Anderson Moores CRGV News

AlabamaRot.co.uk collate Anderson Moores Veterinary Specialists news page for CRGV information:-

IMPORTANT INFORMATION REGARDING DOGS WITH ACUTE KIDNEY INJURY (‘ALABAMA ROT’)

Information Sheets for Download

If you are a veterinary practice or pet shop please feel free to download and print the Owner Information Sheet for your clients/customers [alalabmarot.co.uk server]:

Information sheet for Dog Owners – update May 2015

Information sheet for Vets – update Oct 2014

30th May 2015

There has been one further confirmed case of cutaneous and renal glomerular vasculopathy (CRGV) over the past two months (Blandford Forum, Dorset). We are not currently awaiting any further pathology results from affected dogs.

We have written an information sheet/newsletter on CRGV for dog owners and this can read by clicking on: May 2015 updated leaflet for owners.

7th April 2015 update
There have been three further confirmed cases of cutaneous and renal glomerular vasculopathy (CRGV) over the past month (Cheshire, Nottinghamshire and Hampshire). We have also seen two suspected CRGV cases that have survived (from Berkshire and Hampshire). We are not currently waiting on any further pathology results from affected dogs.

A link to the scientific publication on CRGV is provided below. There is a link to a CRGV podcast featuring David Walker on our facebook page: https://www.facebook.com/VetSpecialists

23rd March 2015

We are pleased to be able to report that a paper summarising the details of 30 of the confirmed cases has now been published by The Veterinary Record and is freely available online:

http://veterinaryrecord.bmj.com/content/early/2015/03/13/vr.102892.abstract

27th February 2015 update

There have been two further confirmed cases of cutaneous and renal glomerular vasculopathy (CRGV) over the past few weeks (Cornwall and West Yorkshire).

A paper we have written summarising information from 30 of the confirmed cases will be published over the next few weeks by The Veterinary Record and will be open access (i.e. available to all online). A link to the paper and a further update will be posted on this webpage over the next few weeks.

29th January 2015 update

There have been six further confirmed cases of cutaneous and renal glomerular vasculopathy (CRGV) over the past few weeks (Hampshire, Greater London, Dorset, Berkshire, Kent and East Sussex). An additional case treated at Anderson Moores was considered highly likely to have had CRGV and fortunately survived, meaning that a definitive diagnosis was not made (since this requires post mortem testing).
The Forestry Commission are no longer hosting a table with the exact geographical location of cases. At this stage we do not know for certain if there is an environmental trigger for CRGV. Indeed, if there is an environmental trigger we do not know when, in relation to the development of clinical signs, this occurs (e.g.  environmental exposure could occur one day, one week, or one month before clinical signs develop). Any information posted about geographical location may therefore not be that relevant given dogs are often walked in different areas. Updates and further information will continue to be posted on this webpage with the broad geographical location of cases.

5th January 2015 update

There have been two further confirmed case of cutaneous and renal glomerular vasculopathy (CRGV) over the past few weeks (Runcorn and Manchester). We are not currently waiting on any further pathology results from affected dogs and have not been contacted about other possible cases.

December 2014 update 

There has been one confirmed case of cutaneous and renal glomerular vasculopathy (CRGV) since our last update (Hampshire – Deerleap). Although an environmental trigger has been proposed as the possible cause of CRGV this has not been proven. We continue to advise owners to remain vigilant and contact their local Veterinary surgeon if they are concerned.

21st October 2014 update 

We would like to remind you that we are entering the time of year when cases of cutaneous and renal glomerular vasculopathy (CRGV or ‘Alabama rot’) have presented. Affected dogs typically present with a lesion(s) on the distal limb although lesions have also been seen on the face and ventrum. The skin lesions may initially appear as superficial erosions and may progress to full thickness ulceration. Initially you may just notice your dog licking at their foot or leg and it may not be clear what the problem is underneath the fur. Lesion size has ranged from 0.5 to 5cm in diameter. There is no apparent breed, age or sex predilection. Forty five dogs have been histopathologically confirmed to have been suffering from CRGV in the UK over the past two years. Cases have been identified across the whole of the UK and some dogs have survived.

