Practical Matters: Boost your hypoalbuminemia workup

Assessing albumin production and the possible causes of albumin loss is important when diagnosing and treating patients with hypoalbuminemia. Unless the patient's history suggests malnutrition, perform diagnostic tests, including a complete urinalysis, a urine protein-creatinine ratio, a bile acid assay, and possibly a fecal alpha1 proteinase inhibitor test. The proteinase inhibitor test may be useful for early detection of protein-losing enteropathy. In fact, the test result may be positive before hypoalbuminemia develops.1 However, in such cases, it may be necessary to obtain endoscopic or surgical full-thickness gastrointestinal biopsy samples for a definitive diagnosis. When protein-losing enteropathy has resulted in hypoalbuminemia, endoscopy may be the preferred method to obtain the biopsy samples.

Scott R. Helms, DVM, DABVP

If panhypoproteinemia (low albumin and globulin) is present, protein-losing enteropathy should be the primary differential diagnosis.2,3 Not all patients with protein-losing enteropathy will present with gastrointestinal signs. Furthermore, some patients may have concurrent protein-losing nephropathy or advanced hepatic disease that may contribute to the hypoalbuminemia. So evaluating for concurrent disease is recommended even in confirmed cases of protein-losing enteropathy.

REFERENCES

1. Murphy KF, German AJ, Ruaux CG, et al. Fecal alpha1-proteinase inhibitor concentration in dogs with chronic gastrointestinal disease. Vet Clin Pathol 2003;32:67-72.

2. Kull PA, Hess RS, Craig LE, et al. Clinical, clinicopathologic, radiographic, and ultrasonographic characteristics of intestinal lymphangiectasia in dogs: 17 cases (1996-1998). J Am Vet Med Assoc 2001;219:197-202.

3. Willard MD, Zenger E, Mansell JL. Protein-losing enteropathy associated with cystic mucoid changes in the intestinal crypts of two dogs. J Am Anim Hosp Assoc 2003;39:187-191.

Scott R. Helms, DVM, DABVP

Unifour Veterinary Referrals

126 Highway 321 S.W.

Hickory, NC 28602