88 | Alabama rot in dogs: how to spot it quickly and care for your patients confidently
In this episode, we’re chatting about a condition that’s been on our radar for a few years now, and is both incredibly challenging and frustrating to manage - and that’s cutaneous and renal glomerular vasculopathy, or as it’s better known, Alabama rot.
CRGV first appeared in the UK in 2012, and we’ve seen cases pop up every year since. It’s difficult to predict, still poorly understood and comes with high morbidity and mortality rates. However, as nurses and technicians, we play a vital role in identifying it early, educating our clients, and supporting our patients throughout their hospitalisation. And we’ll be chatting all about how to do just that throughout today’s episode.
First things first. What IS Alabama Rot, and why do we see it in dogs?
Alabama Rot, or CRGV, is a rare but often fatal disease that affects the small blood vessels in the skin and kidneys of dogs.
Patients with idiopathic CRGV have a form of thrombotic microangiopathy (TMA); a disease where patients develop widespread microscopic clots (microthrombi) within the small blood vessels.
The skin is the largest organ in the body and has an extensive blood supply via networks of vessels within the dermis. And, within the kidneys, hundreds of thousands of nephrons each contain a glomerulus - a capillary ball which filters the blood to remove waste products.
These microthrombi obstruct these small vessels, causing widespread tissue damage and, in many cases, acute kidney injury (AKI).
How does CRGV affect our patients?
Affected patients develop endothelial damage - the inner lining of their vessels becomes injured. This leads to platelet activation, as platelets try to plug the site of vessel injury and prevent haemorrhage. Clotting factors then join this platelet plug and form small clots (aka microthrombi), since platelets alone cannot prevent bleeding for longer than a few seconds.
However, these microthrombi obstruct the vessel lumen, impacting blood flow and subsequently causing tissue necrosis. In the skin, this looks like small wounds, ulcers or sores; in the kidneys, the nephrons don’t receive enough blood, causing renal injury and potentially irreversible renal failure.
The challenge? We still don’t know what causes it.
Despite extensive research over the past 13 years, no infectious agent, environmental toxin, or clear source has been definitively identified. Investigations into potential causes, including bacterial toxins, seasonal fungi, environmental contaminants, and even leeches or slugs, have not identified a conclusive cause.
Most affected dogs are walked in woodland or muddy areas, especially in the colder months - but this might be coincidental.
Ok, so that’s what Alabama Rot is, and what it does. But which dogs are affected?
CRGV can affect dogs of any breed or age, but the highest-risk groups include gundogs and hounds, especially Labradors, English Springers, and Whippets. Young adult dogs appear to be overrepresented in reported cases. It tends to occur between November and May, with cases peaking in winter and early spring, suggesting a possible seasonal or environmental trigger.
The condition isn’t thought to be contagious, but cases are often clustered geographically, particularly in southern and central England. Some dogs have lived with others who also developed skin lesions or AKI, but we don’t yet understand the whole picture.
Ultimately, any dog can pick up CRGV. Until we know more about the cause and pattern of the disease through further research, it’s hard to say that one specific patient is at increased risk. Clients should take care when walking dogs during the ‘peak’ season, especially through wooded or muddy areas.
What clinical signs do dogs with CRGV present with?
In many cases, the first clinical sign is a skin lesion - most often on the distal limbs (especially the paws), but also reported on the face, ventrum, and even the oral mucosa.
CRGV-associated skin lesions may appear as:
Focal erosions or ulcers
Non-healing sores
Red, swollen, or bruised skin
Crusting or exudate
They can resemble traumatic wounds, burns, or even insect bites, which makes them easy to misdiagnose. They often do NOT respond to topical treatment or antibiotics.
It’s after these skin lesions appear that patients develop signs of acute kidney injury, such as:
Vomiting
Inappetence
Lethargy or dullness
Polyuria or polydipsia (early)
Oliguria or anuria (late-stage AKI)
Halitosis (from uraemia)
Oral ulceration
Neurological signs such as twitching, dull mentation or seizures (uremic encephalopathy)
Not every dog with a skin lesion will go on to develop AKI - but in those that do, the prognosis significantly worsens. Published data show very high mortality rates in AKI cases; in referral populations, survival may be ~30‑40%, but many dogs do not survive. This means that rapid identification, stabilisation and intensive treatment and nursing care are essential.
Ok, that’s what Alabama Rot is, but how do we diagnose it?
Unfortunately, aside from post-mortem, there is currently no reliable test that definitively confirms CRGV.
Instead, we’ll piece together the suspected diagnosis using a combination of different tests, including skin examination and sampling, biochemistry and haematology, urine analysis and diagnostic imaging.
The common blood, urine and imaging results in dogs with CRGV include:
Azotaemia, hyperkalaemia and hyperphosphataemia on biochemistry
Proteinuria, haematuria and granular casts on urine analysis
Thrombocytopenia and mild anaemia on haematology
Evidence of acute kidney injury on ultrasound, such as renomegaly, increased cortical echogenicity, or perirenal fluid.
In addition, patients usually have characteristic skin lesions, particularly around the distal limbs. The patient may also have environmental risk factors, such as being located in an area with confirmed cases, though this is not always the case.
What about collecting biopsies from these patients?
Definitive diagnosis requires biopsies from the kidney and skin lesions submitted for histopathology. Whilst skin biopsies are relatively easy to obtain, renal biopsies are technically challenging and often require submission to a specialist renal pathology lab. Since sampling will require general anaesthesia (which may not be appropriate in a critical patient), and is not recommended in patients with bleeding tendencies, they are generally not performed antemortem in CRGV patients.
If submitted (usually postmortem), histology typically reveals epidermal ulceration and necrosis with vasculitis, and extensive glomerular damage.
