Evaluation of the association between initial proteinuria and morbidity rate or death in dogs with naturally occurring chronic renal failure

Objective - To determine whether urine protein-to-creatinine ratio (UP:C) ≥ 1.0 at initial diagnosis of chronic renal failure (CRF) is associated with greater risk of development of uremic crises, death, and progression of renal failure in dogs. Design - Prospective cohort study. Animals - 45 dogs with CRF. Procedure - Dogs were prospectively assigned to 2 groups on the basis of initial UP:C < 1.0 or ≥ 1.0. The association between magnitude of proteinuria and development of uremic crises and death was determined before and after dogs with initial UP:C ≥ 1.0 were assigned to 3 subgroups and compared with dogs with initial UP:C ≤ 1.0. Changes in reciprocal serum creatinine concentration were used to estimate decrease in renal function. Results - Initially, dogs had similar clinical characteristics with the exception of systolic blood pressure and UP:C. Relative risks of development of uremic crises and death were approximately 3 times higher in dogs with UP:C ≥ 1.0, compared with dogs with UP:C < 1.0. Relative risk of adverse outcome was approximately 1.5 times higher for every 1-unit increment in UP:C. The decrease in renal function was of greater magnitude in dogs with UP:C ≥ 1.0, compared with dogs with UP:C < 1.0. Conclusions and Clinical Relevance - Initial UP:C ≥ 1.0 in dogs with CRF was associated with greater risk of development of uremic crises and death, compared with dogs with UP:C < 1.0. Initial determinations of UP:C in dogs with naturally occurring CRF may be of value in refining prognoses.