Relationship between serum iohexol clearance, serum SDMA concentration, and serum creatinine concentration in non-azotemic dogs

New biomarkers and scintigraphic evaluation of renal function in dogs with canine leishmaniosis

This study evaluated the utility of new renal biomarkers in canine leishmaniosis (CanL). A total of 6 healthy dogs (CG) and 22 dogs with CanL (LeishVet stage III or GIII (n = 11) and stage IV or GIV (n = 11)) were included. Plasma creatinine, urea, cystatin C (pCysC), and symmetric dimethylarginine were analyzed. In urine, neutrophil gelatinase-associated lipocalin, retinol-binding protein, Tamm-Horsfall protein, and total protein were measured using their ratios with creatinine (uNGAL/c, uRBP/c, uTHP/c, and UPC, respectively). The estimated glomerular filtration rate (eGFR) was assessed by 99mTc-DTPA scintigraphy. All glomerular biomarkers strongly correlated with eGFR and showed statistically significant differences between CanL stages but not with CG, except for pCysC, which was particularly noteworthy for its statistical significance, instilling confidence in its potential use. All tubular biomarkers presented significant differences between GIV and CG; however, only uNGAL/c and uTHP/c differentiated between GIII and CG. Moreover, none could distinguish between the GIII and GIV groups. These data suggest that the new glomerular biomarkers could help determine stages of renal disease in CanL. uNGAL/c and uTHP/C showed advantages in making an earlier diagnosis. Ultimately, pCysC presented tremendous potential, as it was statistically significant for both uses. This research provides valuable information to understand the behavior of these biomarkers in renal disease secondary to CanL.

Renal Biomarkers in Companion Animals-A Review

Recent advancements in molecular biology have led to the discovery of potential biomarkers for the diagnosis of acute kidney disease (AKD) and chronic kidney disease (CKD). The use of multiple biomarkers in the diagnosis of kidney disease has the potential to enhance both specificity and sensitivity, enabling early detection and intervention that could ultimately reduce morbidity and mortality rates. This review provides an overview of studies on urine and blood biomarkers and examines their utility and significance in various clinical settings. Further and continuous research is needed to support the application of these biomarkers in clinical practice to facilitate early diagnosis, guidance for different interventions, and the monitoring of disease progression.

A Retrospective Evaluation of Serum Symmetric Dimethylarginine Concentration in Dogs With Protein-Losing Enteropathy

BACKGROUND

Serum symmetric dimethylarginine (SDMA) is abnormally increased in people with inflammatory bowel disease (IBD). Changes in dogs with gastrointestinal disease, such as protein-losing enteropathy (PLE), have not been assessed.

OBJECTIVES

Evaluate SDMA concentration in non-azotemic dogs with PLE.

ANIMALS

A total of 127 client-owned dogs, 17 with PLE, 34 controls matched for age, breed, sex, and neuter status, and 76 additional controls for multiple linear regression modeling.

METHODS

Retrospective case-control study. The clinical records of a United Kingdom referral hospital were reviewed. Dogs with azotemia or prior glucocorticoid or immunosuppressive treatment were excluded. Dogs diagnosed with PLE that had serum symmetric dimethylarginine (SDMA) concentrations measured were compared with the matched controls. Signalment, clinical presentation, clinicopathological abnormalities, treatment, and SDMA concentration pre- (PLE-T0) and post- (PLE-T1) treatment were recorded.

RESULTS

At baseline, SDMA concentration was higher in PLE (T0, 15.2 ± 2.02 μg/dL) than in control (11.0 ± 3.13 μg/dL) dogs (p < 0.001; Hedge's G, 1.48), but decreased with treatment (PLE-T1: 10.3 ± 2.78 μg/dL; T0 vs. T1: p = 0.01, Hedge's G, 1.31). Serum creatinine concentration was similar in PLE (T0, 0.81 ± 0.24 μg/dL) and control (0.85 ± 0.26 μg/dL) dogs at baseline (p = 0.57; Hedge's G, 0.18). Serum albumin concentration was lower in PLE (1.60 ± 0.51 g/dL) than in control (2.96 ± 0.49 g/dL) dogs (p < 0.001; Hedge's G, 2.68) before treatment, but increased with treatment (PLE-T1: 2.29 ± 0.65 g/dL; T0 vs. T1: p = 0.003; Hedge's G, 1.14), although it remained lower than the concentration in controls (p = 0.002; Hedge's G, 1.23). No other clinicopathological differences were evident.

CONCLUSIONS AND CLINICAL IMPORTANCE

Serum SDMA concentration is increased in dogs with PLE; the clinical relevance of this finding requires further investigation.

Influence of Carcinoma and Sarcoma on Neutrophil Gelatinase-Associated Lipocalin and Symmetric Dimethylarginine Concentrations in Dogs

BACKGROUND

It is unknown if tumors or concomitant renal disease influence neutrophil gelatinase-associated lipocalin (NGAL) and symmetric dimethylarginine (SDMA) concentrations in tumor-bearing dogs.

OBJECTIVES

Determine the effect of tumor presence, tumor type, and metastasis on concentrations of serum NGAL (sNGAL), SDMA, urinary NGAL (uNGAL), and uNGAL-to-creatinine ratio (uNGAL/Cr) in dogs with carcinoma or sarcoma without clinically relevant renal disease.

