Proteinuria reduction after treatment with miltefosine and allopurinol in dogs naturally infected with leishmaniasis

Aim: The aim of this study was to evaluate changes in proteinuria in dogs naturally infected with visceral leishmaniasis, following treatment with miltefosine (MLF) and allopurinol. Materials and Methods: Medical records of 40 dogs with leishmaniasis, treated with 2 mg/kg MLF every 24 h PO and 10 mg/kg allopurinol every 12 h for 28 days were reviewed. 20 dogs were included in the study, and clinical staging was performed following guidelines of the Canine leishmaniasis (CanL) Working Group, and dogs were categorized for proteinuria according to the International Renal Interest Society (IRIS) staging system. Clinical score, indirect fluorescent antibody test titer, serum total protein, gamma globulin (IgG), serum creatinine and urea concentration, and urine protein creatinine ratio (UP/C) were recorded at the time of diagnosis before the start of therapy (D0) and at the end of 28 days of therapy (D28). Results: Following the CanL Working Group staging, all 20 dogs were classified as the clinical Stage C (Clinical disease) before and after the cycle of treatment. Before the cycle of therapy, dogs were categorized according to the IRIS staging system, as: 9/20 non-proteinuric (NP), 7/20 borderline proteinuric (BP), and 4/20 proteinuric (P). After treatment, 12/20 dogs were NP, 7/20 were BP, and 1/20 was P. There was a significant change in UP/C values before and after one cycle of treatment with MLF. In detail, after 28 days of therapy, 2 of 9 NP dogs became BP, 3 of the 7 BP dogs became NP, and 2 of the 4 P dogs became NP. Conclusion: This study showed a significant decrease in UP/C values occurred after one cycle of treatment with MLF and allopurinol in dogs naturally affected with CanL. This suggests that MLF does not increase proteinuria, and the use of MLF could be considered for the management of dogs with leishmaniasis, particularly in those with impaired renal function at the time of diagnosis.