1
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Kelley MD, Thompson‐Butler DA, Tanner MC, Thomason JD, Whitehouse WH. Effects of an intravenous infusion of diltiazem on glomerular filtration rate, electrolyte excretion, and urine output in healthy dogs. Vet Med (Auckl) 2022; 36:2098-2103. [DOI: 10.1111/jvim.16575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Megan D. Kelley
- Department of Clinical Sciences College of Veterinary Medicine, Kansas State University Manhattan Kansas USA
| | - Dorothy A. Thompson‐Butler
- Department of Clinical Sciences College of Veterinary Medicine, Kansas State University Manhattan Kansas USA
| | - Matthew C. Tanner
- Department of Clinical Sciences College of Veterinary Medicine, Kansas State University Manhattan Kansas USA
| | - Justin D. Thomason
- Department of Clinical Sciences College of Veterinary Medicine, Kansas State University Manhattan Kansas USA
| | - William H. Whitehouse
- Department of Clinical Sciences College of Veterinary Medicine, Kansas State University Manhattan Kansas USA
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Chalifoux NV, Rizzo K, Stefanovski D, Weinstein NM, Silverstein DC. Clinical application of the StatSensor and StatSensor Xpress point-of-care creatinine measurement devices in dogs. Vet Clin Pathol 2022; 51:533-542. [PMID: 35729751 DOI: 10.1111/vcp.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/16/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Creatinine is a universally important blood parameter used to detect and monitor acute and chronic kidney disease. Reliable measurements at the bedside remain a challenge in human and veterinary medicine. Despite its potential, a trustworthy point-of-care creatinine biosensor has yet to be established. OBJECTIVES We aimed to determine the precision and accuracy of the StatSensor (SS) and StatSensor Xpress (SSX) handheld creatinine measurement devices in dogs. METHODS Paired creatinine samples from dogs with normal (creatinine ≤159 μmol/L), moderate (159-354 μmol/L), and marked (>354 μmol/L) azotemia were compared with a commercial enzymatic analyzer. Within-day precision and linearity studies were performed prior to method comparison studies. Method comparison was evaluated using Bland-Altman, concordance correlation coefficient, Deming, and Passing-Bablok regression analysis. RESULTS Seventy-eight dogs were enrolled in the study, including 28 (35%), 25 (32%), and 26 (33%) with normal, moderate, and marked azotemia. Total error surpassed recommendations for all devices, and linearity deviated from identity for the SS1 and SS2. The concordance correlation coefficients of the SS1, SS2, SSXI, and SSX2, were 0.69, 0.59, 0.82, and 0.44, respectively. Bland-Altman analyses showed a high variation in the differences, and relationships showed high heteroskedasticity with negative systemic bias among high creatinine concentrations. CONCLUSIONS Neither the SS and SSX are considered acceptable for clinical applications in dogs. Further research is indicated for the development of a reliable, cost-effective, point-of-care creatinine analyzer to improve the rapid detection and monitoring human and veterinary patients.
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Affiliation(s)
- Nolan V Chalifoux
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Kaila Rizzo
- Veterinary Specialty Hospital Sorrento Valley, San Diego, California, USA
| | - Darko Stefanovski
- Department of Clinical Studies New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Nicole M Weinstein
- Department of Pathobiology, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Deborah C Silverstein
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
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Bar-Nathan M, Chen H, Rimer D, Segev G. Long-term outcome of dogs recovering from acute kidney injury: 132 cases. J Vet Intern Med 2022; 36:1024-1031. [PMID: 35478193 PMCID: PMC9151474 DOI: 10.1111/jvim.16435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Information regarding long‐term outcome of dogs recovering from acute kidney injury (AKI) is limited. Objectives Determine the long‐term outcome of dogs recovering from AKI and identify predictors for serum creatinine concentration (sCr) normalization and long‐term outcome. Animals One hundred thirty‐two dogs with AKI that survived ≥30 days postdischarge. Methods Retrospective study. Search of medical records of dogs diagnosed with AKI that survived to discharge. Follow‐up data were retrieved from medical records and by telephone interviews with the owners or primary care veterinarians or both. Results Estimated median survival time (MST) was 1322 days (95% confidence interval [CI], 1147‐1626), and 76% of the dogs were alive at last contact. Normalization of sCr was documented in 55% of the dogs at discharge and in additional 20% during the follow‐up period. The proportion of dogs with sCr normalization decreased with increase in AKI grade (P = .02). Long‐term survival was not associated with sCr normalization (P = .63). Etiology was associated with the long‐term outcome (P = .004). Conclusion and Clinical Importance Long‐term survival of dogs with AKI is longer than previously described. Normalization of sCr in 99 dogs (75%) occurred, either at discharge or within the follow‐up period. Normalization of sCr was not associated with long‐term survival. Estimated MST of dogs with sCr normalization was not different compared with dogs that developed azotemic chronic kidney disease (CKD), presumably because of slow CKD progression rate. Etiology is an important factor determining sCr normalization and long‐term survival, emphasizing the importance of the reversibility of renal injury rather than its severity.
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Affiliation(s)
- Mali Bar-Nathan
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Hilla Chen
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Dar Rimer
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Rimer D, Chen H, Bar-Nathan M, Segev G. Acute kidney injury in dogs: Etiology, clinical and clinicopathologic findings, prognostic markers, and outcome. J Vet Intern Med 2022; 36:609-618. [PMID: 35103347 PMCID: PMC8965273 DOI: 10.1111/jvim.16375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/15/2022] [Accepted: 01/20/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common, potentially fatal condition. OBJECTIVES To characterize the etiologies, clinical and clinicopathologic findings, hospitalization period, and outcome of dogs with AKI and to identify markers of negative prognosis. ANIMALS Two hundred forty-nine client-own dogs diagnosed with AKI and hospitalized at a veterinary teaching hospital. METHODS Retrospective study. Search of medical records for dogs with AKI. RESULTS Common clinical signs included lethargy (225/249, 90%), anorexia (206/249, 83%), and vomiting (168/249, 68%). Etiologies included ischemic/inflammatory (144/249, 58%), infectious (19/249, 8%), nephrotoxicosis (14/249, 6%), or other (13/249, 5%). Hospital-acquired AKI was diagnosed in 9% (23/249) of the dogs. Median presentation and peak serum creatinine (sCr) concentrations were 4 mg/dL (range, 1.1-37.9) and 4.6 mg/dL (range, 1.1-43.1), respectively. Dogs were classified to AKI grades as follows: Grade I, 6 (2%), Grade II, 38 (15%), Grade III, 89 (36%), Grade IV, 77 (31%), and Grade V, 39 (16%). One hundred and sixty-four (66%) dogs survived. There was a positive association between death and AKI grade (P = .009). The case fatality rate was higher among dogs with anuria compared with dogs without anuria (50% vs 28%, respectively; odds ratio [95% confidence interval]: 2.5 [1.39-4.6]; P = .002). Forty-seven (18.8%) dogs underwent hemodialysis, of which 60% survived. CONCLUSION AND CLINICAL IMPORTANCE Two-thirds of dogs with AKI survived. Hospital-acquired AKI was common. The severity of AKI, as reflected by presence of anuria, AKI grade, and other body organs involvement, was associated with the outcome.