ANIMALS

Twenty-one dogs with carcinoma, 18 with sarcoma, and 20 healthy age-controlled dogs.

METHODS

Concentrations of sNGAL, SDMA, and uNGAL, and uNGAL/Cr ratio were measured from banked samples collected during a previous prospective study. Patient clinicopathological and histopathology records were reviewed, and those with renal azotemia or moderate to severe histopathological renal abnormalities were classified as having clinically relevant renal disease. Biomarker concentrations were compared between tumor-bearing dogs without clinically relevant renal disease and healthy age-controlled dogs. Additionally, comparisons were made between dogs with carcinoma and sarcoma, as well as between dogs with and without metastasis. Correlations between uNGAL and sNGAL concentrations, along with acute phase protein (APP) concentrations, were also analyzed.

RESULTS

Tumor-bearing dogs without clinically relevant renal disease had increased uNGAL/Cr (p < 0.001), but not sNGAL, compared with healthy controls. Although median SDMA concentrations did not significantly differ between groups, increased concentrations were found in 32% of dogs with carcinoma and 20% of dogs with sarcoma. No differences were found between dogs with carcinoma and those with sarcoma, or between dogs with metastasis and those without. Urinary and serum NGAL concentrations were moderately correlated, while weak to no correlations were observed with APPs.

CONCLUSION

Carcinomas and sarcomas, but not metastasis, influence uNGAL/Cr and SDMA concentrations in dogs.

Evaluation of renal function in dogs using pulsed Doppler ultrasonography

Background

In human medicine, efforts have been made to evaluate venous blood flow in the kidneys to diagnose renal disease and estimate renal function. In dogs, previous studies have predicted renal function using the resistive index (RI) and pulsatility index (PI), which are derived from renal arterial blood flow velocity assessed via pulsed Doppler ultrasonography. However, to date, no study has been conducted on renal venous blood flow velocity in dogs.

Aim

To investigate the relationship between renal venous blood flow velocity and renal function.

Methods

Ten normal beagle dogs underwent blood tests and glomerular filtration rate (GFR) measurements. Pulsed Doppler ultrasonography was performed under sedation to measure the maximum venous flow velocity (Vmax), minimum venous flow velocity (Vmin), and venous impedance index in the renal and interlobular veins. The RI and PI were calculated from the renal and interlobular arteries.

Results

Vmax and Vmin of the renal vein were negatively correlated with GFR in both kidneys. No significant correlations were found between other measures and GFR. These results suggest a relationship between GFR and venous flow velocity in the renal veins assessed using pulsed Doppler ultrasonography.

Conclusion

These findings demonstrate the potential of this methodology as a new tool for predicting abnormalities in the renal venous blood flow and renal congestion in dogs. Further large-scale studies and comparisons between healthy dogs and dogs with impaired renal function are needed to validate this relationship.

Urinary neutrophil gelatinase-associated lipocalin as early biomarker for renal disease in dogs with leishmaniosis

Canine leishmaniosis (CanL), caused by Leishmania sp., presents a wide array of symptoms; renal dysfunction is frequently observed in these dogs and is associated with a poor prognosis and increased mortality. The traditional biomarkers namely urea and creatinine can detect renal damage but only in advanced stages of the disease. However, it has been shown that the symmetric dimethylarginine assay (SDMA) or the protein/creatinine ratio (UPC) and are early biomarkers of renal dysfunction. Their elevation occurs earlier than that of creatinine, but other novel biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) are currently under investigation. Our objective was to determine whether the urine NGAL-creatinine ratio (uNGAL/c) can provide very early diagnosis of kidney disease in CanL. In total, 68 dogs were included in the study: 15 healthy dogs and 53 dogs with CanL who were classified according to International Renal Interest Society (IRIS) classification: IRIS 1 (N= 34), IRIS 2 (N= 9) and IRIS 3/4 (N= 10). IRIS 1 was subdivided according to proteinuria in IRIS 1NP (13 dogs with UPC < 0.2), IRIS 1BL (8 dogs with UPC = 0.2-0.5) and IRIS 1 P (13 dogs with UPC > 0.5). Blood samples were collected for complete hematological and biochemistry analysis including plasma NGAL. Urinalysis included specific gravity, UPC, CysC and NGAL expressed as a ratio with creatinine. The mean concentrations of pCysC and SDMA in CanL, show a statistically significant increase from IRIS 1NP, not being statistically significant for pCysC in the IRIS 1BL group. The UPC show a statistically significant increase from IRIS 1NP. In all groups with CanL for uCysC/c and uNGAL/c was observed a statistically significant increase. The uNGAL/c in the group proteinuric animals, presents a positive correlation with all renal biomarkers studied. In the group of non-proteinuric animals, the uNGAL/c presents a positive correlation with SDMA and UPC. The uNGAL/c can be considered a reliable indicator of renal disease in dogs diagnosed with CanL who are non-azotemic and non-proteinuric.

