Health Screening for Protein-Losing Enteropathy (PLE), Protein‑Losing Nephropathy (PLN), Renal Dysplasia (RD),
and Addison’s Disease
Recommended by SCWTCA and its Researchers
Source: Soft Coated Wheaten Terrier Club of America (scwtca.org)
During your Wheaten’s annual health check, our veterinary researchers, Meryl Littman VMD DACVIM, Shelly Vaden DVM DACVIM, and David Williams ECVIM-CA/ACVIM, recommend owners test their Wheatens annually for evidence of PLE/PLN, RD, and/or Addison’s Disease. Here is what you and your veterinarian should look for:
Quick Definitions
- PLE & PLN:
These are syndromes characterized by a loss of proteins from the gastrointestinal tract (Protein-Losing Enteropathy – PLE) or the kidneys (Protein-Losing Nephropathy – PLN) - RD:
Renal Dysplasia (RD) is the abnormal development of the kidney. This malformation can result in early renal failure. - Addison’s Disease:
Addison’s disease (Hypoadrenocorticism) is the insufficient production and secretion of hormones (glucocorticoids, mineralocorticoids) by the adrenal gland cortex.
Clinical Signs
Clinical signs of a disease are the things you can see or that your veterinarian may discover on his physical examination of your Wheaten. Remember, testing is important: in many conditions, clinical signs do not show up until well after tests may indicate signs of the disease. Also, many clinical signs of one disease can also be signs of another.
| RD | PLE | PLN1 | Addison’s2 |
| · Increased water consumption
· Increased urination (dilute urine) · “Poor doer” · Decreased appetite · Vomiting · Possibly prone to urinary tract infection |
· Vomiting
· Diarrhea · Weight loss · Ascites · Edema · Pleural effusion |
· Listlessness/depression
· Decreased appetite, vomiting, weight loss · Ascites, Edema, Pleural effusion · Increased water consumption · Increased urination (less common) · Thromboembolic phenomena & hypertension (less common) |
· Listlessness/ depression
· Decreased appetite, vomiting, weight loss · Inability to handle stress · Sudden collapse · Slow heart rate |
1PLE and PLN are difficult to diagnose. The initial stages of the disease may be mistaken for liver, glandular or other enteric or kidney diseases. Wheatens with PLE and/or PLN may have serious thromboembolic events (such as pulmonary embolism) before symptoms or renal failure start, even before there is increased serum creatinine or BUN.
2 The clinical signs of Addison’s Disease are often nonspecific and can mimic those of multiple other medical disorders.
Laboratory Tests Run By Your Vet
Your veterinarian can check for signs of these diseases with blood and urine tests. It is important the panels run by your Vet test for everything listed here; not all routine blood and urine tests do, so you must make sure the ones listed here are run.
Blood and urine tests cannot predict whether a dog will develop these diseases. But they can determine whether or not a dog is now clear of signs of disease and establish baseline values for future comparison. Early detection can offer more choices for treatment and can often provide longer and better quality of life.
Your veterinarian should run the following tests:
- Biochemical profile, including:
- Total protein (TP)
- Albumin (Alb)
- Globulin
- Creatinine (Cr)
- Blood Urea Nitrogen (BUN)
- Cholesterol (Chol)
- Sodium (Na)
- Potassium (K+)
- Phosphorus (Phos)
- Complete Blood Count
- Routine Urinalysis, including:
- Specific gravity
- Dipstick
- Urinary sediment
- Urine Protein/Creatinine Ratio
- RECOMMENDED but OPTIONAL:
- ERD or MA test for microalbuminuria.
- Fecal API test
If you or your veterinarian suspect RD or Addison’s, the following tests can be run:
- Renal Dysplasia (RD):
- Abdominal radiographs/Ultrasound
- Final confirmation of RD: Kidney biopsy (wedge, not Tru-cut); Your veterinarian can call Dr. Vaden to discuss size. Her contact information can be found below.
