Assessment of Renal Function and Bilirubin Measurement in Urine as Prognostic Value in Immune-Mediated Hemolytic Anemia in Dogs

BORBA-JUNIOR, IVANIO T.; BASSO, ROBERTA M.; GORENSTEIN, TATIANA G.; LIMONTA, NAYARA; SANTOS, BRUNA DOS; RAMOS, MARCOS M.; TAKAHIRA, REGINA K.

doi:10.1590/0001-3765202620241141

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ANIMAL SCIENCE • An. Acad. Bras. Ciênc. 98 (1) • 2026 • https://doi.org/10.1590/0001-3765202620241141 linkcopy

Assessment of Renal Function and Bilirubin Measurement in Urine as Prognostic Value in Immune-Mediated Hemolytic Anemia in Dogs

Authorship SCIMAGO INSTITUTIONS RANKINGS

Immune-mediated hemolytic anemia (IMHA) is the leading cause of hemolytic anemia in dogs. Although renal injury has been reported in IMHA patients, laboratory findings defining the type and extent of renal damage remain inconsistent. The aim of this study was to evaluate key laboratory findings in the assessment of renal function in dogs with a suspected diagnosis of IMHA and to correlate these findings with disease prognosis. A prospective study was conducted on 21 dogs treated at a veterinary hospital with a suspected diagnosis of IMHA. Blood samples were collected for complete blood count and biochemical analyses, and urinalysis was performed. Significant alterations in renal function were observed in IMHA patients. The urinary protein-to-creatinine ratio (UPC) was elevated compared to controls (P < 0.0002) and correlated with the degree of anemia (R = -0.638) and the inflammatory status, assessed by white blood cell count (R = 0.550). In addition, urinary bilirubin levels were increased in IMHA patients (P < 0.0001), suggesting that bilirubin is an important prognostic marker of the disease. Renal function is impaired in IMHA patients, and urinary bilirubin levels serve as a valuable prognostic indicator.

Key words
Biomarkers; Canine; Hemolysis; Proteinuria; Veterinary clinical pathology

	IMHA patients (n=21)	Controls (n=10)	P value
Physicochemical parameters of urinalysis
USG *	1.025 (1.016 – 1.038)	1.040 (1.021 – 1.053)	0.10
pH *	6 (5.87 – 7)	6 (5.75 – 6.25)	0.47
Protein (mg/dL) *	69.2 (44 – 114)	13.2 (7.85 – 18.6)	< 0.0001
UPC ratio *	1.22 (0.76–2.12)	0.06 (0.03–0.09)	0.0002
Urinary Total bilirubin (mg/dL) *	9.22 (5.00 – 12.2)	1.40 (0.75 – 1.90)	< 0.0001
Urinary Direct bilirubin (mg/dL) *	4.23 (1.42 – 7.28)	0.80 (0.35 – 1.40)	0.0002
Urinary Indirect bilirubin (mg/dL) *	3.00 (1.18 – 5.40)	0.30 (0.15 – 0.65)	0.002
Urinary sediment
Renal or pelvic epithelial cells, yes:no (%)	11:21 (52%)	0:10 (0%)	0.004
Bladder or urethral epithelial cells, yes:no (%)	8:21 (38%)	3:10 (30%)	0.99
Granular casts, yes:no (%)	8:21 (38%)	0:10 (0%)	0.03
bilirubin crystals yes:no (%)	7:21 (33%)	0:10 (0%)	0.06

Variable	Correlated with	Correlation coefficient	P
UPC	USG UTB UDB Serum TB Serum DB Serum IB Urea Creatinine ALP Albumin Hematocrit WBC NLR	-0.455 0.615 0.365 0.739 0.714 0.675 0.184 -0.340 0.681 -0.568 -0.638 0.550 0.662	0.014 0.0001 0.048 0.0001 0.0001 0.0001 0.331 0.066 0.0001 0.001 <0.0001 0.002 0.0001

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[tfnI] *Median (interquartile range); IMHA: Immune-mediated hemolytic anemia; USG: urine specific gravity; UPC: urine protein-to-creatinine ratio; The presence of epithelial cells was considered positive when one or more cells were observed per field. The presence of granular casts and bilirubin crystals was considered positive when 0–1 particles per field (400x) were observed. P values were obtained via the Mann–Whitney test or Fisher’s exact test for categorical variables.