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Friday SE, Oyama MA, Massey LK, Aronson LR. Effect of metastatic calcification on complication rate and survival in 74 renal transplant cats (1998-2020). Vet Surg 2023; 52:952-960. [PMID: 37395131 DOI: 10.1111/vsu.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/25/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To report the incidence of metastatic calcification in cats with renal failure presenting for renal transplantation, and to determine if metastatic calcification detected prior to renal transplantation is associated with complication rates and patient survival. STUDY DESIGN Retrospective case series. SAMPLE POPULATION Seventy-four cats. METHODS In imaging studies, 178 feline renal transplant recipients from 1998 to 2020 were evaluated for metastatic calcification. Demographic, clinicopathological data, intraoperative complications, postoperative complications, need for hemodialysis, and survival times were recorded. Exclusion criteria were cats lacking imaging reports and cats with gastric, renal, or tracheal/bronchial calcification alone. Univariable and multivariable analyses were performed to determine variables that were independently associated with survival. Kaplan-Meier analysis was used to generate survival plots and estimate median survival times with a 95% confidence interval (CI). RESULTS Seventy four of 178 cats met the inclusion criteria. Fifteen of 74 (20.3%) cats had metastatic calcification prior to renal transplantation. Twelve of 74 (16.2%) cats developed calcification following transplantation, and 47 of 74 (63.5%) cats had no calcification during the study period. Median follow-up time was 472 days, with a range of 0-1825 days. Cats with pretransplant calcification had shorter median survival times (147 days) than cats without calcification (646 days) (p = .0013). Metastatic calcification pretransplant was associated with an increased risk of death by 240% (95% CI, 1.22-4.71). CONCLUSION Metastatic calcification in renal transplant cats is a negative prognostic indicator and is associated with decreased survival times. CLINICAL SIGNIFICANCE These findings may help guide therapeutic recommendations and owner expectations in cats undergoing renal transplantation.
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Affiliation(s)
- Sarah E Friday
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark A Oyama
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura K Massey
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lillian R Aronson
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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El-Husseiny HM, Mady EA, Helal MAY, Tanaka R. The Pivotal Role of Stem Cells in Veterinary Regenerative Medicine and Tissue Engineering. Vet Sci 2022; 9:648. [PMID: 36423096 PMCID: PMC9698002 DOI: 10.3390/vetsci9110648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/09/2022] [Accepted: 11/18/2022] [Indexed: 07/30/2023] Open
Abstract
The introduction of new regenerative therapeutic modalities in the veterinary practice has recently picked up a lot of interest. Stem cells are undifferentiated cells with a high capacity to self-renew and develop into tissue cells with specific roles. Hence, they are an effective therapeutic option to ameliorate the ability of the body to repair and engineer damaged tissues. Currently, based on their facile isolation and culture procedures and the absence of ethical concerns with their use, mesenchymal stem cells (MSCs) are the most promising stem cell type for therapeutic applications. They are becoming more and more well-known in veterinary medicine because of their exceptional immunomodulatory capabilities. However, their implementation on the clinical scale is still challenging. These limitations to their use in diverse affections in different animals drive the advancement of these therapies. In the present article, we discuss the ability of MSCs as a potent therapeutic modality for the engineering of different animals' tissues including the heart, skin, digestive system (mouth, teeth, gastrointestinal tract, and liver), musculoskeletal system (tendons, ligaments, joints, muscles, and nerves), kidneys, respiratory system, and eyes based on the existing knowledge. Moreover, we highlighted the promises of the implementation of MSCs in clinical use in veterinary practice.
