Clinicopathological features of 44 dogs with protein-losing enteropathy (PLE) of non-neoplastic origin

To describe clinical presentation and to evaluate clinical activity scores (CIBDAI/CCECAI) and clinicopathological data in dogs with PLE of non-neoplastic origin Medical records of dogs referred between January 2009 and November 2013 to the Veterinary Teaching Hospital of Turin and Veterinary Clinic of Valdinievole, with a diagnosis of non neoplastic PLE were retrospectively reviewed. Dogs with history of chronic gastrointestinal signs (> 3 weeks), hypoalbuminemia of gastrointestinal origin and histopathological evidence of non-neoplastic intestinal inflammation were included. All dogs were scored using the canine IBD activity index (CIBDAI) and the canine chronic enteropathy activity index (CCECAI). Based on the response to subsequent empirical therapeutic trials, dogs were classified as steroid-, food- or antibiotic responsive. In addition, they were divided into 4 groups based on hypoalbuminemia severity. Finally, a score (Score Evaluation of Response to Therapy; SERT) of 2, 1 or 0 was given to each dog based on satisfactory, poor or no clinical response to treatment, respectively Steroid-, food- and antibiotic-responsive enteropathies were diagnosed in 40, 3 and 1 dogs, respectively. Twenty-four dogs were male and 20 female. Median age at diagnosis was 6.4 years. German Sheperds were overrepresented (n=9). Presenting complains included vomiting (n=26), appetite variations (n=26), diarrhea (small bowel n=30; large bowel n= 6; mixed n= 8), peripheral edema, abdominal or pleural effusion (n= 21), muscular twitching or convulsions (n=4) and pruritus (n=3). Pre-treatment CIBCAI and CCECAI ranged from 4 to 17 and 5 to 19, respectively. Post-treatment CIBCAI and CCECAI ranged from 1 to 14 and 1 to 15, respectively. SERT was 2 in 19, 1 in 14 and 0 in 11 dogs, respectively. Total protein, globulins, total calcium, cholesterol, magnesium and cobalamin were decreased in 40/44, 37/44, 35/43, 23/43, 13/35 and 9/33 dogs, respectively. Twenty-nine dogs survived more than 6 months, while 11 dogs died within 6 months of the initial diagnosis; 4 dogs were lost at follow up. No correlation (Spearman Rho, p>0.05) between albumin concentration and pre-/post-treatment clinical scores was found. Significant differences (Student's t test p<0.01) in albumin concentration and clinical scores before and after treatment were found. Pre-treatment albumin concentration was not associated with survival (Student's t test p>0.05), nor to SERT (ANOVA p>0.05). No significant differences were found between hypoalbuminemia severity groups and age (ANOVA F p>0.05), weight (ANOVA F p>0.05), pre- and post-treatment clinical scores (Kruskal test p>0.05; Chi Squared p>0.05), survival and SERT (Chi Squared p>0.05) In addition to classic gastrointestinal signs, dogs of this study often showed clinical signs associated with hypoalbuminemia and low oncotic pressure. Clinical outcome was variable, but many dogs experienced remission of clinical signs and prolonged survival. This study found that not all PLE dogs with high clinical scores and severe hypoalbuminemia at presentation have a guarded prognosis (1). Furthermore, the severity of hypoalbuminemia could not be a reliable indicator of survival or positive response to treatment (2).