High alp in dogs

High alp in dogs

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High alp in dogs with CKD: Aetiopathogenetic considerations and clinical relevance

1. Introduction {#sec1-toxins-12-00064}


Cats and dogs are the second most common mammalian species requiring hospitalisation for management of chronic kidney disease (CKD), following companion dogs and cats. The diagnosis of CKD is mostly based on blood tests and imaging studies, including ultrasound (US), radiography and nuclear imaging [[@B1-toxins-12-00064],[@B2-toxins-12-00064],[@B3-toxins-12-00064]]. However, US is less sensitive to detect renal damage in cats and dogs than in humans, in whom it is the primary diagnostic method in CKD [[@B1-toxins-12-00064],[@B2-toxins-12-00064]]. In addition, US is not very helpful for early detection of structural damage, in particular, in the case of focal glomerulonephritis [[@B1-toxins-12-00064]]. Moreover, US is not a gold standard for determination of renal parenchymal thickness [[@B4-toxins-12-00064]], as it does not provide a functional index of renal impairment [[@B5-toxins-12-00064]]. However, US is still the imaging modality of choice in dogs and cats to evaluate renal morphologic aspects and to differentiate among the major nephropathies in dogs and cats [[@B3-toxins-12-00064]].

The prevalence of CKD in dogs and cats has increased with the increasing popularity of renal-friendly diets. A recent study estimated that the overall prevalence of CKD in dogs and cats was 9.4% (95% confidence interval 8.8--9.9) [[@B6-toxins-12-00064]]. In humans, the prevalence of CKD in the general population is between 13% and 20% [[@B7-toxins-12-00064]].

The risk factors for the development of CKD include, among others, advanced age, diabetes mellitus, proteinuria, hypertension, neoplasia and inherited and acquired conditions such as renal tubular acidosis, amyloidosis, systemic inflammatory diseases, lupus and immune-mediated glomerulonephritis [[@B1-toxins-12-00064],[@B8-toxins-12-00064]].

Hypertension is the most common clinical sign in dogs and cats with CKD [[@B2-toxins-12-00064],[@B3-toxins-12-00064],[@B8-toxins-12-00064],[@B9-toxins-12-00064]]. The clinical significance of hypertension in these patients is unknown.

The aim of this study was to determine the prevalence and clinical relevance of hypertension in dogs and cats with CKD.

2. Results {#sec2-toxins-12-00064}


Between 1 January 2008 and 31 December 2017, 815 dogs and 714 cats were evaluated for the presence of CKD at the Clinical Hospital, University of Veterinary Medicine Budapest. The total number of dogs and cats evaluated was 1639. A total of 532 dogs (64.8%) and 537 cats (74.2%) were diagnosed with CKD.

The median age at the time of the first assessment of CKD was 6 years (range 0.5--16) in dogs and 5 years (range 0.5--16) in cats. The overall prevalence of hypertension was 34.5% (176/518) in dogs and 55.9% (349/637) in cats.

The overall prevalence of CKD increased with increasing age in dogs and cats ([Table 1](#toxins-12-00064-t001){ref-type="table"}). In dogs, the prevalence of CKD in the <,6 month old and the 6--10 month old age group was 7.1% (2/29) and 6.6% (10/150), respectively, which increased to 18.5% (26/143) in the 6--12 month age group and to 35.4% (31/86) in the >,12 month old age group. In cats, the prevalence of CKD in the <,6 month old and the 6--10 month old age group was 3.4% (1/29) and 3.3% (4/123), respectively, which increased to 6.7% (9/133) in the 6--12 month old age group and to 41.3% (31/75) in the >,12 month old age group.

The median (range) systolic blood pressure (SBP) was 162 mmHg (103--223) in dogs and 144 mmHg (84--191) in cats. The median (range) diastolic blood pressure (DBP) was 107 mmHg (79--148) in dogs and 108 mmHg (70--136) in cats. There were no statistically significant differences in SBP or DBP between the four age groups in both dogs and cats. The mean SBP of the animals with hypertension was 157 ± 14 mmHg and the mean DBP was 109 ± 9 mmHg. In dogs, SBP was significantly lower in dogs weighing less than 15 kg and older than 7 years ([Table 1](#toxins-12-00064-t001){ref-type="table"}). In cats, SBP was significantly lower in dogs older than 7 years. There was no difference in DBP between dogs with and without hypertension in either weight group.

The most frequent kidney disease in both dogs and cats was

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