• Open Access

Consensus Recommendations for Immunosuppressive Treatment of Dogs with Glomerular Disease Based on Established Pathology

Authors

  • IRIS Canine GN Study Group Established Pathology Subgroup,

  • G. Segev,

    chair, Corresponding author
    1. Koret School of Veterinary Medicine (Segev), The Hebrew University of Jerusalem, Rehovot, Israel
    • Corresponding author: Gilad Segev, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, PO box 12, Rehovot 76100, Israel; e-mail: gsegev@agri.huji.ac.il.

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  • L.D. Cowgill,

    1. Department of Medicine and Epidemiology (Cowgill), School of Veterinary Medicine, University of California-Davis, Davis, CA
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  • R. Heiene,

    1. Blue Star Animal Hospital, Gothenburg, Sweden and PetVett Dyresykehus, Oslo, Norway (Heiene)
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  • M.A. Labato,

    1. Department of Clinical Sciences (Labato), Foster Hospital for Small Animals, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
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  • D.J. Polzin

    1. Department of Veterinary Clinical Sciences (Polzin), College of Veterinary Medicine, University of Minnesota, St Paul, MN
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  • All subgroup members listed above of the IRIS Canine GN Study Group contributed equally in the preparation of this manuscript

Abstract

The purpose of this report was to provide consensus recommendations for the use of immunosuppressive therapy in dogs with active glomerular diseases. Recommendations were developed based on comprehensive review of relevant literature on immunosuppressive therapy of glomerular disease in dogs and humans, contemporary expert opinion, and anecdotal experience in dogs with glomerular disease treated with immunosuppression. Recommendations were subsequently validated by a formal consensus methodology. The Study Group recommends empirical application of immunosuppressive therapy for dogs with severe, persistent, or progressive glomerular disease in which there is evidence of an active immune-mediated pathogenesis on kidney biopsy and no identified contraindication to immunosuppressive therapy. The most compelling evidence supporting active immune-mediated mechanisms includes electron-dense deposits identified with transmission electron microscopic examination and unequivocal immunofluorescent staining in the glomeruli. For diseases associated with profound proteinuria, attendant hypoalbuminemia, nephrotic syndrome, or rapidly progressive azotemia, single drug or combination therapy consisting of rapidly acting immunosuppressive drugs is recommended. The Study Group recommends mycophenolate alone or in combination with prednisolone. To minimize the adverse effects, glucocorticoids should not be used as a sole treatment, and when used concurrently with mycophenolate, glucocorticoids should be tapered as quickly as possible. For stable or slowly progressive glomerular diseases, the Study Group recommends mycophenolate or chlorambucil alone or in combination with azathioprine on alternating days. Therapeutic effectiveness should be assessed serially by changes in proteinuria, renal function, and serum albumin concentration. In the absence of overt adverse effects, at least 8 weeks of the rapidly acting nonsteroidal drug therapy and 8–12 weeks of slowly acting drug therapy should be provided before altering or abandoning an immunosuppressive trial.

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