Findings from physical observation: Edema in the tip of limbs and groin Current medications: Benazepril (Fortekor) 0.75mg/kg SID Amlodipine 1mg/head SID Furosemide 0.5mg/kg BID Medical history: Atopic dermatitis, Protein Losing Enteropathy - Lymphangiecstasia September 2019 Visited our clinic with a loss of appetite. No digestive symptoms were present. Blood test (Only the abnormal values are listed): TP...3.5 ALB...1.4g/dL CRP...7.0 Imaging test: pleural & peritoneal effusion Urinalysis: Proteinuria(-) - thoracic drainage, endoscopy, and biopsy - Diagnosed as lymphangiectasia Treatment with prednisolone stabilizes protein values. We gradually decreased the dose and continued treatment with 0.5mg/kg prednisolone once in three days (because the itch from atopic dermatitis returned when under no treatment). January 18th, 2020 Visited our clinic with swelling of the chest and little appetite. Physical examination: Edema all over the body. Fine crackles vaguely heard in the lungs. Blood test: BUN...63.5mg/dL CRE...0.6mg/dL (Protein and cholesterol values were normal) Urinalysis: Proteinuria+++ UPC>=7.59 Blood pressure: 215-141 (MAP 172) Imaging tests: No problems seen in the X-ray of lungs or cardiac ultrasound Provisional diagnosis of Protein Losing Nephropathy (or glomerulonephritis / nephrotic syndrome) Treatments: Benazepril (Fortekor) 0.75mg/kg SID, Amlodipine 1mg/head, Furosemide 0.5mg/kg BID No prednisolone for the moment. We stopped transfusions since IV drips worsened the edema. After 2 days the edema subsided and we saw an increase in appetite. Blood pressure was normal, no crackles were heard in the lungs, UPC was down to 2.5 and everything was looking better, but… On the 4th day (May 19th) edema reappeared. An increase was seen in the following values: BUN 98 CRE 2.0 K5.5 (Na144) Crackles in the lung were heard again. There were no changes in values of UPC, TP, ALB. Loss of appetite. - Dose increase for diuretics. January 24th, 2020 Edema worsened, worse physical condition. No change in values of TP, ALB. BUN 110 CRE2.3 K7.1 (Na146) My questions are: 1. When proteinuria is serious but TP and ALB are normal, would you consider proteinuria as one of the potential causes of edema? 2. The exact cause is unknown, but the edema seems to have subsided with the use of diuretics. Are diuretics always effective for edema (even in cases other than heart disease)? 3. The only type of diuretics I've used is loop diuretics, but should I be using other kinds like thiazide diuretics? 4. We're planning on checking ACTH and having a cardiovascular specialist examine the heart just in case. Do you recommend any other additional tests? 5. In dogs with Protein Losing Nephropathy, which is more effective; ACEIs or ARBs?