Health Screening for Protein-Losing Enteropathy (PLE), Protein‑Losing Nephropathy (PLN), Renal Dysplasia (RD), and Addison's Disease
Recommended by SCWTCA and its Researchers

During your Wheaten's annual health check, our veterinary researchers, Meryl Littman VMD DACVIM, Shelly Vaden DVM DACVIM, and David Williams ECVIM-CA/ACVIM, recommend owners test their Wheatens annually for evidence of PLE/PLN, RD, and/or Addison's Disease. Here is what you and your veterinarian should look for:

• Quick Definitions
• Clinical Signs
• Laboratory Tests Run By Your Vet
• Optional Tests
• Diagnosing PLE/PLN/RD/Addison's
• What to do next?

Quick Definitions

• PLE & PLN:
  These are syndromes characterized by a loss of proteins from the gastrointestinal tract (Protein-Losing Enteropathy - PLE) or the kidneys (Protein-Losing Nephropathy – PLN)
• RD:
  Renal Dysplasia (RD) is the abnormal development of the kidney. This malformation can result in early renal failure.
• Addison's Disease:
  Addison's disease (Hypoadrenocorticism) is the insufficient production and secretion of hormones (glucocorticoids, mineralocorticoids) by the adrenal gland cortex.

Clinical Signs

Clinical signs of a disease are the things you can see or that your veterinarian may discover on his physical examination of your Wheaten. Remember, testing is important: in many conditions, clinical signs do not up until well after tests may show signs of the disease. Also, many clinical signs of one disease can also be signs of another.

RD	PLE	PLN1	Addison's2
Increased water consumption Increased urination (dilute urine) "Poor doer" Decreased appetite Vomiting Possibly prone to urinary tract infection	Vomiting Diarrhea Weight loss Ascites Edema Pleural effusion	Listlessness/ depression Decreased appetite, vomiting, weight loss Ascites, edema, pleural effusion Increased water consumption Increased urination (less common) Thromboembolic phenomena & hypertension (less common)	Listlessness/ depression Decreased appetite, vomiting, weight loss Inability to handle stress Sudden collapse Slow heart rate

¹PLE and PLN are difficult to diagnose. The initial stages of the disease may be mistaken for liver, glandular or other enteric or kidney diseases. Wheatens with PLE and/or PLN may have serious thromboembolic events (such as pulmonary embolism) before symptoms or renal failure start, even before there is increased serum creatinine or BUN.

² The clinical signs of Addison's Disease are often nonspecific and can mimic those of multiple other medical disorders.

Laboratory Tests Run By Your Vet

Your veterinarian can check for signs of these diseases with blood and urine tests. It is important the panels run by your Vet test for everything listed here,Note that not all routine blood and urine tests do, so you must make sure the ones listed here are run.

Blood and urine tests cannot predict whether a dog will develop these diseases. But they can determine whether or not a dog is now clear of signs of disease and establish baseline values for future comparison. Early detection can offer more choices for treatment and can often provide longer and better quality of life.

Your veterinarian should run the following tests:

1. Biochemical profile, including:
   • Total protein (TP)
   • Albumin (Alb)
   • Globulin
   • Creatinine (Cr)
   • Blood Urea Nitrogen (BUN)
   • Cholesterol (Chol)
   • Sodium (Na)
   • Potassium (K+)
   • Phosphorus (Phos)
2. Complete Blood Count
3. Routine Urinalysis, including:
   • Specific gravity
   • Dipstick
   • Urinary sediment
4. Urine Protein/Creatinine Ratio
5. RECOMMENDED but OPTIONAL:
   • ERD or MA test for microalbuminuria.
     If doing UPC, these tests are not necessary.
6. RECOMMENDED but OPTIONAL:
   
   • Fecal API test

If you or your veterinarian suspect RD or Addison's, the following tests can be run:

• Renal Dysplasia (RD):
  • Abdominal radiographs/Ultrasound
  • Final confirmation of RD: Kidney biopsy (wedge, not Tru-cut); Your veterinarian can call Dr. Meryl Littman to discuss size. Her contact information can be found below.
• Addison's:
  • ACTH stimulation test

Optional Tests

The two optional tests below may be early indicators of PLE and PLN. You can arrange for these through your veterinarian at the same time you do your annual screening. Alternatively, you can take the samples at home and ship them for testing in a kit SCWTCA has developed. For information on these, please click on the links below:

• PLE: Fecal API (FAPI) Test
• PLN: Microalbuminuria (MA) test. Alternatively, you can ask your vet to run an ERD test in his office.