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Affiliation(s)
- Dar Rimer
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Hilla Chen
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Mali Bar-Nathan
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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5
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Nivy R, Chaim N, Hanael E, Sutton GA, Bruchim Y, Aroch I, Segev G. Prospective evaluation of 5 urinary biomarkers as predictors of acute kidney injury in nonazotemic, hospitalized dogs. J Vet Intern Med 2021; 35:2812-2820. [PMID: 34738653 PMCID: PMC8692222 DOI: 10.1111/jvim.16308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Early recognition of acute kidney injury (AKI) is hindered by current definitions and use of traditional, insensitive markers. HYPOTHESIS/OBJECTIVES Urinary (u) activity of γ-glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP), and concentrations of heat-shock protein 70 (HSP70) and interleukins (ILs) -6 and -18, are predictive biomarkers for AKI and survival. ANIMALS Nonazotemic, hospitalized dogs (n = 118) and healthy controls (n = 20). METHODS A prospective observational study. Nonazotemic dogs at risk of AKI were recruited and their urinary biomarker concentrations were measured at presentation. Serum creatinine (sCr) and symmetric dimethylarginine (sSDMA) were measured daily until discharge/death. RESULTS The overall case fatality rate was 18.6%. Fifteen dogs (12.7%) developed AKI, which was associated with death (relative risk, 3.2; 95% confidence interval [CI], 1.57-6.55). All 5 urinary biomarkers were significantly higher in hospitalized dogs compared to controls, with minimal overlap. uHSP70/uCr, uGGT/uCr, and uIL-6/uCr at presentation were higher in dogs which later developed AKI. Areas under the receiver operator characteristic curve (AUROC) (95% CI) for the 3 biomarkers as predictors of AKI were 0.67 (0.51-0.83), 0.68 (0.55-0.81), and 0.78 (0.65-0.91), respectively. When they were categorically classified as elevated/normal, each additional elevated biomarker increased the odds for AKI (OR, 2.83; 95% CI, 1.23-6.52, P = .01). Agreement between sCr and sSDMA was poor (Cohen's kappa = .071). The AUROC of SDMA at presentation for AKI prediction was 0.73 (0.51-0.95). CONCLUSIONS AND CLINICAL IMPORTANCE Kidney injury was common, irrespective of subsequent worsening of azotemia or death. The predictive value of individual urinary biomarkers was reduced by moderate sensitivities and specificities. SDMA showed moderate discriminatory utility for AKI prediction, and often displayed discordant results with sCr.
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Affiliation(s)
- Ran Nivy
- The Hebrew University of Jerusalem, Koret School of Veterinary Medicine, Jerusalem, Israel
| | - Netanel Chaim
- The Hebrew University of Jerusalem, Koret School of Veterinary Medicine, Jerusalem, Israel
| | - Erez Hanael
- The Hebrew University of Jerusalem, Koret School of Veterinary Medicine, Jerusalem, Israel
| | - Gila Abells Sutton
- The Hebrew University of Jerusalem, Koret School of Veterinary Medicine, Jerusalem, Israel
| | - Yaron Bruchim
- The Hebrew University of Jerusalem, Koret School of Veterinary Medicine, Jerusalem, Israel
| | - Itamar Aroch
- The Hebrew University of Jerusalem, Koret School of Veterinary Medicine-Internal Medicine, Small Animals, Rehovot, Israel
| | - Gilad Segev
- The Hebrew University of Jerusalem, Koret School of Veterinary Medicine-Internal Medicine, Small Animals, Rehovot, Israel
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Martinez J, Londoño LA, Schaer M. Retrospective evaluation of acute kidney injury in dogs with pit viper envenomation (2008-2017): 56 cases. J Vet Emerg Crit Care (San Antonio) 2020; 30:698-705. [PMID: 32975046 DOI: 10.1111/vec.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/24/2019] [Accepted: 02/25/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the clinicopathological characteristics of dogs that develop acute kidney injury (AKI) secondary to pit viper envenomation, and to describe the association between development of AKI and clinical course and outcome. DESIGN Retrospective study. SETTING University teaching hospital. ANIMALS Client-owned dogs treated with at least 1 vial of antivenom following pit viper envenomation and that had at least 2 plasma creatinine concentrations measured during the course of hospitalization. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Sixty-three dogs met the inclusion criteria. One was excluded due chronic kidney disease, and 6 were excluded due to nonsteroidal anti-inflammatory drug administration. Of the 56 dogs included in the study, 16 developed AKI (29%). Dogs with AKI received a significantly higher dose of antivenom, 8.7 ± 6.8 total vials versus dogs in the non-AKI group that received 4.2 ± 2.6 vials (P = 0.006). Dogs in the AKI group were significantly more tachycardic (P = 0.028), hypotensive (P = 0.002), had a higher shock index (P = 0.012), and were more likely to receive transfusions with packed red blood cells (P = 0.042) than dogs in the non-AKI group. No significant association was identified between the development of AKI and length of hospitalization. The only factors that were significantly associated with degree of severity of AKI included the receipt of blood transfusion (P = 0.006) and number of vials of antivenom administered (P = 0.03). The development of AKI was significantly associated with outcome (P < 0.001), with 5 of 16 (31%) dogs in the AKI group surviving to discharge, 7 of 16 (44%) dying, and 4 of 16 (25%) being euthanized versus 39 of 40 (98%) surviving to discharge in the non-AKI group and 1 of 40 (2%) dying in hospital. CONCLUSION Development of AKI in dogs following pit viper envenomation carries an increased risk of mortality that is associated with severity of shock at presentation and increased doses of antivenom administration.
