Erythrogram Patterns in Dogs with Chronic Kidney Disease

Abstract

Anemia is considered a common finding in dogs with chronic kidney disease (CKD), typically as normochromic, normocytic, and non-regenerative. Although anemia can occur at any CKD IRIS (International Renal Interest Society) stage, its severity is related with the loss of kidney function. The aim of the present study was to retrospectively evaluate quantitative and morphological abnormalities of the erythrogram in dogs at different CKD IRIS stages. A total of 482 CBCs from 3648 initially screened were included in the study. Anemia was present in 302/482 (63%) dogs, in the majority of which it was normochromic, normocytic, and non-regenerative (295/302; 98%). The number of reticulocytes was <60,000/μL in the majority of dogs (248/295; 84%), with a correlation between poor regeneration rate and progression of CKD (p = 0.0001). The frequency of anemia significantly differed (p = 0.0001) among the IRIS stages: 108/231 (47%) in IRIS 2, 77/109 (71%) in IRIS 3, and 117/142 (82%) in IRIS 4. Dogs at IRIS stages 3 and 4 were more likely to have moderate to severe anemia, compared to dogs at IRIS stage 2 (p = 0.0001). Anisocytosis was the most frequent morphological abnormality (291/482; 60%), whereas the presence of poikilocytosis showed an association with progression of IRIS stages (p = 0.009). Among different morphological abnormalities, the frequency of fragmented red blood cells and Howell-Jolly bodies showed a significant association with the progression of CKD. Anemia was a frequent finding in CKD dogs, mostly associated with none to poor regeneration rate. Similar to human medicine, advanced CKD stages are more frequently characterized by morphological alterations, such as fragmented red blood cells and Howell-Jolly bodies, which may suggest a more severe condition of reduced bone marrow activity and microangiopathy.

Keywords: CKD; anemia; dog; erythrogram.

Figure 1

Spearman’s correlation analysis between RBC and serum creatinine and urea. Statistically significant, negative linear correlation (p < 0.0001; r −0.3470) between RBC (M/μmol) and serum creatinine (mg/dL), and statistically significant negative linear correlation (p < 0.0001; r −0.2840) between RBC (M/μmol) and serum urea (mg/dL) in the totality of anemic CKD dogs (n = 302).

Figure 2

Spearman’s correlation analysis between HCT and serum creatinine and urea. Statistically significant, negative linear correlation (p < 0.0001; r −0.3439) between HCT (%) and serum creatinine (mg/dL), and statistically significant negative linear correlation (p < 0.0001; r −0.2194) between HCT (%) and serum urea (mg/dL) in the totality of anemic CKD dogs (n = 302).

Figure 3

Spearman’s correlation analysis between HGB and serum creatinine and urea. Statistically significant, negative linear correlation (p < 0.0001; r −0.3286) between HGN (g/dL) and serum creatinine (mg/dL), and statistically significant negative linear correlation (p < 0.0001; r −0.2194) between HGB (g/dL) and serum urea (mg/dL) in the totality of anemic CKD dogs (n = 302).