Description of serum symmetric dimethylarginine concentration and of urinary SDS-AGE pattern in dogs with ACTH dependent hyperadrenocorticism

Serum symmetric dimethylarginine (SDMA) and patterns of urinary protein separated by sodium dodecyl sulfate agarose gel electrophoresis (SDS-AGE) have not been investigated as biomarkers in dogs with ACTH-dependent hyperadrenocorticism (ADHAC). This exploratory prospective study aimed to evaluate SDMA, serum creatinine (sCR), and SDS-AGE in dogs with ADHAC with and without proteinuria (ADHAC-P and ADHAC-nP, respectively). Thirty-five pet dogs classified as ADHAC-P (n=16), ADHAC-nP (n=6) and healthy (n=13) were included. Renal biomarkers were evaluated in all dogs at diagnosis. Baseline concentration of SDMA was not significantly different between the three groups (P = 0.15) whereas sCr was significantly lower in dogs in ADHAC dogs compared to healthy dogs (88.0 µmol/L [70.4-132.6; 79.2-114.4]) whether they had proteinuria or not (P = 0.014 and 0.002, respectively). However, baseline concentrations of sCr and SDMA were not significantly different between dogs with ADHAC-P dogs (SDMA, 8 µg/dL [5-12; 7-9]; sCr, 57.2 µmol/L [35.2-212.2; 52.8-92.4]) and ADHAC-nP dogs (SDMA, 8.5 µg/dL [7-13; 8-10]; sCr, 70.4 µmol/L [61.6-79.2; 61.6-70.4]) (P = 0.35 and P = 0.41, respectively). Proteinuria in dogs with ADHAC-P was mainly of glomerular origin (SDS-AGE pattern: glomerular in 10/16 dogs; mixed glomerular/tubular in four dogs). In our study, SDMA was neither significantly different in dogs with ADHAC whether they were proteinuric or not, nor between ADHAC and healthy dogs. Urinary electrophoresis provides additional information to the UPC and further investigations are needed to determine whether it may help identify dogs with ADHAC-P requiring specific antiproteinuric treatment.

Serum symmetric dimethylarginine in older dogs: Reference interval and comparison of a gold standard method with the ELISA

BACKGROUND

Serum symmetric dimethylarginine (SDMA) is used to screen for renal dysfunction in dogs. The gold standard technique for measuring SDMA, liquid chromatography-tandem mass spectrometry (LC-MS/MS) is not widely available. Age-specific reference intervals for SDMA in older dogs are lacking.

OBJECTIVES

Prospective study in older dogs to validate a commercially available LC-MS/MS method for SDMA, compare SDMA concentrations with concentrations measured using ELISA and obtain a reference interval (RI) for older dogs using both methods.

ANIMALS

Client-owned older dogs undergoing health screening.

METHODS

The LC-MS/MS method was analytically validated (limit of detection, precision, and linearity). Serum was sent cooled overnight for ELISA or was frozen at -80°C until batch analysis using LC-MS/MS. Results of LC-MS/MS and ELISA were compared and RIs for older dogs were calculated according to international guidelines.

RESULTS

The LC-MS/MS method showed good linearity (r2  = .99) and precision (coefficient of variation <10%), with a laboratory RI between 8.0 and 14.0 μg/dL. Paired measurements were available from 118 different dogs. Median SDMA concentration were 9.4 (range, 5.0-21.2) using LC-MS/MS and 12.0 (range, 5.0-22.0) μg/dL using ELISA. Both methods significantly differed with a mean difference of 2.2 μg/dL. The RI for older dogs for LC-MS/MS was 4.4-15.0 μg/dL, and for ELISA was 6.4-17.4 μg/dL.

CONCLUSIONS AND CLINICAL IMPORTANCE

The ELISA provided significantly higher SDMA concentrations compared to the validated LC-MS/MS method, indicating the need for device- or assay-specific RI. The obtained age-specific RI for SDMA is considerably higher in older dogs compared to the general laboratory RI.

Novel renal injury markers in dogs with ehrlichiosis

Canine monocytic ehrlichiosis (CME) has been observed to impact renal function. Currently, the recognition of acute kidney injury is through the nonspecific biomarker serum creatinine (sCr). Novel markers of renal injury such as urinary clusterin (uClust) and urinary cystatin B (uCysB) may increase our understanding of the relationship between ehrlichiosis and renal cellular injury. The aim of this study was to evaluate novel renal injury biomarkers in dogs with acute CME. Twenty healthy dogs were enrolled in the control group (CG), and 16 dogs naturally infected with Ehrlichia canis were included in the Ehrlichia Group (EG). All dogs were followed for 45 days. EG dogs were treated with doxycycline twice daily for the first 30 days. Urine and serum were collected at: 0, 0.5, 1, 15, 30, and 45 days after start of treatment. Urine concentrations of uClust and uCysB were determined using a research ELISA immunoassay. A linear mixed model was used to estimate population mean of renal injury markers with patient as the random effect, and day and treatment as fixed effects. EG was observed to have higher uClust values compared to CG (estimated population mean EG: 213 ng/dL vs. CG: 84 ng/dL, P < 0.001). EG was observed to have higher uCysB values compared to CG (estimated population mean EG: 248 ng/dL vs. CG: 38 ng/dL, P < 0.001). Increases in uCysB and uClust suggest the presence of renal injury and a possible mechanism for the observed predisposition to chronic kidney disease in dogs with ehrlichiosis.