At initial presentation with a skin lesion(s) dogs are typically otherwise asymptomatic (feeling well), but over the subsequent one to nine days they develop clinical signs referable to acute kidney injury (AKI). This may include being very thirsty, depressed, off their food or vomiting. Some patients will present with skin lesions and AKI concurrently and rarely dogs present with AKI prior to the development of skin lesions.

Your veterinary surgeon may decide to take blood and urine to test and monitor for the development of this disease. Blood results will reveal azotaemia and possibly thrombocytopaenia, mild anaemia and hyperbilirubinaemia. Urinalysis will reveal dilute urine and possibly glucosuria and casts.

If you are a dog owner and are concerned about your pet, please speak to your local vet in the first instance who would be welcome to contact us. We are collating national data on all possible cases and continue to work with National Authorities. We can provide histopathology free of charge on suspected cases.

If you are a Veterinary surgeon and are concerned that a case you have been presented with may be suffering from CRGV then please feel free to contact us for further advice.

22nd July 2014 update 

No new cases of cutaneous and renal glomerular vasculopathy (CRGV) have been identified since early June 2014. We were awaiting pathology results from two cases (Hampshire and Somerset) and both of these cases have now been confirmed to have been affected by CRGV. With the recognition of one historical case this brings the total number of confirmed cases to forty four.

Any further major developments over the next few months will be posted on our website otherwise updates will be posted on our facebook page (www.facebook.com/VetSpecialists).

1st July 2014 update 

The number of dogs affected by cutaneous and renal glomerular vasculopathy (CRGV) seems to be decreasing as the year progresses with the last confirmed case being in early June 2014. Since the last update, two further dogs have been confirmed to have been affected by CRGV (Dorset and Lancashire) and we are awaiting results on a further two suspected cases (Hampshire and Somerset). This brings the total number of confirmed cases to forty one.
A manuscript summarising the clinicopathological findings will be submitted this month with publication anticipated later in the year.
The epidemiological data that has been collected to date continues to be reviewed and we continue to encourage dog owners of affected and unaffected dogs to complete a questionnaire which can be found at www.aht.org.uk/cms-display/aki-form.html.
Any further major developments over the next few months will be posted on our website otherwise updates will be posted on our facebook page (www.facebook.com/VetSpecialists).

14th May 2014 update 

An additional five dogs have been confirmed to have been suffering from cutaneous and renal glomerular vasculopathy (CRGV) bringing the total number of confirmed cases across the UK to thirty nine. Three of these dogs were from the North West, one was from Kent and one was from the New Forest. The geographical location of all affected cases can be seen on the Forestry Commission website (http://www.forestry.gov.uk/alabamarot).
We continue to actively pursue an underlying cause for this disease and are working with a number of academic institutions in the UK and US.
We have been contacted by a number of concerned clients asking if a vaccine is available to protect against CRGV. Unfortunately the underlying cause of CRGV is not known and therefore a vaccine cannot be developed.
We continue to encourage dog owners of affected and unaffected dogs to complete a questionnaire which can be found at http://www.aht.org.uk/cms-display/aki-form.html.
We are happy to assist with enquiries regarding this distressing condition, but due to the volume of enquiries, we can only respond to enquiries from veterinary surgeons. If you are a pet owner and would like advice please contact your local veterinary practice.

7th April 2014 update 

Thirty dogs across the UK have now been confirmed to have been affected by cutaneous and renal glomerular vasculopathy (‘Alabama rot’). These dogs have all had examination of kidney tissue performed to confirm the diagnosis. A list of the geographical location of cases can be found on the Forestry Commission website (http://www.forestry.gov.uk/alabamarot).

There has been some suggestion in the media that cutaneous and renal glomerular vasculopathy is caused by feeding raw food. We have found no link to any particular brand or type of food, nor have we identified any link to raw diets.

It has been suggested that washing dogs post walking can definitely prevent this disease. Although washing may not an unreasonable thing to do, we do not know the cause of cutaneous and renal glomerular vasculopathy and it is therefore impossible to give specific, accurate advice on prevention. An environmental cause is only one of a number of possibilities.