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Affiliation(s)
- Hussein M. El-Husseiny
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi 183-8509, Tokyo, Japan
- Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh, Elqaliobiya 13736, Egypt
| | - Eman A. Mady
- Laboratory of Veterinary Physiology, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi 183-8509, Tokyo, Japan
- Department of Animal Hygiene, Behavior and Management, Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh, Elqaliobiya 13736, Egypt
| | - Mahmoud A. Y. Helal
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi 183-8509, Tokyo, Japan
- Department of Animal Medicine, Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh, Elqaliobiya 13736, Egypt
| | - Ryou Tanaka
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-shi 183-8509, Tokyo, Japan
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Aronson L, Phillips H, Oyama M. Characterization of preoperative cardiovascular status and association with outcome following feline renal allograft transplantation: 166 cases. J Am Vet Med Assoc 2022; 260:1518-1525. [DOI: 10.2460/javma.22.03.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
OBJECTIVES
To retrospectively evaluate preoperative historical, biochemical, and cardiovascular screening data for predictors of survival to discharge and long-term survival in feline renal allograft recipients from 1 institution.
ANIMALS
166 cats that underwent renal transplantation at the University of Pennsylvania between 1998 and 2018.
PROCEDURES
Medical records were reviewed for preoperative historical information, biochemical data, and cardiac assessment including auscultation findings, pre- and postoperative systolic blood pressure measurements, thoracic radiographic evaluation, and echocardiographic measurements. The need for hemodialysis, the number of surgical procedures, native kidney biopsy diagnosis and survival time was also recorded. Kaplan-Meier analysis was used to generate survival plots and estimate median survival times with a 95% CI. Univariable and multivariable analysis were performed to determine variables that were independently associated with survival to discharge and long-term survival.
RESULTS
The patient population primarily consisted of adult male DSH cats (70%) diagnosed with IRIS stage 4 CKD (66.3%). Abnormalities identified on preoperative cardiac assessment, including hypertension, the presence of a murmur, echocardiographic changes, and radiographic signs of congestive heart failure, were not associated with survival to discharge or long-term survival. Age was the only single significant variable associated with survival, and the risk of death increased by 11% (95% CI, 6% to 17%) for every 1 year in patient age.
CLINICAL RELEVANCE
The presence of cardiac abnormalities identified during the screening process of cats presenting for transplantation should not immediately exclude a potential candidate for the procedure. Owners considering transplantation should be educated on the impact of age on survival following surgery.
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Affiliation(s)
- Lillian Aronson
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Heidi Phillips
- Department of Veterinary Clinical Medicine, Veterinary Medical Teaching Hospital, College of Veterinary Medicine, University of Illinois, Urbana, IL
| | - Mark Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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Voga M, Adamic N, Vengust M, Majdic G. Stem Cells in Veterinary Medicine-Current State and Treatment Options. Front Vet Sci 2020; 7:278. [PMID: 32656249 PMCID: PMC7326035 DOI: 10.3389/fvets.2020.00278] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 04/27/2020] [Indexed: 12/12/2022] Open
Abstract
Regenerative medicine is a branch of medicine that develops methods to grow, repair, or replace damaged or diseased cells, organs or tissues. It has gained significant momentum in recent years. Stem cells are undifferentiated cells with the capability to self—renew and differentiate into tissue cells with specialized functions. Stem cell therapies are therefore used to overcome the body's inability to regenerate damaged tissues and metabolic processes after acute or chronic insult. The concept of stem cell therapy was first introduced in 1991 by Caplan, who proposed that massive differentiation of cells into the desired tissue could be achieved by isolation, cultivation, and expansion of stem cells in in vitro conditions. Among different stem cell types, mesenchymal stem cells (MSC) currently seem to be the most suitable for therapeutic purposes, based on their simple isolation and culturing techniques, and lack of ethical issues regarding their usage. Because of their remarkable immunomodulatory abilities, MSCs are increasingly gaining recognition in veterinary medicine. Developments are primarily driven by the limitations of current treatment options for various medical problems in different animal species. MSCs represent a possible therapeutic option for many animal diseases, such as orthopedic, orodental and digestive tract diseases, liver, renal, cardiac, respiratory, neuromuscular, dermal, olfactory, and reproductive system diseases. Although we are progressively gaining an understanding of MSC behavior and their mechanisms of action, some of the issues considering their use for therapy are yet to be resolved. The aim of this review is first to summarize the current knowledge and stress out major issues in stem cell based therapies in veterinary medicine and, secondly, to present results of clinical usage of stem cells in veterinary patients.