Association between glomerular filtration rate and plasma N-terminal pro-atrial natriuretic peptide concentration in dogs

OBJECTIVES

To investigate the association between plasma N-terminal pro-atrial natriuretic peptide concentration and glomerular filtration rate in dogs.

MATERIALS AND METHODS

Dogs were classified into four categories by bodyweight. Dogs were divided into four groups (Groups 1 to 4) based on glomerular filtration rate estimates using plasma iohexol clearance per bodyweight category. Generalised linear models were built to explore the relationship between plasma N-terminal pro-atrial natriuretic peptide concentration and glomerular filtration rate and the effect of confounders on plasma N-terminal pro-atrial natriuretic peptide concentration.

RESULTS

Fifty-three dogs were included (Group 1, 25; Group 2, seven; Group 3, five; and Group 4, 16). The medians (interquartile range) N-terminal pro-atrial natriuretic peptide concentrations for Groups 1 to 4 were 7224 pg/mL (4766 to 10,254 mg/dL), 8958 pg/mL (4935 to 11,271 mg/dL), 9280 pg/mL (9195 to 10,384 mg/dL) and 12,683 pg/mL (9133 to 19,217 mg/dL), respectively. Group 4, estimated to have the highest reduction in glomerular filtration rate, had a higher plasma N-terminal pro-atrial natriuretic peptide concentration than Groups 1 to 3. Based on the final generalised linear model, influencing factors for plasma N-terminal pro-atrial natriuretic peptide concentration were plasma iohexol clearance (-0.136; 95% confidence interval, -0.227 to -0.046) and bodyweight (-0.058; 95% confidence interval, -0.098 to -0.018).

CLINICAL SIGNIFICANCE

N-terminal pro-atrial natriuretic peptide concentration is associated with the glomerular filtration rate.

Urinary cystatin C and N-acetyl-beta-D-glucosaminidase (NAG) as early biomarkers for renal disease in dogs with leishmaniosis

Canine leishmaniasis (CanL) is a disease caused by Leishmania infantum that can vary from a subclinical infection to a severe disease. Dogs affected with CanL present varying degrees of renal dysfunction. Unfortunately, traditional biomarkers such as urea and creatinine detect renal damage in advanced stages of the disease, so more accurate biomarkers are needed. Hence, we aimed to study how urinary cystatin C (CysC) and N-acetyl-beta-D-glucosaminidase (NAG), behave in dogs with CanL at different stages of the disease. Eighty-six CanL infected dogs were classified according to LeishVet stages: LI (16 dogs), LIIa (12 dogs), LIIb (12 dogs), LIII (16 dogs) and LIV (30 dogs); as a control, 17 healthy dogs were studied. Blood samples were collected for complete haematological and biochemistry analysis including plasma cystatin C. Urine analysis included urine specific gravity (USG), urine protein to creatinine ratio (UPC), CysC and NAG expressed as a ratio with creatinine uCysCc (μg/g) and uNAGc (IU/g). The haematological, biochemical and urinary analysis coincided with the LeishVet guidelines. The statistical study of the uCysCc ratio and the uNAGc, showed significant increase when compared against control starting from group LI (p < 0.05). Interestingly, when the cut-off values were calculated using the ROC curve, uCysCc (258.85 µg/g) and uNAGc (2.25 IU/g) 75 % of the dogs included in LI groups surpassed the threshold. Hence our study indicates that uCysCc and uNAGc, could help to detect early renal damage in CanL affected dogs.

Hyperthyroid cats and their kidneys: a literature review

Hyperthyroidism and chronic kidney disease (CKD) are common diseases of geriatric cats, and often occur concurrently. Thus, a thorough understanding of the influence of thyroid function on renal function is of significant value for all feline practitioners. Among other effects, hyperthyroidism causes protein catabolism and increases renal blood flow and glomerular filtration rate (GFR). These effects render traditional renal markers insensitive for the detection of CKD in cats with uncontrolled hyperthyroidism. Furthermore, the development of iatrogenic hypothyroidism with over treatment of hyperthyroidism can be detrimental to renal function and may negatively affect long-term survival. This review discusses important diagnostic considerations of feline hyperthyroidism, as well as key treatment modalities, with an emphasis on the use of radioiodine and the importance of post treatment monitoring of thyroid and renal parameters. In Australia, a common curative treatment for cats with benign hyperthyroidism (i.e. thyroid hyperplasia or adenoma) is a fixed dose of orally administered radioiodine, regardless of the serum total thyroxine concentration at the time of diagnosis. This review discusses the long term outcomes of this standard of care in comparison with current, relevant research literature from around the world. Finally, this review explores the use of symmetric dimethylarginine (SDMA) in assessing renal function before and after treatment in hyperthyroid cats. SDMA correlates well with GFR and creatinine in non-hyperthyroid cats, but our understanding of its performance in hyperthyroid cats remains in its infancy.

Short course of immune-suppressive doses of prednisolone, evaluated through a prospective double-masked placebo-controlled clinical trial in healthy Beagles, is associated with sustained modifications in renal, hydration, and electrolytic status

OBJECTIVE

To investigate the effects and duration of orally administered prednisolone on renal function evaluated by glomerular filtration rate (GFR) determination and creatinine (Cr) and symmetric dimethylarginine (SDMA) concentrations as well as on urinalysis, electrolytes, and hydric status in healthy dogs.