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Affiliation(s)
- Jennifer Martinez
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida
| | - Leonel A Londoño
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida
| | - Michael Schaer
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida
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Cortadellas O. Can we improve the diagnosis of early stages of acute kidney injury in hospitalised dogs? Vet Rec 2019; 185:49-51. [DOI: 10.1136/vr.l4562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Oscar Cortadellas
- Departamento Medicina y Cirugía Animal; Hospital Clinico Veterinario, Universidad CEU Cardenal Herrera; Valencia Spain
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Murgia E, Troia R, Bulgarelli C, Pelizzola M, Foglia A, Dondi F, Giunti M. Prognostic Significance of Organ Dysfunction in Cats With Polytrauma. Front Vet Sci 2019; 6:189. [PMID: 31294034 PMCID: PMC6598119 DOI: 10.3389/fvets.2019.00189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/28/2019] [Indexed: 11/13/2022] Open
Abstract
Polytrauma is a common emergency condition in small animals and is frequently associated with higher morbidity and mortality rates compared to minor trauma. Multiple Organ Dysfunction Syndrome (MODS) is a major complication of extensive traumatic injury, carrying a high risk of death despite intensive care treatment. Little is known about the prevalence and the prognostic impact of MODS in feline polytrauma. The current study aimed to prospectively evaluate the occurrence and the prognostic significance of organ dysfunction at admission in a population of polytraumatized cats. Cats with polytrauma requiring intensive care unit hospitalization were included and categorized according to outcome (survivors/non-survivors). Clinical and clinicopathological data, including scores of disease severity [Animal Trauma Triage Score (ATTS), APPLEfast, and APPLEfull], selected organ dysfunction and presence of MODS were evaluated upon admission, and analyzed with respect to mortality. Non-parametric statistics was performed and P < 0.05 was considered significant. Thirty-eight cats met the inclusion criteria: 8/38 (21%) had penetrating trauma, while 30/38 (79%) had blunt trauma. The overall in-hospital mortality was 37% (14/38). Cats with evidence of MODS upon admission had significantly higher frequency of death compared to cats without MODS (9/14 vs. 2/24 P = 0.0004). Hemostatic dysfunction, respiratory dysfunction, and MODS upon admission were significantly associated with mortality in the univariate logistic regression analysis (P = 0.005, P = 0.001, P = 0.001, respectively). The values of APPLEfast, APPLEfull, and ATTS were independently associated with a higher risk of death and positively correlated with the number of dysfunctional organs (P = 0.025, P = 0.004, P = 0.003, r = 0.57, P = 0.0002; r = 0.59, P = 0.0001; r = 0.55, P = 0.0003, respectively). Multiple Organ Dysfunction Syndrome is a common complication of feline polytrauma and its development is associated with increased disease severity and worse outcomes. The presence of hemostatic dysfunction and respiratory dysfunction upon admission is associated with a higher risk of death. The ATTS and the APPLE scores are useful prognostic tools for the assessment of cats with polytrauma.
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Affiliation(s)
- Elsa Murgia
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Roberta Troia
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Cecilia Bulgarelli
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Pelizzola
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Armando Foglia
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Dondi
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Massimo Giunti
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Perondi F, Lippi I, Ceccherini G, Marchetti V, Guidi G. Evaluation of urinary γ-glutamyl transferase and serum creatinine in non-azotaemic hospitalised dogs. Vet Rec 2019; 185:52. [PMID: 31076519 DOI: 10.1136/vr.104439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 02/19/2019] [Accepted: 04/22/2019] [Indexed: 11/04/2022]
Abstract
Urinary and blood biomarkers for diagnosis of acute kidney injury (AKI) in hospitalised dogs were evalueted. This prospective study included 97 dogs, classified according to the International Renal Interest Society classification into no AKI and AKI grade 1 (48-hour increase in serum creatinine≥0.3 mg/dl and/or urinary production <1 ml/kg/hour for at least six hours). A total of 62 of 97 dogs (64 per cent) were classified as AKI 1. A statistically significant difference was found between no AKI and AKI 1 in urine protein to creatinine ratio, urinary γ-glutamyl transferase (uGGT) and uGGT/cu (P<0.0001). Thirteen of 97 dogs (13.4 per cent) that developed increased creatinine and change in AKI grade showed high mortality (n=9/13; 69.2 per cent). The receiver operating characteristic (ROC) curve analysis of uGGT/cu index as a marker for AKI grade 1 had an area under the ROC curve of 0.78; optimal cut-off point was 57.50 u/g, with sensitivity and specificity of 75.4 per cent and 75.6 per cent, respectively. Overall intensive care unit mortality was 23.7 per cent (23/97), 13.4 per cent (13/97) of which died during hospitalisation and 10.3 per cent (10/97) within 28 days after discharge. uGGT is an acceptable marker for distinguishing between AKI 1 and no AKI.
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Affiliation(s)
- Francesca Perondi
- Dipartimento di Scienze Veterinarie, Università degli Studi di Pisa, Pisa, Italy
| | - Ilaria Lippi
- Dipartimento di Scienze Veterinarie, Università degli Studi di Pisa, Pisa, Italy
| | - Gianila Ceccherini
- Dipartimento di Scienze Veterinarie, Università degli Studi di Pisa, Pisa, Italy
| | - Veronica Marchetti
- Dipartimento di Scienze Veterinarie, Università degli Studi di Pisa, Pisa, Italy
| | - Grazia Guidi
- Dipartimento di Scienze Veterinarie, Università degli Studi di Pisa, Pisa, Italy
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Troìa R, Mascalzoni G, Calipa S, Magagnoli I, Dondi F, Giunti M. Multiorgan dysfunction syndrome in feline sepsis: prevalence and prognostic implication. J Feline Med Surg 2018; 21:559-565. [PMID: 30099963 DOI: 10.1177/1098612x18792106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The current study was designed to evaluate the prevalence and prognostic significance of multiorgan dysfunction syndrome (MODS) in cats with sepsis. METHODS Cats hospitalised in the intensive care unit of a veterinary university hospital with a diagnosis of sepsis were prospectively enrolled and divided according to disease severity and outcome (survivors; non-survivors). The feline acute patient physiological and laboratory evaluation (APPLE) scores were calculated upon admission, as previously described. Specific criteria to identify selected organ dysfunction (hepatic, renal, respiratory, cardiocirculatory, haemostatic) were adapted from the available human and veterinary literature, and evaluated at baseline and at the end of hospital stay. MODS was defined as the presence of at least two dysfunctional organs simultaneously. Non-parametric statistics were used for comparisons. Univariate and multivariate regression analyses to evaluate significant risk factors for death were carried out. Correlations between variables were assessed by the Spearman's rank correlation coefficient. Significance was set at P <0.05. RESULTS A total of 43 cats with heterogeneous sources of sepsis were included. MODS was identified in 25/43 cats upon admission and in 32/43 cats at the end of hospital stay. Regression analyses showed a significantly elevated odds ratio for mortality for the presence of MODS, renal and cardiovascular dysfunction upon admission, as well as for the number of dysfunctional organs. The latter was the only variable retained by the model from the multivariate binary logistic regression analysis. Significant correlations were documented between the number of dysfunctional organs and the APPLE scores. CONCLUSIONS AND RELEVANCE MODS is a frequent complication of feline sepsis, and is associated with worse outcomes. In particular, renal and cardiovascular dysfunction significantly increase the odds for death. Hence, systematic screening for organ dysfunction is advocated in cats with sepsis.
