Testing for MA has been a good indicator of early renal disease in dogs and cats, especially those with glomerular disease. In one study, 12 dogs were infected with Dirofilaria immitus L3 larvae. All of them developed MA 14-23 months post-infection, and the magnitude of MA increased over time and preceded the development of overt proteinuria.

Urine albumin was also studied in 36 male dogs with X-linked hereditary nephropathy, a rapidly progressive glomerular disease, and in 20 Soft-Coated Wheaton Terriers, a breed genetically at risk for the development of protein losing nephropathy. The presence of MA was shown to be a reliable early marker of developing nephropathy and preceded overt proteinuria in both studies.

Non-renal diseases associated with MA fall into the categories of: 1) infectious (e.g., Lyme disease, heartworm disease, FIP, FIV, FeLV); 2) inflammatory (e.g., peridontial disease, chronic skin disease, pancreatitis, hepatitis, IBD); 3) neoplastic; 4) metabolic (e.g,, diabetes mellitus, hyperthyroidism); and 5) cardiovascular disorders. As not all of these diseases are likely to result in permanent renal damage, the presence of MA may be transient and should be interpreted cautiously along with the clinical assessment and other diagnostic testing, as indicated.

In a retrospective study involving 137 dogs with overt proteinuria, (albumin >30 mg/dL) and histopathological diagnosis of glomerulopathy, significant concurrent medical problems were identified in ˜ 50% of the dogs. In a recent study of dogs that were negative for protein on conventional urine protein dipsticks but positive for MA, infectious, inflammatory, or neoplastic diseases were identified in 56% of them.

The first step following a positive MA test is to look for underlying disease conditions that could be involved, and reassess the initial diagnostic work-up (e.g., physical examination, complete urinalysis, serum chemistry profile, complete blood count, and blood pressure measurement). After successful treatment of the condition, if identified, consider repeating the MA test in 1 to 3 months.

If a likely cause of MA cannot be identified, the next step depends on the magnitude of MA. For high positive MA results, a urine protein:creatinine ratio should be run to establish a baseline and monitor disease progression. If the test result is low or medium positive, consider repeating the MA test in 1 to 3 months. If the degree of MA is stable or decreasing in a non-azotemic patient, careful patient monitoring (e.g., physical examination, urinalysis, MA test and serum creatinine every 6 to 12 months) is recommended. However, if the magnitude of MA is increasing over time in a non-azotemic patient, consider additional diagnostic procedures (e.g., thoracic and abdominal radiography, abdominal ultrasonography, serology for regionally prevalent infectious diseases, renal biopsy), and implementing specific therapies reported to delay progression of renal disease (e.g., prescription renal diets, ACE inhibitors).