ANIMALS

14 healthy Beagles.

PROCEDURES

In this prospective double-masked placebo-controlled study, dogs were randomized after baseline evaluation to receive a 7-day course of either prednisolone (1.5 to 2.0 mg/kg, PO, q 12 h) or a placebo. A repeated-measure design was performed, each dog participating in 4 successive sampling sessions. Clinical data, systolic blood pressure, CBC, and biochemical analyses including serum SDMA concentration, GFR determination, urine output quantification, and complete urinalysis were performed for all dogs the day before (D0) and at the end of steroid administration (D7) as well as 2 weeks (D21) and 4 weeks (D35) after the end of treatment.

RESULTS

At D7, when compared with baseline, GFR increased significantly in treated dogs, whereas creatinine and SDMA concentrations decreased significantly. GFR and Cr but not SDMA modifications persisted significantly at D21. None of the variables differed significantly from baseline at D35. The OR of presenting an albumin band on urine electrophoresis was 2.4 times as high in treated versus control dogs (OR, 36; 95% CI, 1.8 to 719.4; P = 0.02).

CLINICAL RELEVANCE

A short-term course of immune-suppressive prednisolone treatment in healthy dogs leads to a sustained but reversible renal hyperfiltration state. Modification in electrolytic variables can affect the clinical interpretation of blood work in such patients.

Evaluation of symmetric dimethylarginine and Doppler ultrasonography in the diagnosis of gentamicin-induced acute kidney injury in dogs

Acute kidney injury is a common problem in dogs and is associated with significant morbidity and mortality. So, the present study aimed to evaluate symmetric dimethylarginine (SDMA) and Doppler ultrasonography including resistive index (RI) in the diagnosis of acute kidney injury in dogs. Ten healthy mongrel dogs were injected with gentamicin sulfate 10% at the dose of 30 mg/kg body weight daily for 10 days for induction of acute kidney injury. Clinical, biochemical, ultrasonographic, and Doppler ultrasonographic examinations and urinalysis were performed for all dogs on 0 day before induction, on the 5th day, and on the 10th day of induction. The results of the current study showed significant increase in plasma level of SDMA, serum urea, creatinine, phosphorus, and potassium and a significant decrease in serum sodium, calcium, and chloride on the 5th day and 10th day of induction, and there was an increase in renal cortical echogenicity of the right and left kidney compared to adjacent liver and spleen, respectively. RI value showed a significant increase on the 5th day and 10th day of induction. The present study showed that SDMA is a sensitive and promising biomarker for diagnosis of acute kidney injury in dogs compared to routine biomarkers; also, the RI of Doppler ultrasonography is useful for early identifying acute kidney injury when the only observable change is an increase in cortical echogenicity.

Prospective evaluation of novel biomarkers of acute kidney injury in dogs following cardiac surgery under cardiopulmonary bypass

OBJECTIVE

To assess the occurrence of acute kidney injury (AKI) in dogs undergoing cardiac surgery under cardiopulmonary bypass (CPB) and explore associations between traditional and novel serum and urinary biomarkers.

DESIGN

Prospective cohort study conducted between July 2018 and April 2019.

SETTING

University teaching hospital.

ANIMALS

Nineteen dogs undergoing cardiac surgery under CPB with preoperative serum creatinine <140 μmol/L (<1.6 mg/dl).

INTERVENTIONS

Blood and urine samples were obtained at 4 time points: preoperatively following general anesthesia induction, immediately postoperatively, and 2 and 4 days postoperatively (T₁ , T₂ , T₃ , and T₄ ). AKI was defined as an increase in serum creatinine ≥26.4 μmol/L (≥0.3 mg/dl) above baseline within 48 hours. Serum creatinine, C-reactive protein (CRP), symmetric dimethylarginine (SDMA), inosine, beta-aminoisobutyric acid (BAIB), urinary clusterin (uClus), and urinary cystatin B (uCysB) were measured. Data were log-transformed (log₁₀ ) when appropriate and assessed using linear mixed-effects models.

MEASUREMENTS AND MAIN RESULTS

AKI occurred in 3 of 19 dogs (15.8%, 95% confidence interval: 0.047-0.384). Inosine increased at T₂ (adjusted mean ± standard error: 53 ± 5.6) in all dogs, and then gradually decreased. Log₁₀ uCysB increased at T₂ (2.3 ± 0.1) in all dogs and remained high. Log₁₀ CRP and log₁₀ uClus increased significantly at T₃ (1.9 ± 0.1 and 3.6 ± 0.1, respectively) in all dogs and remained increased. There was a significant positive association between serum creatinine and SDMA (P < 0.001, estimate ± standard error: 0.06 ± 0.00), between log₁₀ CRP and log₁₀ uClus (P < 0.001, 0.35 ± 0.08), between SDMA and creatinine as well as between SDMA and BAIB (P < 0.001, 11.1 ± 0.83 and P < 0.001, 1.06 ± 0.22, respectively) for all dogs at all time points.

CONCLUSIONS

Inosine and uCysB concentrations changed in all dogs immediately following a surgery under CPB and may indicate tubular injury. Further studies are required to ascertain the usefulness of those biomarkers in early detection of AKI.

