What is hypoalbuminemia?
Hypoalbuminemia is a condition in which the amount of albumin in the blood is lower than normal (“hypo” means “below,” “-emia” means “blood”). Albumin is an important blood protein made by the liver.
In the bloodstream, albumin acts like a fluid magnet, keeping fluid inside blood vessels and preventing it from leaking into surrounding tissues. Albumin also carries substances like vitamins, hormones, and medications throughout the body.
What causes low albumin in dogs?
Low albumin in dogs usually occurs for one of three reasons:
- The liver not making enough albumin (decreased production)
- The body is losing too much albumin (increased loss)
- Albumin is leaking out of the bloodstream and collecting in tissues or body spaces (sequestration)
Causes of decreased albumin production include:
- Chronic liver disease (e.g., chronic hepatitis, cirrhosis, congenital portosystemic shunt)
- Hypoadrenocorticism (Addison’s disease)
- Poor nutrition
Causes of increased albumin loss include:
- Protein losing nephropathy (PLN): Loss through the kidneys
- Protein losing enteropathy (PLE): Loss through the intestine
- Lymphangiectasia
- Chronic inflammatory enteropathy (formerly inflammatory bowel disease)
- Histoplasmosis
- Chronic intussusception
- Severe oozing skin lesions or burns (protein losing dermatopathy)
- Long-term severe blood loss (often from the gastrointestinal tract)
- Acute surgical blood loss
Causes of sequestration include:
- Fluid leaking into the belly or around the lungs (abdominal effusion, pleural effusion)
- Severe inflammation (including infection and immune-mediated conditions)
What are the signs of low albumin?
In early stages, there may be no specific signs of low albumin. Instead, your dog may show signs of the disease causing the low albumin, including diarrhea, weight loss, and oozing or draining skin lesions.
Signs of severe low albumin are caused by fluid leaking out of the bloodstream and can include:
- Swelling (edema) in lower areas of the body, such as the legs and over the sternum (breastbone)
- A bloated abdomen due to abdominal effusion (abnormal accumulation of fluid in the abdominal cavity)
- Increased breathing rate and effort due to pleural effusion (accumulation of excess fluid in the space surrounding the lungs)
- Muffled heart and lung sounds caused by fluid around the lungs
How is low albumin diagnosed?
Low albumin can be detected in a blood sample, often in a biochemistry profile. However, identifying low albumin is only the first step. Additional testing is needed to determine the underlying cause.
Your veterinarian will recommend tests based on your dog’s clinical signs, physical examination findings, and the results of testing done so far. Additional testing may include:
- Urine protein:creatinine ratio (UPC) to identify abnormal protein loss from the kidneys
- Bile acid testing to assess liver function
- Cortisol testing to identify or rule out Addison’s disease (hypoadrenocorticism)
- Gastrointestinal testing such as cobalamin (vitamin B12) and pancreatic function testing, to screen for PLE and other gastrointestinal diseases
- Abdominal ultrasound to evaluate organs like the stomach, liver, pancreas, and intestines
- X-rays to screen for pleural effusion (fluid around the lungs)
If fluid is found around the lungs or in the abdomen, your veterinarian may recommend fluid analysis to look for abnormal cells, infectious organisms, or other clues to the underlying cause.
How is low albumin treated?
Treatment focuses on identifying and managing the underlying disease causing the low albumin, and may involve:
- Changes in diet
- Chronic medications like prednisone to treat immune-mediated conditions
- Medications for kidney or liver disease
- Management of Addison’s disease
- Antifungal therapy for histoplasmosis
- Supportive care to manage signs like vomiting or diarrhea
Specific treatment for severe low albumin often involves hospitalization for treatments including:
- Draining of body cavity fluids to temporarily reduce clinical signs, especially difficulty breathing
- Replacing albumin in the blood using fresh frozen plasma or other blood products in critically ill patients to reduce ongoing fluid sequestration
Regular monitoring, including physical examinations and blood and urine testing, is often recommended to ensure albumin levels are improving and that your dog is responding well to treatment.
What is the prognosis for dogs with low albumin?
The prognosis for dogs with hypoalbuminemia varies widely, depending on the underlying cause. The likelihood of improvement depends on the degree of albumin loss as well as the underlying disease. Your veterinarian can provide a more accurate prognosis for your dog based on their condition and underlying disease.
Dogs with severely low albumin levels have a lower chance of recovering and an increased risk of complications such as thromboembolism (stroke).
