ABSTRACT OF THE WEEK

Comparative immunology, microbiology and infectious diseases
Volume 83 | Issue 0 (April 2022)

Xanthinuria secondary to allopurinol treatment in dogs with leishmaniosis: Current perspectives of the Iberian veterinary community.

Comp Immunol Microbiol Infect Dis. April 2022;83(0):101783.

Laura Jesus¹, Carolina Arenas², Marina Domínguez-Ruiz³, Paolo Silvestrini⁴, Ryane E Englar⁵, Xavier Roura⁶, Rodolfo Oliveira Leal⁷

¹ Hospital Escolar Veterinário - Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal.; ² Hospital Veterinario Anicura Valencia Sur, Valencia, Spain.; ³ Hospital Clínico Veterinario, Universidad Alfonso X el Sabio (UAX), Madrid, Spain.; ⁴ Ryan Veterinary Hospital - PennVet, University of Pennsylvania, USA.; ⁵ College of Veterinary Medicine, University of Arizona, Oro Valley, AZ 85737, USA.; ⁶ Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.; ⁷ Hospital Escolar Veterinário - Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal; CIISA - Centro de Investigação Interdisciplinar em Sanidade Animal, Faculdade de Medicina Veterinária, Universidade de Lisboa, Portugal. Electronic address: rleal@fmv.ulisboa.pt.

Abstract

Xanthinuria is a significant adverse effect in dogs on long-term allopurinol for treatment of leishmaniosis. The study aims to investigate how the Iberian veterinary community (IVC) identifies, manages, and proactively prevents xanthinuria secondary to allopurinol treatment. A cross-sectional study was conducted using an online survey, translated into two languages, and disseminated to the IVC via social networking forums. Respondents were asked to share their treatment regimens, adverse effects attributed to treatment, as well as preventive and reactive measures against xanthuria. Of two-hundred and thirty respondents, 99.6% prescribe allopurinol for canine leishmaniosis. Xanthinuria was estimated to happen in less than one out of every four dogs by 91.7% of the clinicians. Xanthinuria has been detected by 71.6% of respondents at least once. Three out of every four respondents inform owners about deleterious effects of allopurinol, and 28.4% consider implementing a change in diet in advance of treatment as a proactive measure. To monitor xanthinuria, urinalysis and diagnostic imaging are used by 71.2% and 31% of clinicians respectively. When xanthinuria is detected, 43.2% of the respondents discontinue allopurinol, 24% replace it by nucleotide-analogs, 14.9% reduce its dosage, and 3.1% split its dosage but increase administration frequency. Additional measures are taken by 72.1% of the respondents, 59.4% of whom prescribe a low-purine diet. The IVC recognizes xanthinuria as a fairly common secondary effect of long-term allopurinol treatment in dogs with leishmaniosis and recommends periodically monitoring and preventive measures.

Companion Notes

Survey of the Iberian veterinary community on xanthinuria secondary to allopurinol treatment in dogs with leishmaniosis

Introduction on xanthinuria

- common adverse effect in dogs with leishmaniosis being treated with allopurinol

Study design

- study population: Iberian veterinary community

- procedure:

- online anonymous survey placed online after internal validation

- clinician informed about survey via Iberic social network veterinary groups

Results:230 responses obtained: 131 from Portugal and 99 from Spain

- 99.6% (229/230) of clinicians use allopurinol as part of CanLeish treatment

(CanLeish = canine leishmaniosis)

- 71.6% (164/229) have identified xanthinuria in dogs with leishmaniosis

(at least once)

- 91.7% estimated xanthinuria occurred in less than 1 out of every 4 dogs

- 78.7% (129/164) generally diagnose xanthinuria based on detection of crystalluria

- 12.2% by post-removal urolith analysis

- 5.5% on detection of urolithiasis on abdominal ultrasonography

- reported complications associated with xanthinuria included the following:

- urinary clinical signs (dysuria, stranguria, pollakiuria), 68.8% (110/160)

- non-obstructive urolithiasis, 59.4%

- renal mineralization, 37.5%

- bacterial cystitis, 31.3%

- urethral obstruction, 29.4%

- ureteral obstruction, 17.5%

- xanthinuria prevention

- 75.1% (172/229) inform clients of the adverse effects of allopurinol

- 28.4% consider a change to low purine diet

- monitoring of urinary adverse effects

- urinalysis prioritized, 71.2% (163/229)

- diagnostic imaging prioritized, 31% (71/229)

- abdominal ultrasonography preferred, 94.4% (67/71)

- survey abdominal radiography, 5.6%

- steps taken when xanthinuria develops

- 43.2% (99/229) stop allopurinol treatment

- 24% switch for AHCC associated with nucleotides

(AHCC = active hexose correlated compound)

- 17.9% change frequency or dosage of allopurinol administration

- 14.9% reduce dosage

- 3.1% split the dosage but increase administration frequency

- 5.2% stay with same therapy

- additional steps taken when xanthinuria develops, 72.1%

- dietary modification (low purine diet), 59.4% (98/165)

- stimulate water intake, 15.2%

- increase frequency of clinical monitoring, 15.2%

- other, 5.5%

- increase wet food consumption, 4.9%

“Although preventive measures are often neglected, clinicians seem to be conscious about the options to manage xanthinuria in dogs with leishmaniosis, under allopurinol treatment.”

Keywords

Canine; Kidney; Leishmania; Portugal; Spain; Urolithiasis; Xanthine;

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