We would continue to encourage dog owners of affected and unaffected dogs to complete a questionnaire which can be found at http://www.aht.org.uk/cms-display/aki-form.html

25th March 2014 update 

Twenty eight dogs across the UK have now been confirmed to have been affected by cutaneous and renal glomerular vasculopathy (‘Alabama rot’). These dogs have all had examination of kidney tissue performed to confirm the diagnosis. There are also a number of unconfirmed cases that either survived and/or for which no pathology results are available. A list of the geographical location of cases can be found on the Forestry Commission website (http://www.forestry.gov.uk/alabamarot). Case numbers remain relatively low and research into this disease is ongoing. More information can be found in the attached information sheets. We would encourage dog owners of affected and unaffected dogs to complete a questionnaire which can be found at http://www.aht.org.uk/cms-display/aki-form.html

10th March 2014 update 

Since the last update below (24th February 2014), four further dogs have been confirmed to have been affected by cutaneous and renal glomerular vasculopathy (‘Alabama rot’). One of these dogs was from Shropshire, one from Northamptonshire and the other two had been walked in the New Forest (Rhinefield, Deerleap). This brings the total number of confirmed cases to 27 (14 dogs from the New Forest and 13 dogs from elsewhere around the UK). The New Forest District Council have a table on their website (www.newforest.gov.uk/index.cfm?articleid=14110) showing the locations of cases across the UK and this table will be updated regularly. The information sheet for vets and information sheet for owners above has been updated.

Update 24th February 2014

Since the last update below (6th February 2014), three further dogs have been confirmed to have been affected by cutaneous and renal glomerular vasculopathy (‘Alabama rot’). One of these dogs was from Yorkshire, one from Monmouthshire and one from Dorset. The New Forest District Council are hosting a table on their website (http://www.newforest.gov.uk/index.cfm?articleid=14110) showing the locations of cases across the UK. We are awaiting pathology results from a small number of further dogs, and our website and the table will continue to be updated at two weekly intervals as more information becomes available.

6th February 2014 update 

Since December 2013 there have been five dogs confirmed to have been affected by cutaneous and renal glomerular vasculopathy (‘Alabama rot’). All five of these dogs had been walked in the New Forest (Brockenhurst, Wilverley inclosure, Tiptoe, Holmesley campsite and Gordleton). One dog survived but unfortunately four dogs did not survive. We are awaiting pathology results on five further dogs suspected to be suffering from the same condition. None of these dogs survived and they originated from various counties across the UK, not including Hampshire. These dogs have not yet been confirmed as suffering from cutaneous and renal glomerular vasculopathy (CRGV) and the results will be available later this month. A further update will be posted in due course. The New Forest District Council and Forestry Commission have been made aware of the newly reported cases.

This brings the total number of dogs affected by CRGV since late 2012 to nineteen (12 from the New Forest and 7 from other counties in the UK). There are a small number of suspected additional cases (5 dogs) over the past two months that we are not able to confirm as no pathology results are available.

Investigations are ongoing and updates will continue to be posted on our web page. We launched a questionnaire for pet owners last year with the help of the Animal Health Trust in order for us to be able to collect as much information as possible about locations, walking routes and diet. This questionnaire is available at (link deleted 18/10/16). The questionnaire was initially designed for pet owners of affected and unaffected dogs walked in a specific area of the New Forest. It is however applicable to any pet owner walking their dog in the New Forest. The Animal Health Trust will be updating their website to reflect this in due course. A questionnaire for non-New Forest pet owners will be available shortly.

Although this is a problem that we are taking very seriously, we would stress that a relatively small number of dogs have been affected with respect to the total number of dogs walked in the areas mentioned. Most skin lesions on dogs limbs will not be related to this disease. Dogs affected by CRGV have been seen throughout the UK and not solely in the New Forest.

If you are a Veterinary surgeon and have any concerns about a dog that you feel may be affected by this condition and would like to discuss this further then please do not hesitate to contact us via telephone (01962 767920) or e-mail (admin@andersonmoores.com). If you are a pet owner looking for more information then please contact your local veterinary practice. A link to an information sheet on CRGV for Veterinary Surgeons and an information sheet for owners can be found above this update.

Update 22nd January 2014

There has been a significant amount of media interest in the dogs with idiopathic cutaneous and renal glomerular vasculopathy (Alabama Rot) over the past 48 hours. The key messages are that this problem has affected a very small number of dogs and that most wounds/lesions will not be related to this disease and that most cases of kidney failure in dogs are not caused by this disorder. Cases have been seen throughout the UK and not solely in the New Forest.

