The examples and perspective in this article deal primarily with the United Kingdom and do not represent a worldwide view of the subject.(March 2018) |
Alabama rot, Greenetrack disease, or cutaneous and renal glomerular vasculopathy (CRGV) [1] is an often fatal condition in dogs. It was first identified in the US in the 1980s in greyhounds. [2] [3] The high number of affected dogs at the Greenetrack Racing Park, Alabama, led to the initial pseudonyms of Greenetrack Disease and Alabama Rot. [4] The initial symptoms are skin lesions on the legs, chest and abdomen followed by renal involvement. [2] [3]
In November 2012 the first cases were suspected in the UK. [5] In January 2014, the outbreak in England was identified as having the same or similar histological and clinical findings as Alabama rot, though this could not be classified as Alabama Rot as the histological results from the UK lacked the relation to E. coli that was present in all the cases in the US, [1] [2] although a wide range of breeds were affected. [1] The suspected disease has been possibly identified across England and Wales, with a case being reported as far north as North Yorkshire in March 2015. A map posted online shows confirmed (with post-mortem) and unconfirmed (without post-mortem) cases of CRGV since December 2012 in the United Kingdom. [6] In May 2017 it was reported that 98 suspected deaths from the disease have occurred in the UK, including 15 in 2017. [7]
The disease is characterized by cutaneous and sometimes renal changes with the latter frequently being ultimately fatal. [8] [3]
Common symptoms of CRGV include, but are not limited to: [9]
Some veterinary experts theorize the disease is caused by a parasite, while others believe it is bacterial. It is more widely believed that Alabama rot is caused by toxins produced by E. coli but, as there has been no presence of E. coli in histological examination in UK cases, the disease is described there as suspected CRGV rather than Alabama rot per se. Because the exact cause has not been found, developing a vaccine is not possible. The cause of Alabama rot in the UK is under study as of 2013 at Anderson Moores Veterinary Specialists in Winchester, Hampshire. [10] A podcast on Alabama rot was published in April 2014 by the Royal Veterinary College. [11] As of February 2015 the Forestry Commission England will only publish specific site location details if "cases are confirmed as CRGV and a scientific connection to the dogs walked on the site is made". [12]
A comprehensive report on CRGV was published in March 2015 by the British Veterinary Association, concluding that it is a disease of unknown cause "carrying a poor prognosis when azotaemia develops". [13] However, an association has been linked to dogs walking on muddy ground. [14]
Treatment is primarily symptomatic involving wound management of skin lesions and aggressive supportive therapy when renal compromise occurs. Some UK dogs with Alabama rot have been successfully treated since 2013. [10] A webinar on Alabama rot by the Royal Veterinary College on 11 February 2015 was tutored by David Walker of Anderson Moores Veterinary Specialists. [15] As the disease is widely believed to spread via dogs' feet and legs, due to the current lack of treatment the best action is to avoid infection by not walking dogs in a suspected infected area.[ citation needed ]
In August 2018 sources reported that plasmapheresis (therapeutic plasma exchange) resulted in survival of 2 out of 6 dogs with advanced disease. [16] This finding offers hope that such blood filtering could result in better survival rates, particularly if caught early before vascular and renal damage occur.[ citation needed ]
The number of cases in the US is not known, but it was confined to greyhounds and in many cases was not fatal; however, as of 2017 there had been 103 suspected cases in the UK. [17]
Analysis by Felcana found that between 2018 and 2020, South West and South East regions had the highest proportion of Alabama Rot cases per 100,000 dogs in the UK. [18]
The Samoyed is a breed of medium-sized herding dogs with thick, white, double-layer coats. They are spitz-type dogs which take their name from the Samoyedic peoples of Siberia. Descending from the Nenets Herding Laika, they are domesticated animals that assist in herding, hunting, protection and sled-pulling.
Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; and chronic kidney failure, which develops slowly and can often be irreversible. Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications of acute and chronic failure include uremia, hyperkalaemia, and volume overload. Complications of chronic failure also include heart disease, high blood pressure, and anaemia.