Prospective evaluation of 5 urinary biomarkers as predictors of acute kidney injury in nonazotemic, hospitalized dogs

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.

Assessment of glomerular filtration rate measurement in dogs using dynamic contrast CT compared to serum iohexol clearance

Dynamic contrast CT with Patlak plot analysis can be used to determine the glomerular filtration rate (GFR). However, several studies have shown different GFR values and they are most likely less than the values by the standard techniques. The purpose of this prospective, experimental, and method comparison study was to evaluate the GFR using a CT technique (CT-GFR) in 12 healthy dogs compared to serum iohexol clearance (SIC-GFR). All dogs were anesthetized and placed in the right lateral recumbency position and the caudal part was lifted inside the CT gantry. A single-slice dynamic CT of the aorta and both kidneys was scanned sequentially every 2 s for 2 min after a bolus injection (3 mL/s) of iohexol (300 mg/kg). Time attenuation curves (TAC) were constructed and the GFR per volume of kidney was calculated using the Patlak plot analysis method based on 30-120 s time intervals, and results were compared to global GFR from SIC that was determined with eight blood samples for up to 240 min. The CT-GFR value (1.85 ± 0.48 mL/min/kg) was significantly less than the SIC-GFR value (3.40 ± 0.80 mL/min/kg; P < .05). The CT-GFR was correlated with SIC-GFR by the coefficient of correlation (r) at 0.61 (P = .046). In conclusion, the CT-GFR underestimated SIC-GFR and should be used carefully. We suggest that the GFR should be calculated using the equation derived from linear regression between CT-GFR and the standard GFR method. With its own particular parameters, each institute should have its own prediction equation.

A longitudinal study of the persistence of increased creatinine and concordance between kidney biomarkers in cats and dogs

Kidney disease causes morbidity and mortality in dogs and cats. Serum creatinine concentration is an important surrogate marker for glomerular filtration rate (GFR). However, it is not always sensitive to small decreases in kidney function. Efforts to identify additional, more sensitive surrogate markers of GFR to improve detection of early kidney disease has led to the use of symmetrical dimethylarginine (SDMA) in veterinary medicine. There is insufficient information about the behavior of creatinine after an increase and the expected behavior of creatinine and SDMA in these cats and dogs. This study assesses the probability of persistence of increases in creatinine and the subsequent behavior of creatinine and SDMA in animals with persistently increased creatinine. For enrollment, three paired SDMA and creatinine concentrations were required: baseline (T0) with creatinine and SDMA at or below the upper reference limit (URL), T1, and T2 0.5-18 months after T1. The study included 4517 cats and 4576 dogs with increased T1 creatinine concentrations and 54,295 cats and 125,403 dogs with T1 creatinine at or below the URL. The probability of a persistently increased creatinine at T2 was approximately 58% for cats and 49% for dogs after a T1 increase. For animals without a T1 increase the probability of increased creatinine at T2 was only 7% for cats and 3% for dogs. For cats and dogs with persistently increased Cr, the probability of an increased SDMA concentration at T1 was 70-75%. By 24 months, that probability rose to 94% for cats and 88% for dogs.

Longitudinal evaluation of symmetric dimethylarginine and concordance of kidney biomarkers in cats and dogs

Symmetric dimethylarginine (SDMA) is a sensitive surrogate marker for glomerular filtration rate; however, there are uncertainties as to how to interpret mild increases (SDMA 15-19 μg/dL). This descriptive study used retrospective data to evaluate whether cats or dogs that had initial SDMA values (at T0) within the reference interval followed by an increased SDMA (at T1) had persistently increased SDMA (at T2; measured from 14 days to 18 months following T1; Persistence Cohort), and if and when cats or dogs with persistently increased SDMA had increased creatinine up to 24 months (Concordance Cohort). The Persistence Cohort included 16,670 cats and 16,712 dogs. If SDMA at T1 was 15-19 μg/dL, the probability of persistence was 53% for cats and 42% for dogs, while creatinine was concurrently increased in 20% of cats and 18% of dogs. For comparison, if SDMA was not increased at T1 the probability of increased SDMA at recheck was only 20% for cats and 9% for dogs. For cats and dogs with a T1 SDMA of 15-19 μg/dL and with persistent increases at T2, the probability of increased creatinine at T1 was 20% for cats and 18% for dogs, rising to 61% and 55%, respectively, by 24 months. When SDMA at T1 was >25 μg/dL, creatinine was increased in 93% of cats and 92% of dogs by 24 months. Mildly increased SDMA results may provide an opportunity to identify some cats and dogs earlier in their kidney disease.

Alterations of Serum Biochemical and Urinary Parameters in a Canine Population before and after Intravenous Contrast Administration

Intravenous iodinated contrast (IVIC) medium is routinely administered to dogs. Scattered information exists regarding the serum biochemical or urinary profiles associated with the administration of IVIC in dogs. The aim of the study was to describe, compare, and discuss from the perspective of previous studies the alterations in serum biochemical and urinary parameters before (T0) and within one week (T1) of the IVIC administration during routine computed tomography (CT) scan evaluation of 22 dogs. Mature dogs presenting for CT scan evaluation for preoperative oncology staging/surgical planning were included. T1 evaluation was performed within one week of IVIC administration. Statistically significant differences in serum total protein, albumin, chloride, calcium, and phosphorus concentrations, urine protein to creatinine ratio, and urine specific gravity were found between T1 and T0. At T1, the serum creatinine concentration was within reference ranges in all dogs but one. An increase in the urine protein to creatinine ratio was observed in four samples, one of which was non-proteinuric at T0. Changes in biochemistry and urine parameters between T0 and T1 were not considered clinically significant.

