How do veterinarians in Switzerland manage leishmaniosis? A survey-based overview of our treatment approaches with a focus on the management of proteinuria

INTRODUCTION: Canine leishmaniosis is a zoonotic disease with diverse clinical manifestations; renal involvement is among the most severe. In light of the lack of recommendations for managing canine Leishmania-associated proteinuria across LeishVet disease stages, climate change and the associated risk of Leishmania infantum becoming endemic in Switzerland, a targeted evaluation of disease awareness and current therapeutic strategies is needed. This study investigated treatment strategies used by Swiss veterinarians for managing canine leishmaniosis, focusing on proteinuria. An online survey was conducted using LimeSurvey®. A total of 817 veterinarians were contacted, and 149 fully completed questionnaires were analyzed (response rate: 18,2 %). Most respondents reported following LeishVet guidelines in their treatment of leishmaniosis. Urinalysis is performed by 84,6 % of participants. In LeishVet stage 2B (urinary protein:creatinine ratio 0,5-1), 43 % initiate antiproteinuric treatment; in stage 4 (urinary protein:creatinine ratio > 5), 80 % treat proteinuria. Angiotensin-converting enzyme inhibitors are the most frequently used medications, preferred over angiotensin II receptor blockers. Interestingly, the latter are mainly used in advanced stages of the disease. In summary, only a minority of veterinarians initiate antiproteinuric treatment in LeishVet stage 2B (urinary protein:creatinine ratio 0,5-1), although this would be the optimal time for slowing the progression of renal disease. Possible reasons include additional costs and a lack of awareness of the potential negative consequences of proteinuria. The results also show heterogeneity in treatment decisions and highlight the need for clear, stage-based recommendations for the management of proteinuria in canine leishmaniosis.