The dogs we have seen have initially presented to their local vets with skin wounds of unknown origin and have gone on to develop clinical signs of kidney failure within 2-7 days. The skin lesions have generally been 1-4cm in length; they have generally been below the knee or elbow and have either been a red patch with hair loss or a defect in the skin (an ulcer). These lesions are typical of a cutaneous vasculopathy where patches of skin die due to damage to the blood vessels in the skin (i.e. the wounds we have seen in these cases are not thought to have been traumatic wounds sustained on a walk).

We cannot give specific advice on the management of a dog with a skin wound of unknown cause on our website. Some vets in practices in the New Forest have been offering a blood test at initial presentation of a dog with a wound of unknown cause; however, this could well be within reference range at initial presentation.  If you are a Veterinary surgeon and are presented with such a case, and if you feel it is appropriate you could offer baseline serum biochemical testing. This may well be normal at initial presentation; however, it could then be followed up 2-4 days later. Owners who are concerned by an odd-looking wound on their dog’s leg should consult their local veterinary surgeon in the first instance.

If you are a Veterinary surgeon and have any concerns about a dog that you feel may be affected by or at risk of this condition and would like to discuss this further then please do not hesitate to contact us via telephone (01962 767920) or e-mail (info@andersonmoores.com). If you are a pet owner looking for more information then please contact your local veterinary practice in the first instance -it is very difficult for us to offer advice over the phone and you will need your local vet to examine your dog first.

16th January 2014 update 

Over the past month a further two dogs from the New Forest have presented to Anderson Moores Veterinary Specialists with skin wounds/lesions and acute kidney failure. These dogs were walked in the Tiptoe area and Wilverley inclosure. One of the dogs survived but unfortunately one was euthanased as a result of the disease. These are the first new cases we are aware of since late March 2013. Anderson Moores Veterinary Specialists saw six dogs between December 2012 and March 2013 with similar presenting signs. Five of these had been walked in the New Forest and the other dog was from Upton in Dorset. We are aware of at least eight other cases (two from the New Forest and six from around the UK). Three of the dogs seen at Anderson Moores have survived but unfortunately the remaining dogs were euthanased as a result of the severity of their disease.

Testing for the more common causes of acute kidney failure has been normal in all affected dogs. It is the concurrent presence of skin lesions and in some patients thrombocytopaenia (a low blood platelet count) and haemolytic anaemia (a low red blood cell count) that makes the cases so unusual. Histopathological evaluation (microscopic examination) of kidney tissue from post mortem samples from affected dogs by specialist pathologists in the UK and the US has revealed changes similar to those identified in greyhounds diagnosed with idiopathic cutaneous and renal glomerular vasculopathy (abnormalities of the blood vessels of the skin and kidneys of unknown cause). These changes are similar to those seen in human patients with a condition called haemolytic uraemic syndrome (HUS). In some people with HUS anE.coli toxin (shiga toxin) has been identified as the underlying cause; however, the underlying trigger for HUS is not always found. We have examined both the faeces and kidney tissue of affected dogs for E.coli toxin and testing has been negative. Further testing on kidney tissue to try and identify the underlying cause is ongoing. We are very grateful to those owners who consented to post mortem examination of their much loved pets in order to try and investigate the underlying cause of this problem.

The skin wounds develop prior to more generalised clinical signs (lethargy, reduced appetite, vomiting) and the best advice we can give to members of the general public is to seek Veterinary attention early if you notice a wound/lesion on your pet. If you are a Veterinary surgeon and have any concerns about a dog that you feel may be affected by or at risk of this condition and would like to discuss this further then please do not hesitate to contact us via telephone (01962 767920) or e-mail (info@andersonmoores.com). If you are a pet owner looking for more information then please contact your local veterinary practice in the first instance.