A Review of Specific Biomarkers of Chronic Renal Injury and Their Potential Application in Nonclinical Safety Assessment Studies

A host of novel renal biomarkers have been developed over the past few decades which have enhanced monitoring of renal disease and drug-induced kidney injury in both preclinical studies and in humans. Since chronic kidney disease (CKD) and acute kidney injury (AKI) share similar underlying mechanisms and the tubulointerstitial compartment has a functional role in the progression of CKD, urinary biomarkers of AKI may provide predictive information in chronic renal disease. Numerous studies have explored whether the recent AKI biomarkers could improve upon the standard clinical biomarkers, estimated glomerular filtration rate (eGFR), and urinary albumin to creatinine ratio, for predicting outcomes in CKD patients. This review is an introduction to alternative assays that can be utilized in chronic (>3 months duration) nonclinical safety studies to provide information on renal dysfunction and to demonstrate specific situations where these assays could be utilized in nonclinical drug development. Novel biomarkers such as symmetrical dimethyl arginine, dickkopf homolog 3, and cystatin C predict chronic renal injury in animals, act as surrogates for GFR, and may predict changes in GFR in patients over time, ultimately providing a bridge from preclinical to clinical renal monitoring.

Iron status and erythropoiesis response to darbepoetin alfa in dogs with chronic kidney disease

Iron metabolism, hepcidin and some blood profiles were investigated in 13 healthy and 31 chronic kidney disease (CKD) dogs. The study consisted of 2 experiments, experiment I included healthy dogs (CONT) and CKD dogs (stage 2, 3 and 4), while experiment II consisted of anemic CKD dogs subjected to 28-day darbepoetin alfa treatment. The response to darbepoetin alfa could divide anemic CKD dogs into responder (RP) and non-responder (NRP) subgroups. The results from experiment I showed that packed cell volume (PCV) and plasma albumin concentration were significantly lower in CKD dogs of all stages while the total iron binding capacity (TIBC) was lower in only CKD stage 3 and 4 compared with dogs in CONT group. The PCV was related to both TIBC and albumin when considering among all dogs or only in CKD dogs. The hepcidin concentration in CKD dogs with anemia was lower than those without anemia (P<0.05). In experiment II before darbepoetin alfa treatment, RP subgroup had significantly higher iron and TIBC compared with NRP subgroup (P<0.05), the iron concentration was decreased only in RP subgroup after darbepoetin alfa treatment (P<0.05). The percent increase in PCV was correlated with initial TIBC (P<0.01). Plasma hepcidin concentration was not different between CONT and CKD groups and between RP and NRP subgroups both before and after darbepoetin alfa treatment. It is concluded that TIBC and plasma iron concentration play role on anemia and erythropoietic response to darbepoetin alfa treatment in CKD dogs.

Symmetric dimethylarginine concentrations in dogs with hypothyroidism before and after treatement with levothyroxine

OBJECTIVES

To evaluate the serum symmetric dimethylarginine (SDMA) and serum creatinine concentrations in a population of hypothyroid dogs at the time of diagnosis and after treatment.

MATERIALS AND METHODS

Serum SDMA and serum creatinine were measured in serum samples of 24 healthy dogs and 24 hypothyroid dogs, at the time of diagnosis (T0) and after supplementation with levothyroxine (T1).

RESULTS

The mean SDMA concentrations (reference intervals [RI] <18 μg/dL and <14 μg/dL depending on the source) were 11.7 ± 3.5 μg/dL, 13.8 ± 3.1 μg/dL and 11.83 ± 2.87 μg/dL in healthy dogs, and in the hypothyroid dogs at T0 and T1, respectively. The SDMA concentrations were higher in the hypothyroid dogs at T0 in comparison with the healthy dogs. Of the hypothyroid dogs, 1 out of 24 had an SDMA concentration above 18 μg/dL and 12 out of 24 above 14 μg/dL at T0. At T1, none of the hypothyroid dogs had SDMA concentrations above 18 μg/dL and two of them had SDMA concentrations above 14 μg/dL. The serum creatinine concentration was higher in the hypothyroid dogs at T0 as compared to the healthy dogs. At T0, 8 out of 24 hypothyroid dogs had serum creatinine concentrations above the RI (>1.4 mg/dL). In all but one dog, serum creatinine normalised after treatment.

CLINICAL SIGNIFICANCE

The SDMA and serum creatinine concentrations were higher in hypothyroid dogs at diagnosis as compared to healthy dogs. Serum creatinine concentrations were increased in one-third of the hypothyroid dogs and in the majority of cases normalised after levothyroxine supplementation. SDMA concentrations were rarely above the upper limit of the RI when the higest (<18 μg/dL) cut-off was employed. The diagnostic accuracy of SDMA in dogs with thyroid dysfunction requires additional evaluation.

