Kidney disease is the number one cause of death by euthanasia in canines, and has been the latest health topic of the Miniature Bull Terrier fancy. As the breeder and owner of two widely used stud dogs, I was very concerned and therefore, accelerated my testing by contacting my Veterinarian to schedule current UP/C tests. Thankfully both were within the normal range, but with the implications that the deaths of so many MBT's are contributed to hereditary kidney disease and since there have been three deaths contributed to kidney failure out of over one hundred offspring sired by "Biff', I felt I should learn more about kidney disease. Of the three deaths, two of the offspring were necropsied and it was determined their kidney failure was more than likely due to infection. In medicine nothing is 100%, but infection does top the list as the number one cause of kidney failure in the canine.

Four months ago, my knowledge of canine kidney disease was very limited, therefore I could not determine fact from fiction in the information that's been circulating about the disease. I turned to the Internet and found over 1000 sites on the subject. There were a few excellent ones, such as the Cornell University site, but most were set up by individuals with a personal experience or selling products. There was one site "Hereditary nephritis in the Bull Terrier - Evidence for inheritance by autosomal dominant gene," I found interesting, as information found in that article was quoted in an ad that ran in our last ALB. The article was published 13 years ago (1990), from studies conducted in Australia in the 70's and 80's. In the rapidly changing medical field, the age of this study concerned me. For example - the article stated that a Bull Terrier is considered to be proteinuric if the UP/C ratio is 0.3 and above, on two occasions more than a month apart. According to current information from The College of Veterinary Medicine, Cornell University, proteinuria is associated with urine protein creatinine ratios of above 3.0, not 0.3 Since the Australian study did not mention the normal range for the UP/C tests used, and the fact that the actual research was conducted 20 + years ago, it is impossible to evaluate what ratio range was normal and what was abnormal in that particular study. Here in the US, the normal ranges differ among labs. My Veterinarian uses Anteck Diagnostics and their normal range is 0.0 - 1.0, where National Bio Vet Laboratory's normal range is 0.0 - 0.6. The ratio of .5 from Anteck is still in the normal range where a .5 from National Bio Vet Laboratory would be in the high range. I contacted Antect Diagnostics and they stated their normal range is in fact, 0.0 - 1.0, and they stated that the age of the dog being tested should be a consideration, since most cases of chronic renal failure have no specific cause beyond the normal aging process.

A few days after reading the "Australian" article I came across a magazine article in my doctor's office written by medical doctor, Dr. Toni Ann Clair, MD, of East Rockaway, NY, stating - " Many patients turn to the Internet for health information, but unless you have a medical background and can be discerning about the source, you may be taking advice that's WRONG, OUTDATED even POTENTIALLY DANGEROUS! Since the 1990 Australian article is old and outdated, and since the breeders quoting the article, to my knowledge, have no medical background, I felt I should obtain accurate and current information on the subject by contacting a qualified professional in the medical field. I called on Dr. K. Culberson, who has over 30 years of Veterinary experience. Dr. Culberson was kind enough to sit down with me and answer the questions I had listed during my extensive Internet search, as well as questions from other breeders. I will list the questions and answers below, but first, after asking four breeders the definition of nephritis and getting four wrong answers and realizing that sixteen weeks ago didn't know the definition either, I felt it would be of interest to list the definitions of words and terms commonly used in defining kidneys and kidney disease.

Renal - Relating to, involving, located in the region of the kidneys.

Renal Failure - Kidney failure

Acute Renal Disease - A kidney disorder that occurs suddenly. Possible causes include bacterial infections, drug toxicities and poisons.

Chronic Renal Disease - Gradual destruction over a period of time of kidney tissue that will eventually result in reduced kidney function, and often has no identifiable cause.

Inherited Renal Disease - A kidney disorder where the cause is not a degeneration of the kidney tissue, but rather the kidneys fail to develop and mature normally. Inherited kidney disorders frequently affect patients five years of age and younger

Nephritis - Inflammation of the kidney

Hereditary Nephritis - A genetic disorder resulting in structurally defective glomerular (and other) basement membranes.

Glomerulus - Filtering unit of the nephron.

Nephron - The structural and functional unit in the kidney. The nephron is a delicate structurally complicated, microscopically small collection of tiny tubes.

UP/C Test - Urine Protein to Creatinine Ratio test.

