Chronic kidney disease diagnosis

WSAVA guideline

Key findings

• When to biopsy: persistent renal proteinuria UPC >2.0 (entry criterion, p. 2; per 2004 ACVIM consensus, ref 23); tissue sufficiency = LM+TEM+IF, or LM+TEM if conclusive (p. 2).
• Submission triad: LM — 10% buffered formalin, paraffin, ≥10 serial 3-µm sections with H&E, PAS, Masson trichrome, Jones silver (JMS) + 8-µm Congo red from ≥1 cortex specimen; TEM — chilled 3% glutaraldehyde, 55–60 nm sections; IF — chilled Michel's medium ≤72 h, snap-frozen, −80 °C, 4-µm cryosections; FITC anti-dog IgG/IgM/IgA/C3 + anti-human C1q/kappa/lambda (pp. 2–4).
• Never LM alone: LM-only clustering misplaced 22/89 (25%) — 8 MGN cases with unequivocal TEM/IF deposits moved non-ICGN-side; all 13 cluster-3 + 1/13 cluster-2 FSGS moved ICGN-side; "might have led to inappropriate treatment" (pp. 8, 21).
• Table 6: median UPC by cluster — FSGS 5.6/8.7, amyloid 9.8, MPGN 16.1/9.6, MGN 8.9/16.0 (control 0.13) — did not discriminate clusters; reference intervals UPC <0.5, SCr 0.5–1.5 mg/dl, SAlb 2.5–4.0 g/dl (pp. 12, 18).
• Severity gradient: MPGN worst — highest median SCr 3.6 mg/dl (cluster 5), lowest SAlb 1.4 g/dl, hypertension 9/10 and 10/12; FSGS least severe; amyloid least often hypertensive (3/11) (pp. 12, 18).
• Hypertension: systolic consistently >160 mm Hg or antihypertensive other than an ACE inhibitor alone at biopsy (p. 2); Greyhound controls 160–180 mm Hg (white-coat effect) (p. 9).
• Breed/familial: GWAS of Soft-Coated Wheaten Terrier protein-losing nephropathy found NPHS1 and KIRREL2 mutations (nephrin, filtrin — slit diaphragm proteins), FSGS dominant phenotype (p. 18); secondary-FSGS benchmark: 11/12-nephrectomy dogs SCr 2.0–2.5 mg/dl, mean UPC <0.8 (p. 19).
• Staging/therapy link: with immunosuppressive agents for ICGN, "considerable care should be taken to determine which patients will likely benefit" (p. 21).

Drugs named in WSAVA’s own guideline text

As printed in WSAVA’s document, not this app’s own extracted data — see “Related drugs in this reference” below for that.

• — [dose not printed in source]

  Excluded alone from hypertension definition; RSP reports: ACE inhibitor + "renal" diet = standard care (p. 2)

• — [dose not printed in source]

  Any agent other than an ACE inhibitor alone = hypertension at biopsy (p. 2)

• — [dose not printed in source]

  Rationale for ICGN vs non-ICGN separation before treating (p. 21)

• — [dose not printed in source]

  For the 7 deposit-positive FSGS cases if "standard therapies are unsuccessful" (p. 19)

• — [dose not printed in source]

  Only in reference title 8

Recommendations

• Biopsy persistent proteinuria UPC >2.0 with tissue for LM+TEM+IF

  Study entry criterion (p. 2)

• Submit the full LM+IF+TEM triad; never diagnose on LM alone

  22/89 (25%) misclassified (pp. 8, 21)

• Split tissue: formalin / Michel's+snap-freeze / glutaraldehyde

  Methods standard (pp. 2–3)

• 3-µm sections + 4 stains + 8-µm Congo red; avoid 5-µm (overestimates nuclei)

  Methods standard (pp. 2–3, 20)

• Do not infer histology from UPC magnitude; triage severity by category (MPGN worst, FSGS mildest)

  Table 6 (pp. 12, 18)

• Stage hypertension as systolic >160 mm Hg or non-ACE-inhibitor antihypertensive use

  Study definition (p. 2)

• Weigh breed/genetic context (SCWT NPHS1/KIRREL2)

  Cited GWAS (p. 18)

• Manage per IRIS Consensus Guidelines for Glomerular Disease (JVIM 2013); route biopsies to IVRPS (OSU/TAMU) or Utrecht

  Consensus + infrastructure (2015 report; p. 2)

Related drugs in this reference (14)

The quoted line under each drug is its own already-extracted indication text that matched this condition — the reason it’s listed, not a paraphrase. Open a drug for its full species/route breakdown, calculator, and complete adverse-effect list.

Showing 6 of 14 linked drug records. Open a record for species, route and source details.

• AMLODIPINE

  “Systemic hypertension (usually secondary to CKD, hyperthyroidism, cardiac disease) — drug of choice for most clinicians”

  Source dose preview: 0.1–0.5 mg/kg (start 0.1), q24h, PO (Dog)

  Adverse-effect notes: Hypotension, azotemia, lethargy, hypokalemia, reflex tachycardia, weight loss — Infrequent (slow onset limits acute hypotension) · **Gingival hyperplasia** — Long-term use; resolves on discontinuation

• BENAZEPRIL

  “CHF, hypertension, proteinuric CKD/glomerular disease”

  Source dose preview: 0.25–0.5 mg/kg, q24h (up to q12h), PO (Dog)

  Adverse-effect notes: GI distress — Most likely · Azotemia — Possible, especially with high-dose diuretics

• ENALAPRIL

  “CHF adjunct (HCM), hypertension (2nd-line — ACE inhibitors alone often inadequate), proteinuric CKD”

  Source dose preview: 0.5 mg/kg, q24h initially, up to q12h, PO (Dog)

  Adverse-effect notes: GI distress (anorexia, vomiting, diarrhea) — Most common · Lethargy, inappetence — Reported

• EPOETIN DARBEPOETIN

  “**Anemia of chronic kidney disease** (end-stage renal disease) — typically once PCV <20% or symptomatic”

  Source dose preview: 100 units/kg until Hct reaches **target 37–45%**, 3×/wk → 2×/wk → weekly titration, SC (Dog)

  Adverse-effect notes: **Autoantibody formation → refractory aplastic anemia** — The feared complication — reason EPO is "last ditch," PCV in the teens first · Hypertension (worsening), seizures — Renal-patient vascular effects

• FUROSEMIDE

  “Pulmonary edema, CHF, hypercalcemia, hyperkalemia (adjunct), oliguric renal failure”

  Source dose preview: 1–2 mg/kg, q12h, PO (Dog)

  Adverse-effect notes: Ototoxicity — High-dose IV, especially **cats** · Hyponatremia (more so than hypokalemia in dogs), dehydration — Common with chronic use

• MANNITOL

  “Acute oliguric renal failure, ↓intraocular pressure (acute glaucoma), ↓intracranial pressure (cerebral edema/TBI), enhanced elimination of some toxins (aspirin,…”

  Source dose preview: 0.25–0.5 g/kg (20–25% solution), Repeat q4–6h or CRI (8–10% solution) if diuresis occurs, IV over 5–10 min (Dog)

  Adverse-effect notes: Fluid/electrolyte imbalance (esp. hypernatremia) — Most severe concern · Volume overload if oliguria persists — Significant risk