Symmetric dimethylarginine in dogs with myxomatous mitral valve disease at various stages of disease severity

Symmetric dimethylarginine (SDMA) is a serum biomarker of renal damage in dogs. Moreover, SDMA concentration is an independent predictor of development of severe heart failure (HF) in humans with cardiac disease. This study evaluates whether the serum concentration of SDMA in dogs with myxomatous mitral valve disease (MMVD) is influenced by the severity of heart disease, pulmonary hypertension (PH) and treatment of HF. A total of 99 client-owned dogs were included in this retrospective case-control study; 78 dogs were affected by MMVD and classified according to the American College of Veterinary Internal Medicine (ACVIM) guidelines, and 21 were healthy controls. For each dog, history, physical examination, complete blood count, biochemical profile, thoracic radiography, 6-lead standard electrocardiogram and trans-thoracic echocardiography were available. Comparisons were performed between groups of dogs belonging to different ACVIM stages and between dogs with and without PH. The median SDMA concentration was neither significantly different among groups of dogs in different disease stages (overall P = 0.010), nor among dogs with MMVD, nor between those with [14.5 μg/dl (10.5–18.8)] and without PH [13 μg/dl (9–17.2)] (P = 0.295). The concentration of SDMA did not differ between dogs when considering the combined effect of the ACVIM group and cardiac treatment (overall P = 0.486). Furthermore, no correlation was found between SDMA concentration and radiographic and echocardiographic parameters associated with increased MMVD severity. In conclusion, this study failed to demonstrate the presence of renal impairment in dogs with MMVD, and the increase in renal parameters in some dogs in the more advanced stage of MMVD could be attributed to pre-renal azotemia.

Evaluation of serum biomarkers and proteinuria for the early detection of renal damage in dogs with heartworm (Dirofilaria immitis)

Glomerulonephropathy associated with Dirofilaria immitis (heartworm) is relatively frequent in infected dogs. Given the importance and the scarcity of studies focused on its prevalence and diagnosis, the objective was to determine the prevalence of proteinuria and functional indicators of glomerular filtration rate in dogs with heartworm disease and discuss its utility in the detection of renal impairment. Sera and urine from 47 infected dogs were analyzed in a reference laboratory. Urea, creatinine, plasma proteins and serum symmetric dimethylarginine (SDMA) were analyzed in sera, while the UPC ratio was performed in urine. Dogs were further evaluated for the presence/absence of microfilariae, pulmonary and systemic hypertension, and the parasite burden was assessed. The results showed that 19.1 % of dogs showed proteinuria (UPC > 0.5) and 17 % showed borderline proteinuria (UPC 0.2-0.5). Creatinine and SDMA were high (>1.8 mg/dl and ≥18 μg/dl, respectively) in 4.2 % of dogs. UPC ratio was significantly increased in dogs with high parasite burden and in dogs with microfilariemia (p < 0.05). Dogs with pulmonary hypertension showed higher increases in proteinuria as well, which was probably due to the chronicity of the infection. No significant differences were found in serum and urine values regarding systemic blood pressure. Despite the limitations of this study, proteinuria/borderline proteinuria was present in 36.2 % of dogs with heartworm disease, and this may be due to glomerular disease. Therefore, the detection of proteinuria, along with other renal biomarkers in the diagnostic protocols, could help identify kidney alterations or risk of renal damage in heartworm disease.

Relationship between serum iohexol clearance, serum SDMA concentration, and serum creatinine concentration in non-azotemic dogs

BACKGROUND

Serum creatinine and symmetric dimethylarginine (SDMA) are used as surrogate markers of glomerular filtration rate (GFR) in clinical practice. Data pertaining to the correlations between GFR, SDMA, and serum creatinine in client-owned dogs are limited.

OBJECTIVES

To describe the relationship between GFR, SDMA, and serum creatinine in a population of client-owned dogs, and to compare clinical utility of SDMA to GFR estimation for detecting pre-azotemic chronic kidney disease.

ANIMALS

Medical records of 119 dogs that had GFR estimation performed via serum iohexol clearance between 2012 and 2017.

METHODS

Prospective study using archived samples. GFR, SDMA, and serum creatinine results were reviewed and submitting practices contacted for outcome data. All dogs included in the study population were non-azotemic. Correlations between GFR, SDMA, and serum creatinine were determined by regression analysis. Sensitivity, specificity, and positive and negative likelihood ratios of different cutoffs for SDMA and serum creatinine for detecting decreased GFR were calculated, using a 95% confidence interval.

RESULTS

Serum creatinine and SDMA were moderately correlated with GFR (R² = 0.52 and 0.27, respectively, P < .0001) and with each other (R² = 0.33, P < .0001). SDMA >14 μg/dL was sensitive (90%) but nonspecific (50%) for detecting a ≥40% decrease in GFR. Optimal SDMA concentration cutoff for detecting a ≥40% GFR decrease was >18 μg/dL (sensitivity 90%, specificity 83%).

CONCLUSIONS AND CLINICAL IMPORTANCE

In non-azotemic dogs being screened for decreased renal function, using a cutoff of >18 μg/dL rather than >14 μg/dL increases the specificity of SDMA, without compromising sensitivity.