Update October 2013

As you may be aware, unfortunately a number of dogs that had been walked in and around the New Forest developed acute kidney failure between December 2012 and March 2013. Six patients were seen by Anderson Moores Veterinary Specialists over this time period. Three were walked in the Ogdens area, one around the Verely car park area and the other at Wilverley inclosure. The sixth dog was walked in Upton, Dorset. The last case was seen in April 2013. The most recent dog death reported by the media in August 2013 was not considered to be related to the previous cases.
The affected dogs all initially developed sores/lesions on their legs (below the elbow or knee) and then went on to develop acute kidney failure. As a result of this cluster of cases, a letter was sent to Veterinary surgeons in the South of England advising them of this problem. Additionally a letter was placed in the Veterinary Record to alert Veterinary surgeons across the UK. An additional eight cases were identified that were considered to be suffering from the same disorder. Two of these additional eight cases were from the New Forest (Dibden and Verely car park) and the others were from Worcestershire, Cornwall, County Durham and Surrey. Two of the six dogs seen at Anderson Moores Veterinary Specialists survived. Unfortunately none of the other dogs survived despite intensive treatment.
All of the more common, well-known causes of acute kidney failure were excluded in all of the dogs. Detailed further investigations have been performed on blood, urine, faeces and post mortem tissue. This has included bacterial, viral and heavy metal testing. Additionally, kidney tissue has been examined by a number of Veterinary pathologists and human nephropathologists (specialist kidney pathologists). Water testing in the New Forest was also performed. Despite extensive further testing the exact underlying cause unfortunately remains unknown.
A scientific paper is currently being prepared at Anderson Moores Veterinary Specialists to make sure Veterinary surgeons across the UK are aware of this problem. Anderson Moores Veterinary Specialists will continue to collate cases and will continue with investigations seeking the underlying cause of this worrying disease.
If you are a veterinary surgeon and have any concerns about a dog that you feel may be affected by or at risk of this condition and would like to discuss this further then please do not hesitate to contact us via telephone (01962 767920) or e-mail (info@andersonmoores.com). If you are a pet owner then please contact your local veterinary practice in the first instance.

Update 1st May 2013

There have been no further cases in the New Forest that we have been made aware of since the last confirmed case that we reported on 2nd April 2013. Unfortunately no further answers have been forthcoming after further examination of renal tissue by veterinary and human nephropathologists. Further bacterial causes have been explored and have proven negative. The cause therefore remains unknown although testing is on-going and all avenues are being explored. We have been made aware of a small number of dogs outside of the New Forest that have presented with similar signs over the past few months although we have not been made aware of any new cases over the past month. Three of these cases (1 in Surrey and 2 in Worcestershire) had histopathology of their kidney performed and the findings were similar to those identified in the dogs we have pathology from in the New Forest.
We have had an excellent response to the questionnaire that we developed with the Animal Health Trust and Forest Vets and this data will be analysed over the coming weeks. The questionnaire is still online and we continue to encourage pet owners from the New Forest area to complete this. The mapping of dog walking routes is currently focused on Fordingbridge and the surrounding area although there is the opportunity for owners from other areas to describe their walking route. Additional maps are likely to be added in the future. The questionnaire can be found at www.aht.org.uk/newforestdogdeaths. We would ask you to encourage your clients to complete the questionnaire. Many thanks.
We continue to recommend vigilance amongst veterinary surgeons to detect the development of acute kidney injury as early as possible. This will give the best chance of successful treatment. We would also suggest non-steroidal ant-inflammatory drugs (NSAIDs) are used cautiously where there is a lesion or skin injury of unknown origin. NSAID’s should be avoided entirely if there is any suspicion of renal disease.
If you are a veterinary surgeon and have any concerns about a dog that you feel may be affected by or at risk of this condition and would like to discuss this further then please do not hesitate to contact us via telephone (01962 767920) or e-mail (info@andersonmoores.com). If you are an owner then please contact your local veterinary practice in the first instance.

10th April 2013 update 

We wanted to provide a further update to our referring veterinary surgeons. We have had no new cases of acute kidney injury (AKI) referred to us from the Fordingbridge area since 1st March 2013. We have also not been made aware of any additional cases in this area and letters have been sent to all vets in and around the New Forest advising that Anderson Moores Veterinary Specialists are collecting the data. A case from the Ringwood area was seen at Anderson Moores Veterinary Specialists last week. Unfortunately this dog did not survive. Two of the seven dogs seen at AMVS have survived.