Nephritis is inflammation of the kidneys and may involve the glomeruli, tubules, or interstitial tissue surrounding the glomeruli and tubules. It is one of several different types of nephropathy.
Hereditary coproporphyria (HCP) is a disorder of heme biosynthesis, classified as an acute hepatic porphyria. HCP is caused by a deficiency of the enzyme coproporphyrinogen oxidase, coded for by the CPOX gene, and is inherited in an autosomal dominant fashion, although homozygous individuals have been identified. Unlike acute intermittent porphyria, individuals with HCP can present with cutaneous findings similar to those found in porphyria cutanea tarda in addition to the acute attacks of abdominal pain, vomiting and neurological dysfunction characteristic of acute porphyrias. Like other porphyrias, attacks of HCP can be induced by certain drugs, environmental stressors or diet changes. Biochemical and molecular testing can be used to narrow down the diagnosis of a porphyria and identify the specific genetic defect. Overall, porphyrias are rare diseases. The combined incidence for all forms of the disease has been estimated at 1:20,000. The exact incidence of HCP is difficult to determine, due to its reduced penetrance.
Hemolytic–uremic syndrome (HUS) is a group of blood disorders characterized by low red blood cells, acute kidney injury, and low platelets. Initial symptoms typically include bloody diarrhea, fever, vomiting, and weakness. Kidney problems and low platelets then occur as the diarrhea progresses. Children are more commonly affected, but most children recover without permanent damage to their health, although some children may have serious and sometimes life-threatening complications. Adults, especially the elderly, may present a more complicated presentation. Complications may include neurological problems and heart failure.
Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. "Gross hematuria" occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with a microscope or laboratory test. Blood that enters and mixes with the urine can come from any location within the urinary system, including the kidney, ureter, urinary bladder, urethra, and in men, the prostate. Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise. These causes are grouped into glomerular and non-glomerular causes, depending on the involvement of the glomerulus of the kidney. But not all red urine is hematuria. Other substances such as certain medications and foods can cause urine to appear red. Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria. A urine dipstick test may also give an incorrect positive result for hematuria if there are other substances in the urine such as myoglobin, a protein excreted into urine during rhabdomyolysis. A positive urine dipstick test should be confirmed with microscopy, where hematuria is defined by three or more red blood cells per high power field. When hematuria is detected, a thorough history and physical examination with appropriate further evaluation can help determine the underlying cause.
Acute kidney injury (AKI), previously called acute renal failure (ARF), is a sudden decrease in kidney function that develops within 7 days, as shown by an increase in serum creatinine or a decrease in urine output, or both.
IgA nephropathy (IgAN), also known as Berger's disease, or synpharyngitic glomerulonephritis, is a disease of the kidney and the immune system; specifically it is a form of glomerulonephritis or an inflammation of the glomeruli of the kidney. Aggressive Berger's disease can attack other major organs, such as the liver, skin and heart.
Goodpasture syndrome (GPS), also known as anti–glomerular basement membrane disease, is a rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs, glomerulonephritis, and kidney failure. It is thought to attack the alpha-3 subunit of type IV collagen, which has therefore been referred to as Goodpasture's antigen. Goodpasture syndrome may quickly result in permanent lung and kidney damage, often leading to death. It is treated with medications that suppress the immune system such as corticosteroids and cyclophosphamide, and with plasmapheresis, in which the antibodies are removed from the blood.
Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Symptoms most often include fever and flank tenderness. Other symptoms may include nausea, burning with urination, and frequent urination. Complications may include pus around the kidney, sepsis, or kidney failure.
Birt–Hogg–Dubé syndrome (BHD), also Hornstein–Birt–Hogg–Dubé syndrome, Hornstein–Knickenberg syndrome, and fibrofolliculomas with trichodiscomas and acrochordons is a human, adult onset, autosomal dominant genetic disorder caused by the FLCN gene. It can cause susceptibility to kidney cancer, renal and pulmonary cysts, and noncancerous tumors of the hair follicles, called fibrofolliculomas. The symptoms seen in each family are unique, and can include any combination of the three symptoms. Fibrofolliculomas are the most common manifestation, found on the face and upper trunk in over 80% of people with BHD over the age of 40. Pulmonary cysts are equally common (84%) and 24% of people with BHD eventually experience a collapsed lung. Kidney tumors, both cancerous and benign, occur in 14–34% of people with BHD; the associated kidney cancers are often rare hybrid tumors.
