Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of Albumin Creatinine Ratio as an Early Urinary Biomarker for Chronic Kidney Disease in Dogs

  • Hyun-Min Kang (Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University) ;
  • Heyong-Seok Kim (Petobio, Inc.) ;
  • Min-Hee Kang (Department of Bio-Animal Care, Jangan University) ;
  • Jong-Won Kim (Petobio, Inc.) ;
  • Dong-Jae Kang (Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University) ;
  • Woong-Bin Ro (Department of Veterinary Emergency and Critical Care Medicine, College of Veterinary Medicine, Chonnam National University) ;
  • Doo-Won Song (Shine Animal Medical Center) ;
  • Ga-Won Lee (Department of Companion Animal Industry, College of Health and Welfare, Dongshin University) ;
  • Hee-Myung Park (Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University) ;
  • Hwi-Yool Kim (Laboratory of Veterinary Surgery, College of Veterinary Medicine, Konkuk University)
  • Received : 2023.07.27
  • Accepted : 2023.11.07
  • Published : 2023.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Chronic kidney disease (CKD) occurs in more than 15% of the dogs over 10 years of age and causes irreversible renal function deterioration. Therefore, it is important to diagnose CKD early and treat the disease properly. The purpose of this study aimed to to evaluate the clinical utility of urine albumin/creatinine ratio (ACR) using POC (point-of-care) device as an early detection urinary biomarker in CKD dogs and to confirm the correlation between ACR and other known CKD biomarkers. Urine and serum samples were obtained from 50 healthy dogs and 50 dogs with CKD. Serum blood urea nitrogen (BUN), creatinine, and symmetric dimethylarginine (SDMA) concentrations, and urine protein creatinine ratio (UPC) were measured. Urine specific gravity (USG) was evaluated using refractometer, and ACR was measured using an i-SENS A1Care analyzer. The ACR values of dogs with CKD were significantly different from those of healthy dogs (p < 0.001), as with other renal biomarkers. ACR showed significant differences between healthy dogs and dogs with CKD at every IRIS stage (p < 0.005), whereas no significant differences were observed between dogs with CKD IRIS stage I and healthy dogs with UPC. There are significant positive correlation between ACR and BUN (r = 0.611, p < 0.001), creatinine (r = 0.788, p < 0.001), SDMA (r = 0.747, p < 0.001), and UPC (r = 0.784, p < 0.001), and significant negative correlation between ACR and USG (r = -0.700, p < 0.001). In receiver operator characteristic curve analysis, the area under the curve (AUC) was 0.982 (95% CI 0.963-1.000, p < 0.001), with an optimal cut-off value of 64.20 mg/g (94% sensitivity and 94% specificity). Thus, ACR is a useful urinary biomarker for the early diagnosis of proteinuria in CKD and combined use of ACR and other renal biomarkers may be helpful for early diagnosis and prevention of CKD in dogs.

Keywords

Acknowledgement

The authors would like to give special thanks to Nine animal hospital, Times animal medical center, Songjeong animal medical center, Yongkang animal hospital and Cheonan animal medical center, and i-sens Korea Inc. for their assistance in this study. This study result is a part of MS thesis for Hyun-Min Kang, Konkuk University.

