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Evaluation of the association between initial proteinuria and morbidity rate or death in dogs with naturally occurring chronic renal failure

Frédéric Jacob DVM, PhD, DACVIM1, David J. Polzin DVM, PhD, DACVIM2, Carl A. Osborne DVM, PhD, DACVIM3, James D. Neaton PhD4, Claudia A. Kirk DVM, PhD, DACVN, DACVIM5, Timothy A. Allen DVM, DACVIM6, and Laurie L. Swanson7
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  • 1 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108.
  • | 2 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108.
  • | 3 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108.
  • | 4 Division of Biostatistics, School of Public Health, University of Minnesota, Saint Paul, MN 55108.
  • | 5 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996.
  • | 6 Hill's Science and Technology Center, 1035 NE 43rd St, Topeka, KS 66601.
  • | 7 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108.

Abstract

Objective—To determine whether urine protein-to-creatinine ratio (UP:C) ≥ 1.0 at initial diagnosis of chronic renal failure (CRF) is associated with greater risk of development of uremic crises, death, and progression of renal failure in dogs.

Design—Prospective cohort study.

Animals—45 dogs with CRF.

Procedure—Dogs were prospectively assigned to 2 groups on the basis of initial UP:C < 1.0 or ≥ 1.0. The association between magnitude of proteinuria and development of uremic crises and death was determined before and after dogs with initial UP:C ≥ 1.0 were assigned to 3 subgroups and compared with dogs with initial UP:C < 1.0. Changes in reciprocal serum creatinine concentration were used to estimate decrease in renal function.

Results—Initially, dogs had similar clinical characteristics with the exception of systolic blood pressure and UP:C. Relative risks of development of uremic crises and death were approximately 3 times higher in dogs with UP:C ≥ 1.0, compared with dogs with UP:C < 1.0. Relative risk of adverse outcome was approximately 1.5 times higher for every 1-unit increment in UP:C. The decrease in renal function was of greater magnitude in dogs with UP:C ≥ 1.0, compared with dogs with UP:C < 1.0.

Conclusions and Clinical Relevance—Initial UP:C ≥ 1.0 in dogs with CRF was associated with greater risk of development of uremic crises and death, compared with dogs with UP:C < 1.0. Initial determinations of UP:C in dogs with naturally occurring CRF may be of value in refining prognoses. (J Am Vet Med Assoc 2005;226:393–400)

Abstract

Objective—To determine whether urine protein-to-creatinine ratio (UP:C) ≥ 1.0 at initial diagnosis of chronic renal failure (CRF) is associated with greater risk of development of uremic crises, death, and progression of renal failure in dogs.

Design—Prospective cohort study.

Animals—45 dogs with CRF.

Procedure—Dogs were prospectively assigned to 2 groups on the basis of initial UP:C < 1.0 or ≥ 1.0. The association between magnitude of proteinuria and development of uremic crises and death was determined before and after dogs with initial UP:C ≥ 1.0 were assigned to 3 subgroups and compared with dogs with initial UP:C < 1.0. Changes in reciprocal serum creatinine concentration were used to estimate decrease in renal function.

Results—Initially, dogs had similar clinical characteristics with the exception of systolic blood pressure and UP:C. Relative risks of development of uremic crises and death were approximately 3 times higher in dogs with UP:C ≥ 1.0, compared with dogs with UP:C < 1.0. Relative risk of adverse outcome was approximately 1.5 times higher for every 1-unit increment in UP:C. The decrease in renal function was of greater magnitude in dogs with UP:C ≥ 1.0, compared with dogs with UP:C < 1.0.

Conclusions and Clinical Relevance—Initial UP:C ≥ 1.0 in dogs with CRF was associated with greater risk of development of uremic crises and death, compared with dogs with UP:C < 1.0. Initial determinations of UP:C in dogs with naturally occurring CRF may be of value in refining prognoses. (J Am Vet Med Assoc 2005;226:393–400)