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Affiliation(s)
- Roberta Troìa
- Department of Veterinary Medical Science, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Giulia Mascalzoni
- Department of Veterinary Medical Science, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Stefano Calipa
- Department of Veterinary Medical Science, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Ilaria Magagnoli
- Department of Veterinary Medical Science, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Francesco Dondi
- Department of Veterinary Medical Science, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Massimo Giunti
- Department of Veterinary Medical Science, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Bologna, Italy
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11
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Troìa R, Gruarin M, Grisetti C, Serafini F, Magna L, Monari E, Giunti M, Dondi F. Fractional excretion of electrolytes in volume-responsive and intrinsic acute kidney injury in dogs: Diagnostic and prognostic implications. J Vet Intern Med 2018; 32:1372-1382. [PMID: 29770972 PMCID: PMC6060310 DOI: 10.1111/jvim.15146] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 02/24/2018] [Accepted: 04/12/2018] [Indexed: 12/19/2022] Open
Abstract
Background The value of fractional excretion (FE) of electrolytes to characterize and prognosticate acute kidney injury (AKI) is poorly documented in dogs. Objectives To evaluate the diagnostic and prognostic roles of FE of electrolytes in dogs with AKI. Animals Dogs (n = 135) with AKI treated with standard care (February 2014‐December 2016). Methods Prospective study. Clinical and laboratory variables including FE of electrolytes, were measured upon admission. Dogs were graded according to the AKI‐IRIS guidelines and grouped according to AKI features (volume‐responsive, VR‐AKI; intrinsic, I‐AKI) and outcome (survivors/non‐survivors). Group comparison and regression analyses with hazard ratios (HR) evaluation for I‐AKI and mortality were performed. P < .05 was considered significant. Results Fifty‐two of 135 (39%) dogs had VR‐AKI, 69/135 (51%) I‐AKI and 14/135 (10%) were unclassified. I‐AKI dogs had significantly higher FE of electrolytes, for example, FE of sodium (FENa, %) 2.39 (range 0.04‐75.81) than VR‐AKI ones 0.24 (range 0.01‐2.21; P < .001). Overall, case fatality was 41% (55/135). Increased FE of electrolytes were detected in nonsurvivors, for example, FENa 1.60 (range 0.03‐75.81) compared with survivors 0.60 (range 0.01‐50.45; P = .004). Several risk factors for death were identified, including AKI‐IRIS grade (HR = 1.39, P = .002), FE of electrolytes, for example, FENa (HR = 1.03, P < .001), and urinary output (HR = 5.06, P < .001). Conclusions and Clinical Importance Fractional excretion of electrolytes performed well in the early differentiation between VR‐AKI and I‐AKI, were related to outcome, and could be useful tools to manage AKI dogs in clinical practice.
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Affiliation(s)
- Roberta Troìa
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Via Tolara di Sopra 50, Ozzano dell'Emilia, Bologna, Italy
| | - Marta Gruarin
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Via Tolara di Sopra 50, Ozzano dell'Emilia, Bologna, Italy
| | - Chiara Grisetti
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Via Tolara di Sopra 50, Ozzano dell'Emilia, Bologna, Italy
| | - Federica Serafini
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Via Tolara di Sopra 50, Ozzano dell'Emilia, Bologna, Italy
| | - Luca Magna
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Via Tolara di Sopra 50, Ozzano dell'Emilia, Bologna, Italy
| | - Erika Monari
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Via Tolara di Sopra 50, Ozzano dell'Emilia, Bologna, Italy
| | - Massimo Giunti
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Via Tolara di Sopra 50, Ozzano dell'Emilia, Bologna, Italy
| | - Francesco Dondi
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Via Tolara di Sopra 50, Ozzano dell'Emilia, Bologna, Italy
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Babyak JM, Weiner DE, Noubary F, Sharp CR. Prevalence of Elevated Serum Creatinine Concentration in Dogs Presenting to a Veterinary Academic Medical Center (2010-2014). J Vet Intern Med 2017; 31:1757-1764. [PMID: 28891088 PMCID: PMC5697188 DOI: 10.1111/jvim.14823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/22/2017] [Accepted: 08/03/2017] [Indexed: 12/16/2022] Open
Abstract
Background The epidemiology of kidney disease is not extensively described in dogs. Hypothesis/Objectives To better understand the prevalence of elevated serum creatinine concentration in dogs. Animals Client‐owned dogs. Methods A retrospective, observational cross‐sectional study design was used. We made a dataset of 115,631 hospital visits of all dogs presenting from October 2010 to October 2014. We estimated the prevalence and risk of elevated serum creatinine, defined as >1.6 mg/dL, in evaluated dogs. Results Of 115,631 visits, 98,693 were outpatient visits and 16,938 were hospital admissions. Among outpatient visits, 9,983 (10.1%) had serum creatinine assessment (4,423 [44.3%] visits were first visits), whereas, among hospital admissions, 12,228 (60.0%) had at least 1 serum creatinine (7,731 [75.6%] admissions were first admissions). The prevalence of elevated serum creatinine concentration in all evaluated dogs was 11.5% (95% CI: 11.0%, 11.9%); 10.2% (95% CI: 9.6%, 10.8%) of inpatients and 12.9% (95% CI: 12.1%, 13.8%) of outpatients had elevated serum creatinine concentration. The relative risk (RR) of elevated serum creatinine concentration was significantly higher in geriatric dogs (outpatient RR 1.45 [95% CI: 1.23, 1.70], inpatient RR 1.43 [95% CI: 1.16, 1.76]) and lower in young dogs (outpatient RR 0.39 [95% CI: 0.26, 0.59], inpatient RR 0.44 [95% CI: 0.32, 0.62]) when compared to the measured population risk. Conclusions and Clinical Importance When selected for laboratory evaluation, the proportion of dogs presenting to an academic medical center with evidence of kidney injury is high compared to previous reports and might reflect a population of sicker dogs.