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Affiliation(s)
- Metka Voga
- Faculty of Veterinary Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Neza Adamic
- Faculty of Veterinary Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Modest Vengust
- Faculty of Veterinary Medicine, University of Ljubljana, Ljubljana, Slovenia
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Aronson LR. Update on the Current Status of Kidney Transplantation for Chronic Kidney Disease in Animals. Vet Clin North Am Small Anim Pract 2016; 46:1193-218. [DOI: 10.1016/j.cvsm.2016.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Snell W, Aronson L, Phillips H, Beale L, Larenza Menzies MP. Influence of anesthetic variables on short-term and overall survival rates in cats undergoing renal transplantation surgery. J Am Vet Med Assoc 2015; 247:267-77. [DOI: 10.2460/javma.247.3.267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Garcia de Carellan Mateo A, Brodbelt D, Kulendra N, Alibhai H. Retrospective study of the perioperative management and complications of ureteral obstruction in 37 cats. Vet Anaesth Analg 2015; 42:570-9. [PMID: 25732861 DOI: 10.1111/vaa.12250] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 10/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe perioperative management and complications, risk factors and mortality rates in cats anaesthetized for treatment of ureteral obstruction. STUDY DESIGN Retrospective, clinical, cohort study. ANIMALS Thirty-seven client-owned cats anaesthetized for ureteral surgery. METHODS Records with sufficient data for cats treated between March 2010 and March 2013 were examined for breed, age, gender, history, concurrent diseases, pre- and post-anaesthetic biochemical and haematological parameters, American Society of Anesthesiologists classification, anaesthetic protocol, surgical technique, surgeon, perioperative complications and mortality within 48 hours after extubation. Associations between risk factors and outcome variables were evaluated using univariable analysis. Odds ratios and 95% confidence intervals were calculated for significant parameters. Sensitivity and specificity using receiving operator characteristic curve analysis were calculated for creatinine, potassium level and standard base excess (SBE) to denote survival or non-survival. RESULTS Preoperatively, all cats were azotaemic: mean±SD urea was 31.6 ± 26.9 mmol L(-1) and median (range) creatinine was 562 μmol L(-1) (95 μmol L(-1) to off scale). Thirteen cats were hyperkalaemic (K+ 6.5 mmol L(-1)). Anaesthesia-related complications included bradycardia (n=8, 21.6%), hypotension (n=15, 40.5%) and hypothermia (n=32, 86.5%). Seven cats (18.9%) died postoperatively. Non-survivors were significantly (p=0.011) older (9.8±1.9 years) than survivors (6.4±3.1 years) and had higher potassium concentrations (p=0.040). Risk factors associated with mortality were ASA classes IV and V (p=0.022), emergency procedures (p=0.045) and bicarbonate administration (p=0.002). Non-survivors had higher creatinine concentrations (p=0.021) and lower SBE (p=0.030). CONCLUSION AND CLINICAL RELEVANCE Intraoperative anaesthetic complications were common; increased age, poor health status, preoperative bicarbonate administration, hyperkalaemia and increased creatinine were associated with increased risk for death and can be used to predict risk for complications.
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Affiliation(s)
| | - David Brodbelt
- Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, UK
| | - Nicola Kulendra
- Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, UK
| | - Hatim Alibhai
- Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, UK
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Phillips H, Occhipinti LL, Aronson LR. Septicemia and Infection due to ESBL-producing K. pneumoniae Following Feline Renal Allograft Transplantation. J Am Anim Hosp Assoc 2015; 51:119-29. [PMID: 25695559 DOI: 10.5326/jaaha-ms-6103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 12 yr old castrated male domestic longhair underwent renal transplantation for treatment of chronic interstitial nephritis. Full-thickness intestinal biopsies obtained prior to transplantation revealed mild enteritis. Twelve months following transplantation, the patient underwent surgery for resection of a mesenteric mass causing septic peritonitis. The mesenteric mass was resected and an intestinal resection and anastomosis was performed. Extended-spectrum-β-lactamase producing Klebsiella pneumoniae was cultured from the resected tissue and urinary tract. Bacterial rods were noted to be circulating in the bloodstream, causing septicemia. Despite aggressive treatment of the septic peritonitis and septicemia using surgical debridement, drain placement, aggressive antibiotic therapy with IV meropenem, and vasopressor support, the patient succumbed to persistent hypotension and suffered cardiopulmonary arrest. Extended-spectrum-β-lactamase-producing bacteria are of growing concern in human and veterinary medicine, maintaining susceptibility often only to carbapenem and aminoglycoside antibiotics. Resistance to even those antibiotics is emerging. Veterinary patients with a history of antibiotic therapy, central venous or urinary catheterization, immunosuppression, enteric surgery, and an extended stay in the intensive care unit may be predisposed.