- Addison’s:
- ACTH stimulation test
Optional Tests
The two optional tests below may be early indicators of PLE and PLN. You can arrange for these through your veterinarian at the same time you do your annual screening. Alternatively, you can take the samples at home and ship them for testing in a kit SCWTCA has developed. For information on these, please click on the links below:
- PLE: Fecal API (FAPI) Test
- PLN: Microalbuminuria (MA) test. Alternatively, you can ask your vet to run an ERD test in his office.
Diagnosing PLE/PLN/RD/Addison’s
These diseases can be difficult to diagnose and can be confused with each other. Here are some of the similarities and differences.
| RD | PLN | PLE | Addison’s | |
| Age of Onset | <1-3 yrs | Mean ~ 6 yrs | Mean ~ 4.5 yrs | Young (in general) |
| Sex Predilection | None noted | Female: male=1.6 | Female: male=1.7 | Female (in general) |
| Polyuria/Polydipsia | Yes | Only 25% had PU/PD | No, unless on steroids | Yes |
| Vomiting/Diarrhea | Yes | Yes | Yes | Yes |
| Ascites / Edema | No | Possibly | Possibly | No |
| Azotemia | Yes | Eventually | No | Possibly (pre-renal) |
| Kidney Size | Small | May be normal | Normal | Normal |
| Hypoalbuminaemia | No | Yes | Yes | Possibly (melaena) |
| Hypoglobulinemia | No | No | Yes | Possibly (melaena) |
| Hypercholesterolaemia | No | Yes | Hypocholesterolaemia | No |
| Low Na/K ratio | Not noted | Rarely (~10%) | Rarely (~10%) | Yes |
| Urine Specific Gravity | Isosthenuria | Mean 1.023 | Mean 1.033 | Low (medullary washout) |
| Proteinuria | None or mild | Yes | No | No |
| Histopathology K = kidney I = intestine |
Fetal glomeruli, Fetal mesenchyme (K) | Glomerulonephritis, glomerulosclerosis (K) | IBD, lymphangiectasia, lymphangitis (I) | |
| Source: 1999 ACVIM PROCEEDINGS: Soft Coated Wheaten Terrier PLE-PLN; Meryl P. Littman VMD DACVIM, Philadelphia PA |
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Other important lab findings:
| RD | PLE | PLN1 | Addison’s2 |
| · Elevated creatinine
· Elevated BUN |
· Eosinophilia
· Lymphopenia · Low total protein |
· Elevated serum creatinine
· Elevated BUN · Elevated Urine Protein Creatinine Ratio** |
· Elevated serum creatinine
· Elevated BUN |
Remember, diagnosis of PLE/PLN, RD, or Addison’s is dependent on evaluating everything… test results, clinical signs and symptoms — so do not assume one “bad” item means your dog has these diseases.
What to do next?
- Make sure you do testing every year and have your veterinarian compare results.
- Keep a copy of the results in a file at home so you can always refer back to them or provide them to a new veterinarian if you move.
- Some people keep a spreadsheet on their computer with all the test results.
- The Watchdog Health Tracker, is available through the SCWTCA Endowment.
NOTE: SCWTCA neither recommends nor endorses the tool but provides this information for your assistance.
- The Watchdog Health Tracker, is available through the SCWTCA Endowment.
If these results show any abnormalities, you and your veterinarian need to take immediate action.
- You: Contact your breeder immediately. He or she will want to know in order to help you and to take action on other dogs in their breeding program.
- Your veterinarian: Please contact Dr. Vaden for further advice on diagnosis and treatment.
NOTE:
Because of state veterinary medicine licensure regulations, Dr. Vaden can no longer consult with individual owners who are not patients of their institutions. Any contact with them should be solely through your veterinarian on a professional consultation basis; additionally, your veterinarian can consult with a local member of the ACVIM.
| Dr. Shelly Vaden Professor, Internal Medicine North Carolina State University College of Veterinary Medicine 4700 Hillsborough Street Raleigh NC 27606 (919) 513-6235 (919) 513-6336 fax (include cover sheet) [email protected] |
Issued 5/04 ~ Updated 6/10