References

  1. Bacic A, Kogika MM, Barbaro KC, Iuamoto CS, Simoes DM, Santoro ML. Evaluation of albuminuria and its relationship with blood pressure in dogs with chronic kidney disease. Vet Clin Pathol 2010; 39: 203-209.  https://doi.org/10.1111/j.1939-165X.2009.00207.x
  2. Bartges JW. Chronic kidney disease in dogs and cats. Vet Clin North Am Small Anim Pract 2012; 42: 669-692, vi.  https://doi.org/10.1016/j.cvsm.2012.04.008
  3. Cobrin AR, Blois SL, Kruth SA, Abrams-Ogg AC, Dewey C. Biomarkers in the assessment of acute and chronic kidney diseases in the dog and cat. J Small Anim Pract 2013; 54: 647-655.  https://doi.org/10.1111/jsap.12150
  4. Falus FA, Vizi Z, Szabo KE, Muller L, Reiczigel J, Balogh N, et al. Establishment of a reference interval for urinary albumin-to-creatinine ratio in dogs. Vet Clin Pathol 2022; 51: 585-590.  https://doi.org/10.1111/vcp.13149
  5. Grauer GF. Early detection of renal damage and disease in dogs and cats. Vet Clin North Am Small Anim Pract 2005; 35: 581-596.  https://doi.org/10.1016/j.cvsm.2004.12.013
  6. Harley L, Langston C. Proteinuria in dogs and cats. Can Vet J 2012; 53: 631-638. 
  7. Hebert LA, Spetie DN, Keane WF. The urgent call of albuminuria/proteinuria. Heeding its significance in early detection of kidney disease. Postgrad Med 2001; 110: 79-82, 87-88, 93-96. Erratum in: Postgrad Med 2002; 111: 23. 
  8. Jacob F, Polzin DJ, Osborne CA, Neaton JD, Kirk CA, Allen TA, et al. Evaluation of the association between initial proteinuria and morbidity rate or death in dogs with naturally occurring chronic renal failure. J Am Vet Med Assoc 2005; 226: 393-400.  https://doi.org/10.2460/javma.2005.226.393
  9. Kuwahar Y, Nishii N, Takasu M, Ohba Y, Maeda S, Kitagawa H. Use of urine albumin/creatinine ratio for estimation of proteinuria in cats and dogs. J Vet Med Sci 2008; 70: 865-867.  https://doi.org/10.1292/jvms.70.865
  10. Lees GE, Brown SA, Elliott J, Grauer GE, Vaden SL; American College of Veterinary Internal Medicine. Assessment and management of proteinuria in dogs and cats: 2004 ACVIM Forum Consensus Statement (small animal). J Vet Intern Med 2005; 19: 377-385.  https://doi.org/10.1111/j.1939-1676.2005.tb02713.x
  11. Lees GE. Early diagnosis of renal disease and renal failure. Vet Clin North Am Small Anim Pract 2004; 34: 867-885, v.  https://doi.org/10.1016/j.cvsm.2004.03.004
  12. Mogensen CE, Vestbo E, Poulsen PL, Christiansen C, Damsgaard EM, Eiskjaer H, et al. Microalbuminuria and potential confounders. A review and some observations on variability of urinary albumin excretion. Diabetes Care 1995; 18: 572-581.  https://doi.org/10.2337/diacare.18.4.572
  13. Marquez DF, Ruiz-Hurtado G, Segura J, Ruilope L. Microalbuminuria and cardiorenal risk: old and new evidence in different populations. F1000Res 2019; 8: F1000 Faculty Rev-1659. 
  14. Perini-Perera S, Del-Angel-Caraza J, Perez-Sanchez AP, Quijano-Hernandez IA, Recillas-Morales S. Evaluation of chronic kidney disease progression in dogs with therapeutic management of risk factors. Front Vet Sci 2021; 8: 621084. 
  15. Polzin DJ. Chronic kidney disease in small animals. Vet Clin North Am Small Anim Pract 2011; 41: 15-30.  https://doi.org/10.1016/j.cvsm.2010.09.004
  16. Polzin DJ. Evidence-based step-wise approach to managing chronic kidney disease in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2013; 23: 205-215.  https://doi.org/10.1111/vec.12034
  17. Raila J, Brunnberg L, Schweigert FJ, Kohn B. Influence of kidney function on urinary excretion of albumin and retinol-binding protein in dogs with naturally occurring renal disease. Am J Vet Res 2010; 71: 1387-1394.  https://doi.org/10.2460/ajvr.71.11.1387
  18. Smets PM, Meyer E, Maddens BE, Duchateau L, Daminet S. Urinary markers in healthy young and aged dogs and dogs with chronic kidney disease. J Vet Intern Med 2010; 24: 65-72.  https://doi.org/10.1111/j.1939-1676.2009.0426.x
  19. Whittemore JC, Gill VL, Jensen WA, Radecki SV, Lappin MR. Evaluation of the association between microalbuminuria and the urine albumin-creatinine ratio and systemic disease in dogs. J Am Vet Med Assoc 2006; 229: 958-963. https://doi.org/10.2460/javma.229.6.958