Diagnosing PLE/PLN/RD/Addison's

These diseases can be difficult to diagnose and can be confused with each other. Here are some of the similarities and differences.

Source: 1999 ACVIM PROCEEDINGS: Soft Coated Wheaten Terrier PLE-PLN;
Meryl P. Littman VMD DACVIM, Philadelphia PA

	RD	PLN	PLE	Addison's
Age of Onset	<1-3 yrs	Mean ~ 6 yrs	Mean ~ 4.5 yrs	Young (in general)
Sex Predilection	None noted	Female: male=1.6	Female: male=1.7	Female (in general)
Polyuria/ Polydipsia	Yes	Only 25% had PU/PD	No, unless on steroids	Yes
Vomiting/Diarrhea	Yes	Yes	Yes	Yes
Ascites / Edema	No	Possibly	Possibly	No
Azotemia	Yes	Eventually	No	Possibly (pre-renal)
Kidney Size	Small	May be normal	Normal	Normal
Hypoalbuminaemia	No	Yes	Yes	Possibly (melaena)
Hypoglobulinemia	No	No	Yes	Possibly (melaena)
Hypercholesterolaemia	No	Yes	Hypocholesterolaemia	No
Low Na/K ratio	Not noted	Rarely (~10%)	Rarely (~10%)	Yes
Urine Specific Gravity	Isosthenuria	Mean 1.023	Mean 1.033	Low (medullary washout)
Proteinuria	None or mild	Yes	No	No
Histopathology    K = kidney    I = intestine	Fetal glomeruli, Fetal mesenchyme (K)	Glomerulonephritis, glomerulosclerosis (K)	IBD, lymphangiectasia, lymphangitis (I)

Other important lab findings:

RD	PLE	PLN1	Addison's2
Elevated creatinine Elevated BUN	Eosinophilia Lymphopenia Low total protein	Elevated serum creatinine Elevated BUN Elevated Urine Protein Creatinine Ratio** **Very important!	Elevated serum creatinine Elevated BUN

Remember, diagnosis of PLE/PLN, RD, or Addison's is dependent on evaluating everything ... test results, clinical signs and symptoms — so do not assume one "bad" item means your dog has these diseases.

What to do next?

• Make sure you do testing every year and have your veterinarian compare results.
• Keep a copy of the results in a file at home so you can always refer back to them or provide them to a new veterinarian if you move.
• Some people keep a spreadsheet on their computer with all the test results.
  • You can find a template for this at the Maryland Soft Coated Wheaten Terrier Association website at http://www.mscwta.org/Medical.htm.
  • Another tool, the Watchdog Health Tracker, is available through the SCWT Endowment Fund.

SCWTCA neither recommends nor endorses either tool but provides this information for your assistance.

If these results show any abnormalities, you and your veterinarian need to take immediate action.

1. You: Contact your breeder immediately. He or she will want to know in order to help you and to take action on other dogs in their breeding program.
2. Your veterinarian: Please contact Dr. Littman or Dr. Vaden for further advice on diagnosis and treatment.

NOTE:
Because of state veterinary medicine licensure regulations, Dr. Littman and Dr. Vaden can no longer consult with individual owners who are not patients of their institutions. Any contact with them should be solely through your veterinarian on a professional consultation basis; additionally, your veterinarian can consult with a local member of the ACVIM.

Dr. Meryl P. Littman Associate Professor of Medicine University of Pennsylvania School of Veterinary Medicine 3900 Delancey Street Philadelphia PA 19104-6010 (215) 898-9288 (215) 573-6050 fax (include cover sheet)

Dr. Shelly Vaden Professor, Internal Medicine North Carolina State University College of Veterinary Medicine 4700 Hillsborough Street Raleigh NC 27606 (919) 513-6235 (919) 513-6336 fax (include cover sheet)

Updated May 2004