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Affiliation(s)
- Heidi Phillips
- From the University of Illinois, Urbana, IL (H.P.); Veterinary Specialists of Rochester, Rochester, New York (L.O.); and University of Pennsylvania, Philadelphia, PA (L.A.)
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9
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Yeates JW. Ethical considerations in feline renal transplantation. Vet J 2014; 202:405-7. [DOI: 10.1016/j.tvjl.2014.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
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10
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Pluripotent and Multipotent Domestic Cat Stem Cells: Current Knowledge and Future Prospects. STEM CELLS IN ANIMAL SPECIES: FROM PRE-CLINIC TO BIODIVERSITY 2014. [DOI: 10.1007/978-3-319-03572-7_6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Eatroff AE, Langston CE, Chalhoub S, Poeppel K, Mitelberg E. Long-term outcome of cats and dogs with acute kidney injury treated with intermittent hemodialysis: 135 cases (1997-2010). J Am Vet Med Assoc 2013; 241:1471-8. [PMID: 23176239 DOI: 10.2460/javma.241.11.1471] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the long-term outcome for small animal patients with acute kidney injury (AKI) treated with intermittent hemodialysis (IHD). DESIGN Retrospective case series. ANIMALS 42 cats and 93 dogs treated with IHD for AKI. PROCEDURES Medical records of cats and dogs treated with IHD for AKI from January 1997 to October 2010 were reviewed. Standard methods of survival analysis with Kaplan-Meier product limit curves were used. The log-rank, Mann-Whitney, and Kruskal-Wallis tests were used to determine whether outcome, number of IHD treatments, or duration of hospitalization was different when dogs and cats were classified according to specific variables. RESULTS The overall survival rate at the time of hospital discharge was 50% (21/42) for cats and 53% (49/93) for dogs. The overall survival rate 30 days after hospital discharge was 48% (20/42) for cats and 42% (39/93) for dogs. The overall survival rate 365 days after hospital discharge was 38% (16/42) for cats and 33% (31/93) for dogs. For all-cause mortality, the median survival time was 7 days (95% confidence interval, 0 to 835 days) for cats and 9 days (95% confidence interval, 0 to 55 days) for dogs. CONCLUSIONS AND CLINICAL RELEVANCE Cats and dogs with AKI treated with IHD have survival rates similar to those of human patients. Although there was a high mortality rate prior to hospital discharge, those patients that survived to discharge had a high probability of long-term survival.
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Affiliation(s)
- Adam E Eatroff
- Bobst Hospital, The Animal Medical Center, 510 E 62nd St, New York, NY 10065, USA.