Creatinine - A byproduct of normal metabolism that is produced at a fairly constant rate in the body and is normally filtered by the kidneys and excreted in the urine.

BUN - Blood Urea Nitrogen. A blood test that estimates kidney function.

Genetic Disorder - A genetic disorder is one in which an abnormality in the genetic make-up of the individual plays a significant role in causing the condition. Although some disorders occur because of spontaneous mutation, many genetic disorders are inherited.

Familial Disease - Diseases which occur in more numbers of a family than would be expected by chance. The term "hereditary" is commonly and incorrectly used to describe familial disease. "Hereditary" should not be used unless the mode of inheritance is known.

Hereditary Disease - A disease genetically passed or passable from parent to offspring.

Congenital - A characteristic present at birth. It may be induced by events that occur during pregnancy, or it may be inherited.

Uremia - The condition in which a dog gets sick from wastes (toxins) that build up in the blood.

Proteinuria - Excessively high protein in the urine. The College of Veterinary Medicine Cornell University states - Proteinuria is usually associated with urine protein creatinine ratios of above 3.0

An interview with Dr. K. Culberson

Q - What is the number one cause of death by euthanasia in the canine?

A - Renal failure. Unlike humans, the canine heart generally outperforms the kidneys.

Q - What percentage of death from kidney disease are of genetic (hereditary) origin?

A - In my experience the overall percentage would be less than 1 0%. In some specific breeds that percentage could be higher.

Q - What is the major cause of kidney failure? Would it be a hereditary disease, toxins, old age?

A - Infection is the major cause of kidney failure. The kidneys contain nephrons that are hair like filters and these filters when lost from infection, toxins, etc. are lost forever.

Q - When a puppy is born with one kidney smaller than the other, is it usually genetic or simply a birth defect?

A - It can be a birth defect, or it may be the kidney atrophied from kidney disease. It would be necessary to extract the kidneys upon death to determine the cause.

Q - Why are the normal ranges for UP/C tests different from one lab to another? Are there several different UP/C tests?

A - The tests are basically the same, but they can be run on different equipment, therefore the normal ranges can differ from one lab to another.

Q - In a UP/C test, if the Creatinine level is out of the normal range, or the protein level is out of the normal range, but the ratio is in the normal range, is there a problem?

A - Neither number on it's own may be significant, it is the ratio that is significant.

Q - If both parents test normal, can they still produce affected offspring.

A - In hereditary nephritis, the mode of inheritance is thought to be by an autosomal dominant gene, which would mean that one of the parents must be affected.

Q - If I feed a high protein diet, will the protein level be higher in the UP/C test? If I reduce the protein will it make a difference?

A - Yes, it will make a difference, but if a dog is in kidney failure, with an abnormal UP/C ratio, the level of reduction would not be significant. Contrary to popular myth, diets rich in protein do not cause kidney damage. Research conducted several years ago indicated that rodents were adversely affected by diets high in protein and misguided researchers extrapolated that data to apply to the canine.

Q - What do you feel is the normal UP/C range?

A - As mentioned above, different labs use different ranges. I use Anteck Diagnostics, which is one of, if not the largest diagnostic center in the country. Their normal range is from 0.0 to 1.0. Much depends on the age of the dogs tested. The ratio of an aged dog will most likely be higher than a young dog.

I hope this article helps answer some of the questions concerning kidney disease. I am concerned about the diseases that affect our breed and I'm certainly not sticking my head in the sand and saying that the Miniature Bull Terrier has no genetic health problems I am very much aware of the hereditary diseases that plague the Mini, but we need to be aware that kidney disease, as with heart disease can have causes other than genetics. Before we assume that every Mini that is afflicted with a particular disease, is of a hereditary nature, we should have confirmed evidence and not depend on here say.

There is one very important fact I have learned over my fifteen years in Minis, and that is to seek the knowledge of a medical professional or specialist, when confronted with any health related problem, or health related question and even at that, seek a second or third opinion with serious health concerns.

I firmly believe that testing before breeding and culling dogs with abnormal test results will help to reduce the number of cases of genetically related diseases, but in order to cull such dogs, we need accurate, up- to- date information on the disease and we need to understand test results in order to accuser distinguish what abnormal is. The best way to accomplish this is to ask a medical professional.