Jane Armstrong shone a light on protein losing enteropathy (PLE) in a way that only she can in last week’s veterinary webinar organised by ‘The Webinar Vet’. PLE is a complex syndrome which can be challenging to diagnose, and Jane gave us some great advice on how to get through this whole process.

She explained that PLE needs to be considered in any dog suffering from hypoalbuminaeamia, but other underlying causes will need to be ruled out. These include liver failure, protein losing nephropathy (PLN) and acute gastrointestinal heamorrhage. PLN can be diagnosed by performing a urinalysis and measuring the protein:creatinine ratio which should not be more than 0.5.  Also dogs suffering from PLN will only be hypoalbuminaemic and not hypoglobulinaemic as the globulin molecules are too large to pass through the glomerulus. Dogs suffering from PLE are much more likely to be hypoproteinaemic, suffering from both hypoalbuminamia and hypoglobulinaemia.

Jane went on to explain that surprisingly not every case of PLE has overt gastrointestinal clinical signs. In a study performed on Yorkshire terriers with intestinal lymphangiectasia, two thirds had diarrhoea and, interestingly, one third of cases had no signs of diarrhoea at all. In fact some cases of PLE will actually have dermatological signs courtesy of being hypocalcaemic. If severe enough, clinical signs associated with hypocalceamia will develop, one of which includes intense facial pruritis.

These cases are also prone to developing thromboembolic disease as a complication of gastrointestinal protein loss. Dyspnoea or sudden death may be seen with pulmonary embolism and acute focal oedema of a limb and/or acute posterior paresis being seen with other thromboembolic events. Jane treats her cases of PLE with a low dose of aspirin (0.5-1mg/kg/day) for its antithrombotic effect but she states this may still not be adequate to prevent a thromboembolic event.

Jane discussed intestinal lymphangiectasia in greater depth and explained that this condition was characterised by the dilation of lymphatics and leakage of lymph from villi and deeper portions of the bowel. Lymphangiectasia is often secondary to disease which causes an increase in hydrostatic pressure within lymphatic vessels. This could be due to inflammatory and neoplastic conditions such as IBD and lymphoma respectively. However it is important to remember that an increase in venous pressure will also cause this effect and may be seen in dogs with right sided heart failure and pericardial effusion.

Treatment for lymphangiectasia was discussed further with treatment for any underlying disease such as IBD and a balanced low fat diet being key. Adjunctive therapy with immunosuprressives are generally necessary in these cases with prednisolone being dosed at 1-2mg/kg/day (30mg/m2 for larger dogs). However if side effects associated with prednisolone become an issue, an alternative steroid known as budesonide (Entocort) could be used. It has excellent mucosal effects and has a high percentage metabolism of first pass through the liver allowing the avoidance of most side effects associated with steroids.

I have only touched on just a few of the useful and relevant pieces of advice provided by Jane. There was a lot more discussion centred around treatment and diagnosis including a specific test to help with the diagnosis of PLE. There is little doubt that this is one of those veterinary webinars you cannot and must not miss out on.