We wanted to provide a little more information on what has been excluded by further testing in the dogs with acute kidney injury. This testing is in addition to the exclusion of the more widely known causes of AKI in the dog. Heavy metal testing on tissue from the affected patients and the environment has been negative. Tests for organic and inorganic chemicals in the environment has also been negative. Many bacterial causes have also been excluded with bacterial culture and molecular testing. Histopathology has revealed vasculitis without elucidating the underlying cause. Tissue samples continue to examined by specialist human and veterinary pathologists to see if any more information can be obtained. Testing is on-going in the hope of finding the underlying cause.

We continue to recommend vigilance amongst veterinary surgeons to detect the development of acute kidney injury as early as possible. This will give the best chance of successful treatment. We would also suggest non-steroidal ant-inflammatory drugs (NSAIDs) are used cautiously where there is a lesion or skin injury of unknown origin. NSAID’s should be avoided entirely if there is any suspicion of renal disease.

We have developed a questionnaire with the assistance of the epidemiology team at the Animal Health Trust and we are encouraging pet owners from the New Forest area to complete this. The mapping of dog walking routes is currently focused on Fordingbridge and the surrounding area although there is the opportunity for owners from other areas to describe their walking route. Additional maps are likely to be added in the future. The questionnaire can be found athttp://www.aht.org.uk/cms-display/aki.html. We would appreciate it if you could direct your clients to the questionnaire. Many thanks.

If you are a veterinary surgeon and have any concerns about a dog that you feel may be affected by or at risk of this condition and would like to discuss this further then please do not hesitate to contact us via telephone (01962 767920) or e-mail (info@andersonmoores.com). If you are an owner then please contact your local veterinary practice in the first instance.

Update 9th April 2013:

Following on from the recent cluster of dogs with acute renal failure, we would encourage all pet owners who have visited Fordingbridge or the surrounding area to fill in a questionnaire that has been developed by epidemiologists at the Animal Health Trust. The aim of the questionnaire is to build up a picture of the walking and feeding habits of non-affected and affected dogs.

Link to questionnaire

11th March 2013 update

We have not had any further cases of AKI presented to Anderson Moores Veterinary Specialists since 1st March. We are grateful to colleagues that have contacted us to inform us of possible cases and we are continuing to compile a detailed database of affected dogs.  Renal tissue from affected dogs continues to be reviewed by veterinary colleagues as well as a human nephropathologist. Toxicology testing is on-going with no definitive cause having yet been found.  We are also working with epidemiologists.
If you are a Veterinary surgeon and have any concerns about a dog with acute kidney injury then please do not hesitate to contact us via telephone (01962 767920) or e-mail (info@andersonmoores.com).
If you are a client then please contact your local Veterinary Practice in the first instance. The general advice being given at this stage is to consider avoiding the Latchmore/Ogdens area of the New Forest. If your pet develops a wound on its face or limb then Veterinary attention should be sought.

6th March 2013

Over the past two months we have seen an increased number of dogs presenting with severe acute kidney injury (acute renal failure). Almost all of these dogs have come from the Fordingbridge area; however, others have originated from elsewhere on the South coast. These dogs initially presented to their primary veterinary practices with a lesion on the distal limb and/or face. Symptomatic therapy was given but the dogs subsequently developed severe azotaemia due to acute kidney injury a few days later. Six dogs with foot or face lesions and acute kidney injury have been managed at Anderson Moores Veterinary Specialists and we are aware of two further dogs that were managed at their primary veterinary practices. The underlying aetiology is as yet unknown although a nephrotoxin is suspected. Renal tissue has been sent to colleagues in the USA for further evaluation and we are working hard to explain this worrying cluster of cases.
It is difficult at this time to give dog owners any specific advice to reduce the risk of their dog becoming affected as we do not know the route of entry or the nature of the potential nephrotoxin.  We recommend vigilance amongst veterinary surgeons to detect the development of acute kidney injury as early as possible, as this will give the best chance of successful treatment. We would also recommend non-steroidal antiinflammatories (NSAIDs) are used cautiously where there is a lesion or skin injury of unknown origin, and obviously should be avoided entirely if there is any suspicion of a renal problem.
If you are a veterinary surgeon and have any concerns about a dog that you feel may be affected by or at risk of this condition and would like to discuss this further then please do not hesitate to contact us via telephone (01962 767920) or e-mail (info@andersonmoores.com). If you are an owner then please contact your local veterinary practice in the first instance.

David Walker

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