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Affiliation(s)
- J M Babyak
- Tufts Cummings School of Veterinary Medicine, North Grafton, MA
| | - D E Weiner
- Tufts University School of Medicine, Boston, MA.,Tufts Medical Center, Boston, MA.,Tufts Clinical and Translational Institute, Boston, MA
| | - F Noubary
- Tufts Clinical and Translational Institute, Boston, MA.,Tufts Sackler School of Biomedical Sciences, Boston, MA
| | - C R Sharp
- College of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
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Cole L, Jepson R, Humm K. Systemic hypertension in cats with acute kidney injury. J Small Anim Pract 2017; 58:577-581. [DOI: 10.1111/jsap.12726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 01/24/2023]
Affiliation(s)
- L. Cole
- Department of Clinical Science and Services; The Royal Veterinary College, Hawkshead Lane, Hatfield; Hertfordshire, ALP 7TA UK
| | - R. Jepson
- Department of Clinical Science and Services; The Royal Veterinary College, Hawkshead Lane, Hatfield; Hertfordshire, ALP 7TA UK
| | - K. Humm
- Department of Clinical Science and Services; The Royal Veterinary College, Hawkshead Lane, Hatfield; Hertfordshire, ALP 7TA UK
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Orvalho JS, Cowgill LD. Cardiorenal Syndrome: Diagnosis and Management. Vet Clin North Am Small Anim Pract 2017; 47:1083-1102. [PMID: 28669432 DOI: 10.1016/j.cvsm.2017.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiorenal syndrome (CRS) has not been well characterized in veterinary medicine, yet an accurate appreciation of the kidney and the cardiovascular system and their interactions may have practical clinical implications. A consensus for cardiovascular-renal axis disorders of dogs and cats was recently attempted. The outcome of patients with CRS is likely to improve with the increasing awareness and ability to identify and understand the pathophysiologic characteristics of CRS. The utilization of existing and emerging organ-specific biomarkers with greater sensitivities than conventional diagnostics forecast new opportunities to diagnose and manage cardiac disease.
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Affiliation(s)
- João S Orvalho
- University of California Veterinary Medical Center - San Diego, 10435 Sorrento Valley Road, Suite 101, San Diego, CA 92121, USA.
| | - Larry D Cowgill
- University of California Veterinary Medical Center - San Diego, 10435 Sorrento Valley Road, Suite 101, San Diego, CA 92121, USA; Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, 2108 Tupper Hall, Davis, CA 95616, USA
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15
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Dahlem DP, Neiger R, Schweighauser A, Francey T, Yerramilli M, Obare E, Steinbach SML. Plasma Symmetric Dimethylarginine Concentration in Dogs with Acute Kidney Injury and Chronic Kidney Disease. J Vet Intern Med 2017; 31:799-804. [PMID: 28370549 PMCID: PMC5435041 DOI: 10.1111/jvim.14694] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/21/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022] Open
Abstract
Background Symmetric dimethylarginine (SDMA) is considered a biomarker for early detection of renal dysfunction in human patients with acute kidney injury (AKI). At present, no studies exist analyzing the relevance of SDMA in dogs with AKI. Hypothesis/objectives SDMA would correctly identify dogs with renal disease but would not be able to differentiate between AKI and CKD. Animals Eighteen healthy control dogs, 48 dogs with AKI, and 29 dogs with CKD. Methods Prospective study. Dogs with kidney disease were categorized as having AKI or CKD according to the history, clinical signs, laboratory findings, and results of diagnostic imaging. Plasma SDMA concentration was measured by IDEXX Laboratories. SDMA/creatinine ratio was calculated in dogs with AKI or CKD. Results Median SDMA concentrations were 8.5 μg/dL (6–12 μg/dL), 39.5 μg/dL (8–>100 μg/dL), and 35 μg/dL (12–>100 μg/dL), in healthy, AKI, and CKD, respectively. SDMA concentrations were significantly higher in dogs with AKI (P < .0001) or CKD (P < .0001) in comparison with healthy dogs. Median SDMA/creatinine ratio in dogs with AKI and CKD was 6.5 (1.7–20.9) and 10 (2.4–33.9) (P = .0004), respectively. Although there was overlap of the SDMA/creatinine ratio in dogs with AKI or CKD, it was significantly higher in dogs with CKD compared to dogs with AKI (P = .0004). Conclusions and Clinical Importance In this population, SDMA was suitable for identifying dogs affected by AKI or CKD, but could not differentiate between them.
