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Kidney: idiopathic cutaneous and renal glomerular vasculopathy
Synonym(s): CRGV, Alabama rot, Greenetrack disease
Podcast: Kidney: idiopathic cutaneous and renal glomerular vasculopathy
Introduction
- Cause: unknown.
- Signs: often presents as a cutaneous 'lesion(s)' in an otherwise asymptomatic patient. Patient may or may not subsequently develop clinical signs of acute kidney injury (AKI). AKI may be identified concurrently with skin lesions at initial presentation.
- Diagnosis: histopathology reveals a dermal +/- renal vasculopathy. Suspicion is otherwise based upon clinical signs and exclusion of other possible causes of acute kidney injury.
- Treatment: aggressive management of acute kidney injury if present. Management of cutaneous lesion(s) as appropriate dependent upon presentation. The etiology of idiopathic cutaneous and renal glomerular vasculopathy is unknown and therefore there is currently no specific therapy.
- Prognosis: variable depending upon whether patient presents with cutaneous lesion(s) alone or cutaneous lesions and acute kidney injury. The prognosis in patients that develop acute kidney injury seems to be poor.
Presenting signs
- Cutaneous lesion(s) that often begins as an erythematous and tender cutaneous swelling, often distal to the elbow or over the medial thigh. The muzzle, ventrum and oral cavity (tongue) are also commonly affected
. - The lesion may start as a focal erythematous patch that may vary in size from pinpoint up to 10 cm in diameter. Reported lesions have often, but not exclusively, been circular.
- Often progresses to cutaneous ulceration with exudate.
- Variable amount of surrounding edema, erythema and bruising.
- Cutaneous lesions often extend into the subcutis but rarely into the underlying muscle.
- Local lymph nodes have not generally been reported to be enlarged.
- Signs attributable to AKI Kidney: acute kidney injury (AKI) in a proportion of patients and possibly thrombocytopenia Thrombocytopenia and anemia:
- Lethargy.
- Anorexia.
- Vomiting.
- Diarrhea.
- Polyuria/polydipsia.
- Oliguria/anuria.
- Petechiae.
- Ecchymotic hemorrhages.
- Icterus.
Acute presentation
- Cutaneous lesion(s) as described above +/- clinical signs referable to AKI.
Geographic incidence
- Initially USA (1980s):
- Alabama.
- Colorado.
- Florida.
- Rhode Island.
- Connecticut.
- Massachusetts.
- New Hampshire.
- One case reported in Germany (2002).
- Single case report of a Greyhound in the UK with cutaneous lesions but without AKI (2000).
- Cases reported in the UK from November 2012 onwards.
Age predisposition
- None identified.
Breed/Species predisposition
- Reports initially restricted to greyhounds Greyhound.
- One Great Dane.
- Multiple other breeds in UK cases.
Public health considerations
- None known; however, etiology of the disease is unknown.
Cost considerations
- Treatment costs for the management of acute kidney injury can be high especially if management in a referral center is necessary.
Special risks
- Consider anesthesia Anesthesia: in renal insufficiency carefully in any azotemic patient.
Pathogenesis
Etiology
- Unknown.
Predisposing factors
General- Unknown.
Specific
- Unknown.
Pathophysiology
- Unclear as etiology unknown. Histopathological findings in dogs with CRGV are similar to thrombotic microangiopathy (TMA) in people. The main TMAs in people are hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura. Other causes include malignant hypertension, pre-eclampsia, various autoimmune diseases, genetic abnormalities in the immune system, radiation exposure, and drug-induced lesions. The underlying cause of TMA in the dogs with CRGV is unknown.
Timecourse
- Most dogs initially present symptomatically well with cutaneous lesions but subsequently develop signs of AKI over a few days (median 4 days; range 1-9 days). Some dogs present with cutaneous lesions and AKI at the same time whilst another subset may present with azotemia Azotemia prior to cutaneous ulceration becoming apparent. Many of the originally reported greyhounds with CRGV had cutaneous lesions only and did not develop AKI.
Epidemiology
- Unknown. Cases of CRGV in the UK have been identified in many counties. Data collection is ongoing and epidemiological data should become available over time.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Stevens K B, Jepson R, Holm L P, Walker D J, Cardwell J M (2018) Spatiotemporal patterns and agroecological risk factors for cutaneous and renal glomerular vasculopathy (Alabama Rot) in dogs in the UK. Vet Rec 183 (16), 502 PubMed
- Holm L P, Hawkins I, Robin C, Newton R J, Jepson R, Stanzani G L, McMahon A, Pesavento P, Carr T, Cogan T, Couto C G, Cianciolo R, & Walker D J (2015) Cutaneous and renal glomerular vasculopathy as a cause of acute kidney injury in dogs in the UK. Vet Rec 176 (15), 384 PubMed.
- Noris M, Mescia F, Remuzzi G (2012) STEC-HUS, atypical HUS and TTP are all disease of complement activation. Nature Reviews Nephrology 8 (11), 622-633 PubMed.
- Ross L (2011) Acute kidney injury in dogs and cats. Vet Clin North Am Small Anim Pract 41 (1), 1-14 PubMed.
- Sutton N, Bates N et al (2011) Canine adder bites in the UK: a retrospective study of cases reported to the Veterinary Poisons Information Service. Vet Rec 169 (23), 607 PubMed.
- Chantrey J, Chapman P et al (2002) Haemolytic-Uraemic Syndrome in a Dog. Journal of Veterinary Medicine Series A 49 (9), 470-472 PubMed.
- Rotermund A, Peters M et al (2002) Cutaneous and renal glomerular vasculopathy in a great dane resembling Alabama Rotof greyhounds. Vet Rec 151 (17), 510-512 PubMed.
- Cowan L, Hertzke D et al (1997) Clinical and clinicopathologic abnormalities in greyhounds with cutaneous and renal glomerular vasculopathy: 18 cases (1992-1994). JAVMA 210 (6), 789-93 PubMed.
- Vaden S L, Levine J, Breitschwerdt E B (1997) A retrospective case-control of acute renal failure in 99 dogs. J Vet Intern Med 11 (2), 58-64 PubMed.
- Hertzke D, Cowan L et al (1995) Glomerular ultrastructural lesions of idiopathic cutaneous and renal glomerular vasculopathy of greyhounds. Vet Pathol Online 32 (5), 451-459 PubMed.
- Holloway S, Senior D et al (1993) Hemolytic uremic syndrome in dogs. Journal of Veterinary Internal Medicine 7 (4), 220-227 PubMed.
- Carpenter J, Andelman N et al (1988) Idiopathic cutaneous and renal glomerular vasculopathy of greyhounds. Vet Pathol Online 25 (6), 401-407 PubMed.
Other sources of information
- Website with advice and live map of confirmed cases across the UK: https://www.alabama-rot.co.uk/
- Holm L, Walker D (2018) Dealing with cutaneous and renal glomerular vasculopathy in dogs. In Practice 40, 426-438.
- Hendricks A (2000) Akute Ulzerative Dermatitis Bei Einem Greyhound. Proceedings of the 46th Annual Congress of the Small Animal Veterinary Association, Dusseldorf, Germany, pp 62-63.