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12
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Lommer MJ. Efficacy of Cyclosporine for Chronic, Refractory Stomatitis in Cats: A Randomized, Placebo-Controlled, Double-Blinded Clinical Study. J Vet Dent 2013; 30:8-17. [DOI: 10.1177/089875641303000101] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sixteen cats with chronic stomatitis, that had previously undergone premolar-molar or full-mouth extractions, were randomly assigned a group to receive 2.5 mg/kg cyclosporine or placebo orally twice daily. Neither the clinician nor the clients were aware of the group assignments. Cats were evaluated prior to treatment and every 2 weeks for 6 weeks using a 30 point Stomatitis Disease Activity Index (SDAI) score. Mean improvement in SDAI scores among cats in the treatment group after 6 weeks was 52.7 %. This was significantly different from the mean improvement (12.2 %) of cats in the placebo group. During the 6 week study period, 7 of the 9 cats in the treatment group (77.8 %) showed a > 40 % improvement in SDAI score, while 1 of 7 cats in placebo group (14.3 %) showed a > 40 % improvement in SDAI score. This difference was statistically significant. Individual variability in the absorption of orally-administered cyclosporine was high. Trough whole-blood cyclosporine levels ranged from 32.1 ng/ml to 1,576.2 ng/ml. At the end of the 6 week observation period, there was a statistically significant difference among cats with trough whole-blood cyclosporine levels > 300 ng/ml (72.3 % improvement) compared with cats with cyclosporine levels < 300 ng/ml (28.2 % improvement). Whole-blood cyclosporine levels > 300 ng/ml were associated with significant improvement in oral inflammation in cats with chronic stomatitis that had previously undergone premolar-molar or full-mouth extraction.
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Affiliation(s)
- Milinda J. Lommer
- From Aggie Animal Dental Center, 487 Miller Avenue, Mill Valley, CA 94941
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Hopper K, Mehl ML, Kass PH, Kyles A, Gregory CR. Outcome after Renal Transplantation in 26 Dogs. Vet Surg 2012; 41:316-27. [DOI: 10.1111/j.1532-950x.2011.00924.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Kate Hopper
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California-Davis; Davis; CA
| | - Margo L. Mehl
- San Francisco Veterinary Specialists; San Francisco; CA
| | - Philip H. Kass
- Department of Population Health and Reproduction; School of Veterinary Medicine; University of California-Davis; Davis; CA
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Quimby JM, Webb TL, Gibbons DS, Dow SW. Evaluation of intrarenal mesenchymal stem cell injection for treatment of chronic kidney disease in cats: a pilot study. J Feline Med Surg 2011; 13:418-26. [PMID: 21334237 DOI: 10.1016/j.jfms.2011.01.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2011] [Indexed: 01/25/2023]
Abstract
The feasibility of autologous intrarenal mesenchymal stem cell (MSC) therapy in cats with chronic kidney disease (CKD) was investigated. Six cats (two healthy, four with CKD) received a single unilateral intrarenal injection of autologous bone marrow-derived or adipose tissue-derived MSC (bmMSC or aMSC) via ultrasound guidance. Minimum database and glomerular filtration rate (GFR) via nuclear scintigraphy were determined pre-injection, at 7 days and at 30 days post-injection. Intrarenal injection did not induce immediate or long-term adverse effects. Two cats with CKD that received aMSC experienced modest improvement in GFR and a mild decrease in serum creatinine concentration. Despite the possible benefits of intrarenal MSC injections for CKD cats, the number of sedations and interventions required to implement this approach would likely preclude widespread clinical application. We concluded that MSC could be transferred safely by ultrasound-guided intrarenal injection in cats, but that alternative sources and routes of MSC therapy should be investigated.
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Affiliation(s)
- Jessica M Quimby
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
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Roudebush P, Polzin DJ, Ross SJ, Towell TL, Adams LG, Dru Forrester S. Therapies for feline chronic kidney disease. What is the evidence? J Feline Med Surg 2009; 11:195-210. [PMID: 19237135 DOI: 10.1016/j.jfms.2009.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Practical relevance Successful treatment and prevention of kidney disease in pet animals requires a multidimensional approach to identify and eliminate causes or exacerbating factors, provide professional examination and care on a regular basis, and plan and implement a comprehensive treatment program when necessary. Evidence base Over the years, many therapeutic and preventive interventions have been developed or advocated for chronic kidney disease (CKD), but evidence of efficacy or effectiveness is often lacking or highly variable. Accordingly, the main objective of this systematic review was to identify and critically appraise the evidence supporting various approaches to managing feline CKD; namely, fluid therapy, calcitrioi therapy, antihypertensive therapy, ACE inhibitor therapy, erythropoietic hormone replacement therapy, potassium supplementation, antioxidant supplementation, alkalinization therapy, dietary phosphorus restriction and intestinal phosphate binders, therapeutic renal foods, assisted feeding, dialysis and renal transplantation.