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Affiliation(s)
- D P Dahlem
- Small Animal Clinic (Internal Medicine), Justus-Liebig University Giessen, Giessen, Germany
| | - R Neiger
- Small Animal Clinic (Internal Medicine), Justus-Liebig University Giessen, Giessen, Germany
| | - A Schweighauser
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - T Francey
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - M Yerramilli
- IDEXX Biotechnology Group, IDEXX Laboratories, Inc., Westbrook, ME, USA
| | - E Obare
- IDEXX Biotechnology Group, IDEXX Laboratories, Inc., Westbrook, ME, USA
| | - S M L Steinbach
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
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16
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Nentwig A, Schweighauser A, Maissen-Villiger C, Bruckmaier RM, Zurbriggen A, van Dorland HA, Francey T. Assessment of the expression of biomarkers of uremic inflammation in dogs with renal disease. Am J Vet Res 2016; 77:218-24. [PMID: 27027717 DOI: 10.2460/ajvr.77.2.218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the expression of inflammatory cytokines and enzymes in venous whole blood of dogs with impaired renal function attributable to various causes. ANIMALS 46 dogs with acute kidney injury (AKI), 8 dogs with chronic kidney disease (CKD), and 10 healthy dogs. PROCEDURES Dogs with AKI and CKD were prospectively enrolled during 2010 if they met inclusion criteria. Demographic and laboratory characteristics were evaluated for each dog, and expression of inflammatory cytokines (interleukin [IL]-1α, IL-1β, IL-8, tumor necrosis factor [TNF]-α, IL-10, and transforming growth factor [TGF]-β) and enzymes (inducible nitric oxide synthase [iNOS] and 5-lipoxygenase [5-LO]) was measured in venous whole blood obtained at initial evaluation. RESULTS Dogs with impaired renal function had markedly higher expression of the cytokines IL-1α, IL-1β, and TGF-β and the enzyme 5-LO, compared with expression in healthy dogs. Additionally, 17 of 46 AKI dogs (but none of the CKD dogs) had higher IL-8 mRNA expression and 3 of 8 CKD dogs (but only 2/46 AKI dogs) had higher TNF-α expression, compared with results for healthy dogs. No significant difference between renal disease groups was detected for inflammatory markers and laboratory variables, degree of azotemia, or cause of impaired renal function. CONCLUSIONS AND CLINICAL RELEVANCE In this study, expression of the cytokines IL-1α, IL-1β, and TGF-β and the enzyme 5-LO was clearly increased in dogs with renal disease, which suggested that these markers were part of an inflammatory response in animals with AKI or CKD.
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Reeve J, Warman S, Lewis D, Watson N, Papasouliotis K. Evaluation of a handheld point-of-care analyser for measurement of creatinine in cats. J Feline Med Surg 2016; 19:207-215. [PMID: 26701957 DOI: 10.1177/1098612x15622676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The aim of the study was to evaluate whether a handheld creatinine analyser (StatSensor Xpress; SSXp), available for human patients, can be used to measure creatinine reliably in cats. Methods Analytical performance was evaluated by determining within- and between-run coefficient of variation (CV, %), total error observed (TEobs, %) and sigma metrics. Fifty client-owned cats presenting for investigation of clinical disease had creatinine measured simultaneously, using SSXp (whole blood and plasma) and a reference instrument (Konelab, serum); 48 paired samples were included in the study. Creatinine correlation between methodologies (SSXp vs Konelab) and sample types (SSXpwhole blood vs SSXpplasma) was assessed by Spearman's correlation coefficient and agreement was determined using Bland-Altman difference plots. Each creatinine value was assigned an IRIS stage (1-4); correlation and agreement between Konelab and SSXp IRIS stages were evaluated. Results Within-run CV (4.23-8.85%), between-run CV (8.95-11.72%), TEobs (22.15-34.92%) and sigma metrics (⩽3) did not meet desired analytical requirements. Correlation between sample types was high (SSXpwhole blood vs SSXpplasma; r = 0.89), and between instruments was high (SSXpwhole blood vs Konelabserum; r = 0.85) to very high (SSXpplasma vs Konelabserum; r = 0.91). Konelab and SSXpwhole blood IRIS scores exhibited high correlation ( r = 0.76). Packed cell volume did not significantly affect SSXp determination of creatinine. Bland-Altman difference plots identified a positive bias for the SSXp (7.13 μmol/l SSXpwhole blood; 20.23 μmol/l SSXpplasma) compared with the Konelab. Outliers (1/48 whole blood; 2/48 plasma) occurred exclusively at very high creatinine concentrations. The SSXp failed to identify 2/21 azotaemic cats. Conclusions and relevance Analytical performance of the SSXp in feline patients is not considered acceptable. The SSXp exhibited a high to very high correlation compared with the reference methodology but the two instruments cannot be used interchangeably. Improvements in the SSXp analytical performance are needed before its use can be recommended in feline clinical practice.
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Affiliation(s)
- Jenny Reeve
- 1 School of Veterinary Sciences, University of Bristol, Langford, UK
- 2 Small Animal Hospital, Langford Veterinary Services, Langford, UK
| | - Sheena Warman
- 1 School of Veterinary Sciences, University of Bristol, Langford, UK
- 2 Small Animal Hospital, Langford Veterinary Services, Langford, UK
| | | | - Natalie Watson
- 1 School of Veterinary Sciences, University of Bristol, Langford, UK
- 2 Small Animal Hospital, Langford Veterinary Services, Langford, UK
| | - Kostas Papasouliotis
- 1 School of Veterinary Sciences, University of Bristol, Langford, UK
- 4 Diagnostic Laboratories, Langford Veterinary Services, Langford, UK
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18
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Yozova ID, Howard J, Adamik KN. Retrospective evaluation of the effects of administration of tetrastarch (hydroxyethyl starch 130/0.4) on plasma creatinine concentration in dogs (2010-2013): 201 dogs. J Vet Emerg Crit Care (San Antonio) 2016; 26:568-77. [PMID: 27144501 DOI: 10.1111/vec.12483] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/12/2015] [Accepted: 08/27/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine changes in creatinine concentrations following the administration of 6% tetrastarch (hydroxyethyl starch [HES] 130/0.4) compared to crystalloids (CRYSs) in critically ill dogs. DESIGN Retrospective case series (2010-2013). SETTING University teaching hospital. ANIMALS Two hundred and one dogs admitted to the intensive care unit with initial plasma creatinine concentrations not exceeding laboratory reference intervals (52-117 μmol/L [0.6-1.3 mg/dL]) and receiving either CRYSs alone (CRYS group, n = 115) or HES with or without CRYSs (HES group, n = 86) for at least 24 hours. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Creatinine concentrations at admission to the intensive care unit (T0), and 2-13 days (T1) and 2-12 weeks (T2) after initiation of fluid therapy were analyzed. Creatinine concentrations were analyzed as absolute values and as the maximum percentage change from T0 to T1 (T1max%) and from T0 to T2 (T2max%), respectively. Creatinine concentrations were available for 192 dogs during T1 and 37 dogs during T2. The median cumulative dose of HES was 86 mL/kg (range, 12-336 mL/kg). No difference was detected between the groups for age, gender, body weight, and length of hospitalization. Outcome was significantly different between the HES (66% survived) and the CRYS (87% survived) groups (P = 0.014). No significant difference was detected between groups for creatinine concentrations at T0, T1, T2, T1max%, or T2max%. No significant difference was detected between the groups for T1max% creatinine in dogs subclassified as having systemic inflammatory response syndrome or sepsis. CONCLUSIONS HES administration in this canine population did not result in increased creatinine concentrations compared to administration of CRYSs. Further studies are needed to establish the safety of HES in critically ill dogs.