Ok, so you suspect your patient has CRGV. What treatment and care do we need to consider as veterinary nurses?
The first thing - and the most difficult thing - to know is this: There is no known antidote or cure for CRGV.
Instead, our treatment is supportive and tailored to the individual patient, their clinical signs, and the progression of their disease. Rapid intervention and aggressive management will give us the best outcome, and we play a crucial role in this as nurses and technicians.
The way we manage CRGV patients depends on how they present - ie, if they have skin lesions only, or if they have both skin lesions and AKI.
For dogs with skin lesions only, wound management and regular dressing changes are essential. If a secondary infection is suspected, topical or systemic antimicrobial agents may be given.
Alongside this, patients will need careful pain assessment and appropriate analgesia, avoiding NSAIDs due to the high potential for renal involvement as the disease progresses.
These patients need careful monitoring (particularly of their renal function) to spot any deterioration as soon as possible and adjust their treatment accordingly.
If the patient develops AKI (or presents with evidence of this already), more intensive care will be needed.
This care will include careful use of fluid therapy (titrated to match the patient’s urine output), urinary management and monitoring (including catheterisation and output monitoring), and electrolyte, nutritional and gastrointestinal support.
Feeding tubes, urinary catheters, and advanced vascular access (eg, central venous catheters) are often needed, many of which are practical skills we can perform as veterinary nurses and technicians!
In some cases, dialysis or therapeutic plasma exchange (TPE/plasmapharesis) is used. This is thought to reduce circulating inflammatory substances and toxins, and ‘replace’ the kidneys’ role in filtering the blood whilst their function is severely impaired. These therapies are not widely available nor cheap, so their use is limited, but possible in some specialist centres.
And nursing dogs with CRGV? Well, there’s a LOT we can do.
These patients need such intensive nursing management and benefit from so many of our skills; the essential role we play in their care can’t be overlooked.
Here are some practical ways for you to support dogs with CRGV as a veterinary nurse or technician:
Fluid therapy management and monitoring are crucial, as the risk of overload is high in these patients. Measuring urine output and tracking ins and outs regularly is vital.
Weigh these patients more often; acute weight gain is linked to fluid overload, so regular weight monitoring is indicated.
Many patients with AKI and uraemia often become anorexic - nasal feeding tubes are a great initial choice for these patients. They can also be used to administer enteral water instead of IV fluids, where overload is a risk.
Vasculitis and renal inflammation can be incredibly painful, so pain assessment is an essential part of our nursing care.
Barrier nursing is another essential consideration. Whilst CRGV isn’t infectious, these patients often have many indwelling lines and skin lesions, so are at risk of hospital-acquired infection.
Wound care and management are other areas we champion as nurses and technicians. Appropriate bandage care, wound cleaning and dressing are vital.
These patients are a real challenge to care for, and we know that the high morbidity/mortality rate can make them disheartening - but they need SO much support from us as nurses and technicians, and we can make a real difference to their care. Plus, with the increasing availability of advanced treatments and ongoing research, I’m sure we will see big shifts in these statistics over the coming years.
Did you enjoy this episode? If so, I’d love to hear what you think. Take a screenshot and tag me on Instagram (@vetinternalmedicinenursing) so I can give you a shout-out and share it with a colleague who’d find it helpful!
Thanks for learning with me this week, and I’ll see you next time!
References and Further Reading
Abbondati, E. 2024. Case of the month: cutaneous and renal glomerular vasculopathy [Online] VPG. Available from: https://thevpg.co.uk/case-of-the-month-cutaneous-and-renal-glomerular-vasculopathy-crgv/
Alves, P. 2022. Cutaneous and renal glomerular vasculopathy and the approach to acute kidney injury [Online] VIN. Available from: https://www.vin.com/apputil/project/defaultadv1.aspx?pId=29472&id=11002067
Holm, L. 2020. Pathology and Epidemiology of Cutaneous and Renal Glomerular Vasculopathy in Dogs. Journal of Comparative Physiology, 176, pp. 156-161.
Holm, L. 2015. Cutaneous and renal glomerular vasculopathy as a cause of acute kidney injury in dogs in the UK. Vet Record, 176(15), p.384.
Hope, A. et al. 2019. Canine cutaneous and renal glomerular vasculopathy in the Republic of Ireland: a description of three cases. Irish Veterinary Journal, 72(13).
Jepson, R. et al. 2019. Cutaneous and renal glomerular vasculopathy: what do we know so far? Veterinary Clinics: Small Animal Practice, 49, pp. 745-762.
Jepson, R. et al. undated. Kidney: idiopathic cutaneous and renal glomerular vasculopathy [Online] VetLexicon. Available from: https://www.vetlexicon.com/canis/dermatology/articles/kidney-idiopathic-cutaneous-and-renal-glomerular-vasculopathy/
RVC, 2018. Breakthrough in treatment of cutaneous and renal glomerular vasculopathy [Online] RVC. Available from: https://www.rvc.ac.uk/clinical-connections/breakthrough-in-treatment-of-cutaneous-and-renal-glomerular-vasculopathy
Stevens, K. et al. 2018. Signalment risk factors for cutaneous and renal glomerular vasculopathy (Alabama rot) in dogs in the UK. Vet Record, 183(14), p.148
Walker, J. et al. 2020. Clinicopathological features of cutaneous and renal glomerular vasculopathy in 178 dogs. Vet Record, 189(4), e.72
Walker, D. Cutaneous and renal glomerular vasculopathy: what we know now [Online] Vet Times. Available from: https://www.vettimes.com/clinical/small-animal/cutaneous-and-renal-glomerular-vasculopathy-what-we-know-now-cpdalabamarot
