Scott R. Helms, DVM, DABVP
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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.
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
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