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Affiliation(s)
- Ivayla D Yozova
- Emergency and Critical Care Section, Small Animal Clinic, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Laenggassstrasse 124, 3012 Bern, Switzerland
| | - Judith Howard
- Diagnostic Clinical Laboratory, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Laenggassstrasse 124, 3012 Bern, Switzerland
| | - Katja-Nicole Adamik
- Emergency and Critical Care Section, Small Animal Clinic, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Laenggassstrasse 124, 3012 Bern, Switzerland
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19
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Keir I, Kellum JA. Acute kidney injury in severe sepsis: pathophysiology, diagnosis, and treatment recommendations. J Vet Emerg Crit Care (San Antonio) 2016; 25:200-9. [PMID: 25845505 DOI: 10.1111/vec.12297] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 01/11/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To review the unique pathophysiology of sepsis-induced acute kidney injury (AKI) and highlight the relevant aspects of the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury that may apply to veterinary patients. DATA SOURCES Electronic search of MEDLINE database. HUMAN DATA SYNTHESIS Sepsis-induced AKI is diagnosed in up to 47% of human ICU patients and is seen as a major public health concern associated with increased mortality and increased progression to chronic kidney disease (CKD). Consensus criteria for the definition and classification of AKI has allowed for accurate description of the epidemiology of patients with AKI. AKI develops from a complex relationship between the initial insult and activation of inflammation and coagulation. In contrast to the traditional view, clinical and experimental data dispute the role of renal ischemia-reperfusion in the development of sepsis-induced AKI. Renal tubular dysfunction with activation of the tubuloglomerular feedback mechanism appears to be a crucial contributor to sepsis-induced AKI. Furosemide and n-acetylcysteine (NAC) do not appear to be helpful in the treatment of AKI. Hydroxyethyl starches (HES), dopamine, and supraphysiological concentrations of chloride are harmful in patients with AKI. VETERINARY DATA SYNTHESIS Community and hospital-acquired AKI is a significant factor affecting survival in critical ill patients. Sepsis-induced AKI occurs in 12% of dogs with abdominal sepsis and is an important contributor to mortality. Early detection of AKI in hospitalized patients currently offers the best opportunity to improve patient outcome. The use of urinary biomarkers to diagnose early AKI should be evaluated in critical care patients. CONCLUSION Veterinary clinical trials comparing treatment choices with the development of AKI are needed to make evidence-based recommendations for the prevention and treatment of AKI.
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Affiliation(s)
- Iain Keir
- Center for Critical Care Nephrology, The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, 15260
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20
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Goggs R, Dennis SG, Di Bella A, Humm KR, McLauchlan G, Mooney C, Ridyard A, Tappin S, Walker D, Warman S, Whitley NT, Brodbelt DC, Chan DL. Predicting Outcome in dogs with Primary Immune-Mediated Hemolytic Anemia: Results of a Multicenter Case Registry. J Vet Intern Med 2015; 29:1603-10. [PMID: 26473338 PMCID: PMC4864895 DOI: 10.1111/jvim.13642] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/18/2015] [Accepted: 09/09/2015] [Indexed: 12/13/2022] Open
Abstract
Background Outcome prediction in dogs with immune‐mediated hemolytic anemia (IMHA) is challenging and few prognostic indicators have been consistently identified. Objectives An online case registry was initiated to: prospectively survey canine IMHA presentation and management in the British Isles; evaluate 2 previously reported illness severity scores, Canine Hemolytic Anemia Score (CHAOS) and Tokyo and to identify independent prognostic markers. Animals Data from 276 dogs with primary IMHA across 10 referral centers were collected between 2008 and 2012. Methods Outcome prediction by previously reported illness‐severity scores was tested using univariate logistic regression. Independent predictors of death in hospital or by 30‐days after admission were identified using multivariable logistic regression. Results Purebreds represented 89.1% dogs (n = 246). Immunosuppressive medications were administered to 88.4% dogs (n = 244), 76.1% (n = 210) received antithrombotics and 74.3% (n = 205) received packed red blood cells. Seventy‐four per cent of dogs (n = 205) were discharged from hospital and 67.7% (n = 187) were alive 30‐days after admission. Two dogs were lost to follow‐up at 30‐days. In univariate analyses CHAOS was associated with death in hospital and death within 30‐days. Tokyo score was not associated with either outcome measure. A model containing SIRS‐classification, ASA classification, ALT, bilirubin, urea and creatinine predicting outcome at discharge was accurate in 82% of cases. ASA classification, bilirubin, urea and creatinine were independently associated with death in hospital or by 30‐days. Conclusions and clinical importance Markers of kidney function, bilirubin concentration and ASA classification are independently associated with outcome in dogs with IMHA. Validation of this score in an unrelated population is now warranted.
