rations/food, Kidney/renal disease, Protein
Article class: Clinical Report

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Abstract:

The present review assesses the methods for diagnosis of proteinuria, evaluates the need for treatment, and critically appraises the evidence for medical and dietary therapies. A search of scientific databases was conducted to source peer-reviewed articles. These were assigned a level of evidence and a grade of recommendation based on National Health and Medical Research Council guidelines. Grades of recommendation were: grade A, excellent; grade B, good; grade C, satisfactory; and grade D, poor.

Sulphosalicyclic acid tests and urine dipsticks have high sensitivity and are good for screening for proteinuria in dogs. At low levels of proteinuria, and in cats, more specific assays are recommended. Urine protein to creatinine ratios have high specificity and are used for quantification of proteinuria. Pooled and averaged samples are recommended over single samples.

Proteinuria in dogs and cats has detrimental effects and veterinarians are recommended to pursue treatment (grade B). Angiotensin converting enzyme inhibitors are the most supported therapeutic and should be first line treatment (grade A). Angiotensin receptor blockers (grade C), combination therapy (grade D) and aldosterone receptor antagonists (grade D) are lacking evidence in dogs and cats with proteinuria. The presence of adverse effects in people for the latter two should discourage their use. While renal diets provide overall benefits (grade B), the evidence for their effect on proteinuria is weak (grade D)

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