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Affiliation(s)
- Philip Roudebush
- Scientific Affairs, Hill's Pet Nutrition, PO Box 148, Topeka, KS 66601, USA.
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Kent M. The cat with neurological manifestations of systemic disease. Key conditions impacting on the CNS. J Feline Med Surg 2009; 11:395-407. [PMID: 19389639 PMCID: PMC7128452 DOI: 10.1016/j.jfms.2009.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PRACTICAL RELEVANCE A number of systemic diseases are associated with neurological deficits. Most systemic diseases that impact on the nervous system result in multifocal neurological signs; however, isolated deficits can also be observed. This article reviews the clinical signs, pathophysiology, diagnosis, treatment and prognosis of four important systemic diseases with neurological consequences: feline infectious peritonitis, toxoplasmosis, hypertension and hepatic encephalopathy. CLINICAL CHALLENGES Early recognition of systemic signs of illness in conjunction with neurological deficits will allow for prompt diagnosis and treatment. While neurological examination of the feline patient can undoubtedly be challenging, hopefully the accompanying articles in this special issue will enable the clinician to approach these cases with more confidence. EVIDENCE BASE The veterinary literature contains numerous reports detailing the impact of systemic disease on the nervous system. Unfortunately, very few references provide detailed descriptions of large cohorts of affected cats. This review summarises the literature underpinning the four key diseases under discussion.
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Affiliation(s)
- Marc Kent
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA 30602, USA.
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Case JB, Kyles AE, Nelson RW, Aronson L, Kass PH, Klose TC, Bailiff NL, Gregory CR. Incidence of and risk factors for diabetes mellitus in cats that have undergone renal transplantation: 187 cases (1986–2005). J Am Vet Med Assoc 2007; 230:880-4. [PMID: 17362164 DOI: 10.2460/javma.230.6.880] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare incidence of diabetes mellitus in cats that had undergone renal transplantation with incidence in cats with chronic renal failure, compare mortality rates in cats that underwent renal transplantation and did or did not develop diabetes mellitus, and identify potential risk factors for development of posttransplantation diabetes mellitus (PTDM) in cats. DESIGN Retrospective case series. ANIMALS 187 cats that underwent renal transplantation. PROCEDURES Medical records were reviewed. RESULTS 26 of the 187 (13.9%) cats developed PTDM, with the incidence of PTDM being 66 cases/1,000 cat years at risk. By contrast, the incidence of diabetes mellitus among a comparison population of 178 cats with chronic renal failure that did not undergo renal transplantation was 17.9 cases/1,000 cat years at risk, and cats that underwent renal trans-plantation were 5.45 times as likely to develop diabetes mellitus as were control cats with chronic renal failure. The mortality rate among cats with PTDM was 2.38 times the rate among cats that underwent renal transplantation but did not develop PTDM. Age, sex, body weight, and percentage change in body weight were not found to be significantly associated with development of PTDM. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that cats that undergo renal transplantation have an increased risk of developing diabetes mellitus, compared with cats with chronic renal failure, and that mortality rate is higher for cats that develop PTDM than for cats that do not.
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Affiliation(s)
- Joseph B Case
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
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Iwai S, Endo K, Kobayashi E. Training protocol for feline renal transplantation, using rat vascular anastomosis. Microsurgery 2006; 26:8-12. [PMID: 16444718 DOI: 10.1002/micr.20202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Renal transplantation (RTx) has been a potential treatment for renal failure in pet cats. We developed a training protocol for the microsurgical skills required for feline RTx using rat vessels, which are the same size as the feline renal artery and vein. Using interrupted sutures, the transected abdominal aorta was reestablished in an end-to-end fashion. Venous anastomosis was performed with a continuous running suture in an end-to-side fashion between the portal vein and inferior vena cava. In the arterial anastomotic model, technical errors were checked by postoperative hemorrhaging. Those failures in the venous anastomotic model, technical errors were confirmed by the rat's death. Histological examinations of the epithelialization at the anastomotic site were evaluated in both groups. After training, nine cases of feline RTx were performed safely, using an adequate microsurgical technique.
