Clinicopathologic Findings in Dogs with Protein-Losing Nephropathy and Anti-Borrelia burgdorferi Antibodies
ACVIM 2008
D.J. Slade; T.J. Nolan; M.P. Littman
University of Pennsylvania School of Veterinary Medicine
Philadelphia, PA, USA

The purpose of this retrospective study was to review findings in clinical cases at a referral teaching hospital which were positive for Borrelia burgdorferi (Bb) antibodies by the SNAP-3Dx or SNAP-4Dx (IDEXX) in-house tests and which demonstrated evidence of protein-losing nephropathy (Lyme+PLN). Medical records were reviewed for variables such as signalment, history, clinical signs, results of CBC, biochemical profile, urinalysis, urine protein/creatinine ratio (UPC), exposure to co-infections, renal histopathologic findings, treatments, and outcome.

From May 2001, the SNAP-3Dx (IDEXX) in-house assay was used to test for heartworm antigen and antibodies against Bb and Ehrlichia canis. After Nov 2006, the SNAP-4Dx assay was used to test for the above and anti-Anaplasma phagocytophilum/platys (Ap) antibodies. Positive Bb antibody test results were found in 215/919 (23%) of healthy blood donor dogs compared with 962/3941 (24%) of hospital clinic cases during the period of May 2001-Dec 2007.

Medical records from the hospital population of Bb-seropositive dogs were studied. Within our referral population, 102/962 (10%) of Lyme-positive dogs showed evidence of protein-losing nephropathy (hypoalbuminemia, proteinuria). A preliminary review of 55 of these cases was undertaken. Breeds most frequently represented included Labrador Retrievers (16/55, 29%), Golden Retrievers (6/55, 10%), and mixed breed (15/55, 27%), with males comprising 47% (26/55). Average patient weight was 26.1 kg and average age at presentation was 6.3 years.

Common presenting complaints in 55 dogs included inappetance (89%), lethargy (89%), vomiting (72%), weight loss (69%), peripheral lymphadenopathy (33%), and polyuria/polydipsia (31%); only 9% had a history of lameness and 11% had previous Lyme vaccination. Common blood test abnormalities on admission included anemia (49/53, 92%), thrombocytopenia (42/53, 79%), azotemia (50/52, 96%), hypoalbuminemia (47/52, 90%), and hypercholesterolemia (15/52, 29%). Urinalysis and UPC in all 55 dogs confirmed proteinuria (100%) with USG <1.022 in 72%, glucosuria (27%), and bilirubinuria (27%). Hypertension during hospitalization was found in 69% (37/54). A small group of patients showed antibodies to Ehrlichia canis (3/55, 5%) or Rickettsia rickettsii (2/38, 5%). Anti-Ap antibodies were found in 14% (2/14) of Lyme+PLN dogs tested.

Patients were treated with doxycycline (42/55, 76%), ACE inhibitors (43/55, 78%), amlodipine (14/55, 25%), low-dose aspirin (18/55, 33%), and famotidine (33/55, 60%). A small group (6/55, 11%) received immunosuppressive doses of prednisone. Follow-up of 30 dogs found 60% (18/30) were euthanized or died with mean survival of 24 days post-admission.

In this preliminary study, dogs seropositive for Bb antibodies and exhibiting signs of protein-losing nephropathy had a high mortality rate in the initial period following diagnosis. Further study is warranted to investigate whether other therapeutic modalities, including immune suppression, may be of benefit to these patients.

Speaker Information
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Dennis Slade


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