Focal segmental glomerulosclerosis (FSGS) is a histopathologic finding of scarring (sclerosis) of glomeruli and damage to renal podocytes. This process damages the filtration function of the kidney, resulting in protein presence in the urine due to protein loss. FSGS is a leading cause of excess protein loss—nephrotic syndrome—in children and adults. Signs and symptoms include proteinuria and edema. Kidney failure is a common long-term complication of the disease. FSGS can be classified as primary, secondary, or genetic, depending on whether a particular toxic or pathologic stressor or genetic predisposition can be identified as the cause. Diagnosis is established by renal biopsy, and treatment consists of glucocorticoids and other immune-modulatory drugs. Response to therapy is variable, with a significant portion of patients progressing to end-stage kidney failure. An American epidemiological study 20 years ago demonstrated that FSGS is estimated to occur in 7 persons per million, with males and African-Americans at higher risk.
Livedo reticularis is a common skin finding consisting of a mottled reticulated vascular pattern that appears as a lace-like purplish discoloration of the skin. The discoloration is caused by reduction in blood flow through the arterioles that supply the cutaneous capillaries, resulting in deoxygenated blood showing as blue discoloration. This can be a secondary effect of a condition that increases a person's risk of forming blood clots, including a wide array of pathological and nonpathological conditions. Examples include hyperlipidemia, microvascular hematological or anemia states, nutritional deficiencies, hyper- and autoimmune diseases, and drugs/toxins.
Familial renal disease is an uncommon cause of kidney failure in dogs and cats. Most causes are breed-related (familial) and some are inherited. Some are congenital. Renal dysplasia is a type of familial kidney disease characterized by abnormal cellular differentiation of kidney tissue. Dogs and cats with kidney disease caused by these diseases have the typical symptoms of kidney failure, including weight loss, loss of appetite, depression, and increased water consumption and urination. A list of familial kidney diseases by dog and cat breeds is found below.
Nephrogenic systemic fibrosis is a rare syndrome that involves fibrosis of the skin, joints, eyes, and internal organs. NSF is caused by exposure to gadolinium in gadolinium-based MRI contrast agents (GBCAs) in patients with impaired kidney function. Epidemiological studies suggest that the incidence of NSF is unrelated to gender or ethnicity and it is not thought to have a genetic basis. After GBCAs were identified as a cause of the disorder in 2006, and screening and prevention measures put in place, it is now considered rare.
Mesangial proliferative glomerulonephritis (MesPGN) is a morphological pattern characterized by a numerical increase in mesangial cells and expansion of the extracellular matrix within the mesangium of the glomerulus. The increase in the number of mesangial cells can be diffuse or local and immunoglobulin and/or complement deposition can also occur. MesPGN is associated with a variety of disease processes affecting the glomerulus, though can be idiopathic. The clinical presentation of MesPGN usually consists of hematuria or nephrotic syndrome. Treatment is often consistent with the histologic pattern of and/or disease process contributing to mesangial proliferative glomerulonephritis, and usually involves some form of immunosuppressant.
Necrotizing vasculitis, also called systemic necrotizing vasculitis, is a general term for the inflammation of veins and arteries that develops into necrosis and narrows the vessels.
Malarial nephropathy is kidney failure attributed to malarial infection. Among various complications due to infection, renal-related disorders are often the most life-threatening. Including malaria-induced renal lesions, infection may lead to both tubulointerstitial damage and glomerulonephritis. In addition, malarial acute kidney failure has emerged as a serious problem due to its high mortality rate in non-immune adult patients.
Lupus vasculitis is one of the secondary vasculitides that occurs in approximately 50% of patients with systemic lupus erythematosus (SLE).
Renal ultrasonography is the examination of one or both kidneys using medical ultrasound.