Before treating proteinuria, a proper diagnosis must be established to determine the primary cause. Commonly, proteinuria is a symptom of diabetic nephropathy, therefore, proper glycemic control must be observed to slow the progression of the condition. Typically, medical management involves angiotensin converting enzyme inhibitors as the first-line medication for proteinuria. In some instances when ACE inhibitors cannot control proteinuria, the patient is given angiotensin receptor blocker or aldosterone antagonist such as spironolactone to help in protein retention. If ACE inhibitor therapy is combined with these agents, caution must be observed as there is a risk of developing hyperkalemia. If proteinuria has an autoimmune origin, steroids and steroid-sparing agent in combination with the use of ACE inhibitors are used. In supplement to blood sugar and blood pressure control, dietary salt and protein is restricted. A dietician may be consulted for a healthy eating plan.
Focal cases of pemphigus foliaceus can be treated with varying strengths of topical steroids. The mainstay of therapy for more generalized cases in both dogs and cats are oral glucocorticoids (. prednisone) in combination with steroid-sparing immunosuppressive medications. These non-steroidal immunosuppressive drugs are used In order to minimize the potential side effects of glucocorticoids (. weight gain, excessive drinking and urinating, liver enlargement). In dogs, azathioprine and/or cyclosporine can be utilized, while in cats, chlorambucil and/or cyclosporine are the most popular supportive drugs. Other non-steroidal immunosuppressive drugs include gold salts (dogs and cats) and tetracycline/niacinamide (dogs). Affected animals are started at higher dosages initially until remission is achieved (approximately 4-12 weeks), and are then tapered to the lowest possible dosages that maintain remission.