Canis ISSN: 2398-2942

Protein-losing enteropathy

Synonym(s): PLE

Contributor(s): Ken Harkin, Craig Ruaux, Mellora Sharman

Introduction

  • Excessive loss of proteins into the gut → hypoproteinemia.
  • Cause: primary intestinal pathology.
  • Signs: diarrhea (sometimes), edema, weight loss.
    • Diarrhea typically variable, soft, poorly formed stools.
    • Gastrointestinal signs can show a waxing/waning course.
  • Diagnosis: signs, hypoproteinemia, intestinal biopsy.
  • Treatment: symptomatic. Directed at underlying pathology.
  • Prognosis: guarded.

Pathogenesis

Etiology

Increased intestinal permeability

Reduced lymphatic drainage

Pathophysiology

  • Loss of albumin via intestine exceeds synthesis → hypoproteinemia Hypoproteinemia.
  • Defective lymphatic drainage → ruptured lymph ducts → protein carried in lymph lost into gut lumen.
  • Protein lost in the gut is normally digested and reabsorbed.
  • If protein loss increases, or reuptake is reduced, then protein is lost from body in feces.
  • Hypoproteinemia → peripheral edema, ascites, pleural effusion Pleural: effusion.

Timecourse

  • Insidious onset.
  • Weeks to months.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • The references below may not be the most recent. For recent references go to PubMed and VetMedResource.
  • Kathrani A, Sanchez-Vizcaino F, Hall E J (2019) Association of chronic enteropathy activity index, blood urea concentration, and risk of death in dogs with protein-losing enteropathy. J Vet Intern Med 33(2), 536-543 PubMed.
  • Washabau R, Day M, Willard M, Hall E, Jergens A et al (2010) Endoscopic, biopsy and histopathologic guidelines for the evaluation of gastrointestinal inflammation in companion animals. J Vet Intern Med 24, 10-26 PubMed.
  • Allenspach K, Wieland B, Gröne A and Gaschen F (2007) Chronic enteropathies in dogs: evaluation of risk factors for negative outcome. J Vet Intern Med 21(4), 700-708 PubMed.
  • Mellanby R J, Mellor P J, Roulois A, Baines E A, Mee A P, Berry J L & Herrtage M E (2005) Hypocalcaemia associated with low serum vitamin D metabolite concentrations in two dogs with protein-losing enteropathies. JSAP 46 (7), 345-351 PubMed.
  • Ruaux C G et al (2004) Protein-losing enteropathy is associated with reduced fecal proteolytic activity in dogsVet Clin Pathol 33 (1), 20-22 PubMed.
  • Jergens A, Schreiner C, Dagmar E, Yosiya N, Franklin E et al (2003) A scoring index for disease activity in canine inflammatory bowel disease. J Vet Intern Med 17 (3), 291-297 PubMed.
  • Littman M P et al (2000) Familial protein-losing enteropathy and protein-losing nephropathy in Soft Coated Wheaten Terriers - 222 Cases (1983-1997). J Vet Intern Med 14 (1), 68-80 PubMed.
  • Vaden S L et al (2000) Food hypersensitivity reactions in Soft Coated Wheaten Terriers with protein-losing enteropathy or protein-losing nephropathy or both - gastroscopic food sensitivity, dietary provocation and fecal immunoglobulin E. J Vet Intern Med 14 (1), 60-67 PubMed.
  • Suter M M, Palmer D G, Schenk H (1985) Primary intestinal lymphangiectasia in three dogs: a morphological and immunopathological investigation.​ Vet Pathol 22 (2), 123-130 PubMed.


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