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Affiliation(s)
- Satomi Iwai
- Endo Animal Hospital, Endo Clinical Veterinary Research Corp., Tochigi, Japan
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Iwai S, Endo K, Hakamata Y, Gregory CR, Kobayashi E. Use of nonpenetrating vascular closure staples in feline renal transplantation. Microsurgery 2006; 26:13-6. [PMID: 16444725 DOI: 10.1002/micr.20203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal transplantation is a potential treatment for irreversible renal failure in pet cats. Our aim is to reduce warm ischemic time by using nonpenetrating vascular closure staples (VCS), thereby improving graft survival. Experimental cats were divided into the VCS group (n = 4; autotransplantation) or suture group (n = 6; allotransplantation). The renal artery was anastomosed with the external iliac artery in an end-to-end fashion, and the renal vein was attached to the external iliac vein in an end-to-side fashion. Warm ischemic time as well as arterial and venous anastomotic times were measured. Cats in the suture group were administrated cyclosporine and prednisolone orally after transplantation. Ischemic and anastomotic times in the VCS group were significantly reduced compared with the suture group. Two of 6 allografts had a ureteral anastomotic stricture, and 4 allografts were rejected. Histological findings of autografts showed normal structure. In conclusion, VCS staples were useful in feline renal transplantation.
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Affiliation(s)
- Satomi Iwai
- Division of Organ Replacement Research, Center for Molecular Medicine, Jichi Medical School, Tochigi, Japan
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Kadar E, Sykes JE, Kass PH, Bernsteen L, Gregory CR, Kyles AE. Evaluation of the prevalence of infections in cats after renal transplantation: 169 cases (1987-2003). J Am Vet Med Assoc 2005; 227:948-53. [PMID: 16190595 DOI: 10.2460/javma.2005.227.948] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the prevalence of infections developing postoperatively, document the contribution of infection to increased risk of death, and identify risk factors associated with the development of infectious complications in cats after renal transplantation. DESIGN Retrospective study. ANIMALS 169 cats that received renal allograft transplants. PROCEDURES Medical records of cats receiving renal transplants at the University of California from January 1987 through December 2003 were reviewed. RESULTS 47 infections developed in 43 of 169 cats. Bacterial infections were most common (25/47 cats), followed by viral (13/47), fungal (6/47), and protozoal (3/47) infections. The median duration from transplant surgery to development of infection was 2.5 months. Infection was the second most common cause of death after acute rejection of the transplant, accounting for 14% of deaths overall. Cats with concurrent diabetes mellitus had a significantly increased risk of developing an infection after renal transplantation. Sex, increasing age, concurrent neoplasia, and previous treatment for transplant rejection were not associated with development of infection. CONCLUSIONS AND CLINICAL RELEVANCE Infection was a common complication and an important cause of death or euthanasia in cats after renal transplantation. Development of diabetes mellitus after transplantation significantly increased the risk of infection.
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Affiliation(s)
- Elissa Kadar
- Veterinary Medical Teaching Hospital, University of California, Davis, CA 95616, USA
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Adin CA. Screening criteria for feline renal transplant recipients and donors. CLINICAL TECHNIQUES IN SMALL ANIMAL PRACTICE 2002; 17:184-9. [PMID: 12587285 DOI: 10.1053/svms.2002.36608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal transplantation is associated with several potential complications. Early selection and appropriate screening of candidates has reduced the morbidity and mortality associated with this procedure in human beings. In veterinary medicine, the important process of identification and screening of candidates for renal transplantation occurs primarily in private general or specialty practice. This article reviews guidelines for screening of candidates for renal transplantation and related publications in both veterinary and human literature in an attempt to provide comprehensive information to practitioners involved in the selection process. It is anticipated that early referral of stable cats for renal transplantation will further improve the likelihood of a successful outcome.
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Affiliation(s)
- Christopher A Adin
- University of Florida, Department of Small Animal Clinical Sciences, College of Veterinary Medicine, P.O. Box 100126, Gainesville, FL 32610-0126, USA
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