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Affiliation(s)
- R Goggs
- School of Physiology and Pharmacology, University of Bristol, Bristol, UK
| | - S G Dennis
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - A Di Bella
- Vets Now Referrals Kent, Blue Bell Hill, UK
| | - K R Humm
- Department of Clinical Sciences and Services, RVC, North Mymms, UK
| | | | - C Mooney
- University College Dublin, Dublin, Ireland
| | - A Ridyard
- University of Edinburgh, Edinburgh, UK
| | - S Tappin
- Dick White Referrals, Six Mile Bottom, UK
| | - D Walker
- Anderson Moores Veterinary Specialists, Winchester, UK
| | - S Warman
- Companion Animal Studies, University of Bristol, Langford, UK
| | - N T Whitley
- Davies Veterinary Specialists, Higham Gobion, UK
| | - D C Brodbelt
- Production and Population Health, Royal Veterinary College, North Mymms, UK
| | - D L Chan
- Department of Clinical Sciences and Services, RVC, North Mymms, UK
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Pouchelon JL, Atkins CE, Bussadori C, Oyama MA, Vaden SL, Bonagura JD, Chetboul V, Cowgill LD, Elliot J, Francey T, Grauer GF, Fuentes VL, Moise NS, Polzin DJ, Van Dongen AM, Van Israël N. Cardiovascular-renal axis disorders in the domestic dog and cat: a veterinary consensus statement. J Small Anim Pract 2015; 56:537-52. [PMID: 26331869 PMCID: PMC4584495 DOI: 10.1111/jsap.12387] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 03/14/2015] [Accepted: 06/09/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES There is a growing understanding of the complexity of interplay between renal and cardiovascular systems in both health and disease. The medical profession has adopted the term "cardiorenal syndrome" (CRS) to describe the pathophysiological relationship between the kidney and heart in disease. CRS has yet to be formally defined and described by the veterinary profession and its existence and importance in dogs and cats warrant investigation. The CRS Consensus Group, comprising nine veterinary cardiologists and seven nephrologists from Europe and North America, sought to achieve consensus around the definition, pathophysiology, diagnosis and management of dogs and cats with "cardiovascular-renal disorders" (CvRD). To this end, the Delphi formal methodology for defining/building consensus and defining guidelines was utilised. METHODS Following a literature review, 13 candidate statements regarding CvRD in dogs and cats were tested for consensus, using a modified Delphi method. As a new area of interest, well-designed studies, specific to CRS/CvRD, are lacking, particularly in dogs and cats. Hence, while scientific justification of all the recommendations was sought and used when available, recommendations were largely reliant on theory, expert opinion, small clinical studies and extrapolation from data derived from other species. RESULTS Of the 13 statements, 11 achieved consensus and 2 did not. The modified Delphi approach worked well to achieve consensus in an objective manner and to develop initial guidelines for CvRD. DISCUSSION The resultant manuscript describes consensus statements for the definition, classification, diagnosis and management strategies for veterinary patients with CvRD, with an emphasis on the pathological interplay between the two organ systems. By formulating consensus statements regarding CvRD in veterinary medicine, the authors hope to stimulate interest in and advancement of the understanding and management of CvRD in dogs and cats. The use of a formalised method for consensus and guideline development should be considered for other topics in veterinary medicine.
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Affiliation(s)
- J L Pouchelon
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie d'Alfort, Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Maisons-Alfort 94704, France
| | - C E Atkins
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - C Bussadori
- Clinica Veterinaria Gran Sasso, Milano 20131, Italy
| | - M A Oyama
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - S L Vaden
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - J D Bonagura
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - V Chetboul
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie d'Alfort, Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Maisons-Alfort 94704, France
| | - L D Cowgill
- Department of Medicine and Epidemiology, University of California-Davis, Davis, CA 95616, USA
| | - J Elliot
- Comparative Biomedical Sciences, The Royal Veterinary College, University of London, London NW1 0TU
| | - T Francey
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern 3012, Switzerland
| | - G F Grauer
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506, USA
| | - V Luis Fuentes
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield AL9 7TA, UK
| | - N Sydney Moise
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - D J Polzin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA
| | - A M Van Dongen
- Department of Clinical Sciences of Companion Animals, University of Utrecht College of Veterinary Medicine, Utrecht 3584, The Netherlands
| | - N Van Israël
- ACAPULCO Animal Cardiopulmonary Consultancy, Masta, Stavelot 4970, Belgium
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22
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Bland SK, Côté O, Clark ME, DeLay J, Bienzle D. Characterization of kidney injury molecule-1 in cats. J Vet Intern Med 2015; 28:1454-64. [PMID: 25274439 PMCID: PMC4895577 DOI: 10.1111/jvim.12428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/16/2014] [Accepted: 07/07/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Kidney disease (KD) is common in older cats and presumed to arise from subclinical kidney injuries throughout life. Sensitive markers for detecting kidney injury are lacking. Kidney injury molecule 1 (KIM-1) is a useful biomarker of kidney injury in humans and rodents. HYPOTHESIS/OBJECTIVES Feline KIM-1 is conserved across species, expressed in kidney, and shed into urine of cats with acute kidney injury (AKI). The objectives were to characterize the feline KIM-1 gene and protein, assess available immunoassays for detecting KIM-1 in urine of cats, and identify KIM-1 expression in kidney sections. ANIMALS Samples from 36 hospitalized and 7 clinically healthy cats were evaluated. Hospitalized cats were divided into 2 groups based on absence (n = 20) or presence (n = 16) of historical KD. METHODS Feline KIM-1 genomic and complementary DNA sequences were amplified, sequenced and analyzed to determine the presence of isoforms, exon-intron organization and similarity with orthologous sequences. Presence in urine was evaluated by immunoassay and expression in kidney by immunohistochemistry. RESULTS Three expressed feline KIM-1 transcript variants comprising 894, 810, and 705 bp were identified in renal tissue. KIM-1 immunoassays yielded positive results in urine of cats with conditions associated with AKI, but not chronic KD. Immunohistochemistry of kidney sections identified KIM-1 in proximal tubular cells of cats with positive urine immunoassay results. CONCLUSIONS AND CLINICAL IMPORTANCE Kidney injury molecule 1 was expressed in specific segments of the nephron and detected in urine of cats at risk of AKI. Urine KIM-1 immunoassay may be a useful indicator of tubular injury.
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Affiliation(s)
- S K Bland
- Department of Pathobiology, University of Guelph, Guelph, ON
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Hoareau GL, Epstein SE, Palm C, Ybarra W, Jandrey KE, Cowgill LD. Resolution of anuric acute kidney injury in a dog with multiple organ dysfunction syndrome. J Vet Emerg Crit Care (San Antonio) 2014; 24:724-30. [PMID: 25377656 DOI: 10.1111/vec.12248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 09/28/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To describe the management and resolution of anuric acute kidney injury (AKI) in a dog with multiple organ dysfunction syndrome (MODS) associated with gallbladder wall necrosis. CASE SUMMARY An 11-year-old neutered female spayed dog was referred for evaluation of anuria following cholecystectomy. Following surgery, the patient became anuric with no response to appropriate medical therapy. During the course of hospitalization, the patient developed MODS as evidenced by alteration in renal function, but also cardiovascular dysfunction, coagulation disorders, and hypoglycemia. Several hemodialysis treatments were performed and, along with intensive care, led to resolution of clinical signs and return of urine production. NEW OR UNIQUE INFORMATION This report describes resolution of anuria in a dog with AKI and MODS. In this clinical setting, despite a poor prognosis, survival and recovery of adequate renal function were possible with medical management that included hemodialysis.
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Affiliation(s)
- Guillaume L Hoareau
- Veterinary Medical Teaching Hospital (Hoareau, Ybarra); School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616
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