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Rixon A, Meyer E, Daminet S, Goddard A, Kongtasai T, Pazzi P. Influence of Carcinoma and Sarcoma on Neutrophil Gelatinase-Associated Lipocalin and Symmetric Dimethylarginine Concentrations in Dogs. J Vet Intern Med 2025; 39:e70015. [PMID: 40042235 PMCID: PMC11881161 DOI: 10.1111/jvim.70015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 01/09/2025] [Accepted: 01/09/2025] [Indexed: 05/12/2025] Open
Abstract
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.
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Affiliation(s)
- Anouska Rixon
- Department of Companion Animal Clinical StudiesFaculty of Veterinary Science, University of PretoriaPretoriaSouth Africa
| | - Evelyne Meyer
- Department of Veterinary and BiosciencesFaculty of Veterinary Medicine, Ghent UniversityMerelbekeBelgium
| | - Sylvie Daminet
- Department of Small AnimalsFaculty of Veterinary Medicine, Ghent UniversityMerelbekeBelgium
| | - Amelia Goddard
- Department of Companion Animal Clinical StudiesFaculty of Veterinary Science, University of PretoriaPretoriaSouth Africa
| | - Thirawut Kongtasai
- Department of Small AnimalsFaculty of Veterinary Medicine, Ghent UniversityMerelbekeBelgium
- Department of Clinical Sciences and Public HealthFaculty of Veterinary Science, Mahidol UniversityNakhon PathomThailand
| | - Paolo Pazzi
- Department of Companion Animal Clinical StudiesFaculty of Veterinary Science, University of PretoriaPretoriaSouth Africa
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine, University of TennesseeKnoxvilleTennesseeUSA
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Fulton EA, Weir W, Czopowicz M, McBrearty AR. The relationships between sediment findings and culture results and the presence of proteinuria in canine urine samples. J Small Anim Pract 2023; 64:749-758. [PMID: 37632274 DOI: 10.1111/jsap.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/10/2023] [Accepted: 07/12/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES To assess relationships between urine sediment and microbial culture findings and the presence of proteinuria in canine urine samples, and to assess the change in the percentage of proteinuric samples and urine protein-to-creatinine ratio when urine abnormalities resolve. MATERIALS AND METHODS Canine urine samples collected via cystocentesis and submitted for culture and contemporaneous urinalysis (including urine protein-to-creatinine ratio) were retrospectively identified. Dogs receiving corticosteroids were excluded. Associations between haematuria (red blood cells>5/high-power field), pyuria (white blood cells>5/high-power field), presence of microorganisms on microscopy, active sediment, and positive culture and proteinuria (urine protein-to-creatinine ratio>0.5) were investigated. Patient characteristics were considered possible confounders. In dogs with repeat urinalysis, the associations between active sediment and positive culture resolution on proteinuria and urine protein-to-creatinine ratio were assessed. RESULTS One hundred and ninety-two of 491 samples were proteinuric (39.1%). Age was positively associated with proteinuria. In the multivariable analysis corrected for age, active sediment was the only variable significantly associated with proteinuria (adjusted odds ratio: 2.12; 95% confidence interval: 1.44 to 3.11); however, only 49.8% of samples with active sediment were proteinuric. Neither resolution of active sediment nor positive culture were associated with reduced proportions of proteinuric samples (from 57.9% to 42.1% and from 40.0% to 25.0%, respectively) or significant reductions in urine protein-to-creatinine ratio (median change: -0.16 and -0.14, respectively). CLINICAL SIGNIFICANCE Attributing proteinuria to urinalysis abnormalities or a positive urine culture in canine cystocentesis samples is not supported by our findings, and could result in alternative causes of proteinuria (e.g. renal proteinuria) being overlooked.
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Affiliation(s)
- E A Fulton
- School of Biodiversity, One Health and Veterinary Medicine, The University of Glasgow Small Animal Hospital, 464 Bearsden Road, Glasgow, G61 1QH, Scotland
| | - W Weir
- School of Biodiversity, One Health and Veterinary Medicine, The University of Glasgow Small Animal Hospital, 464 Bearsden Road, Glasgow, G61 1QH, Scotland
| | - M Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, 02-776, Warsaw, Poland
| | - A R McBrearty
- The University of Glasgow Small Animal Hospital and Vets Now, Glasgow, Scotland
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Broadbridge C, Williams TL. Evaluation of haem dipstick pad, urine protein, urine pH and urine protein:creatinine ratio results as a marker of bacteriuria in dogs and cats with inactive urine sediment. J Small Anim Pract 2023. [PMID: 37122145 DOI: 10.1111/jsap.13618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Evaluation of haem dipstick pad, urine protein, urine pH and urine protein:creatinine ratio results as a marker of bacteriuria in dogs and cats with inactive urine sediment. MATERIALS AND METHODS Cats and dogs with contemporaneous urine dipstick, microscopic sediment analysis and microbiological culture and sensitivity results over a four-year period (2016 to 2020) were retrospectively identified. Dogs and cats with active urine sediments (at least five erythrocytes and/or five leukocytes per high-power field) and/or spermaturia were excluded. Association between urine pH, haem dipstick result, protein dipstick result and urine protein:creatinine ratio with bacteriuria were evaluated using binary logistic regression analysis. Likelihood ratios for bacteriuria were calculated at different diagnostic thresholds. RESULTS A total of 668 and 169 dog and cat urine samples were included. Of these, 166 dogs (25%) had a positive urine culture, whilst only 29 cats (17%) had a positive urine culture. In dogs and cats, any positive haem dipstick result was significantly associated with bacteriuria, although only a ≥4+ haem positive result in dogs was associated with a small increase in the likelihood of a positive urine culture, and positive likelihood ratios did not support the use of haem dipstick results as a screening test for bacteriuria in cats. pH, urine protein:creatinine ratio and protein dipstick results were not associated with bacteriuria. CLINICAL SIGNIFICANCE Our findings provide proof of concept that haem dipstick pad results in dogs with inactive sediment and without spermaturia might be useful as a screening test for bacteriuria, although further studies are required to confirm these findings.
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Affiliation(s)
- C Broadbridge
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - T L Williams
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Siu K, Diaz A, Chadwick A, Keys D, Shropshire S, Summers SC. Urine bacterial culture growth and association with urine sedimentation and clinical findings in cats with acute kidney injury. J Feline Med Surg 2022; 24:e295-e301. [PMID: 35748789 PMCID: PMC10812317 DOI: 10.1177/1098612x221105309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A urine culture is often pursued in cats with acute kidney injury (AKI) to screen for bacterial growth in the urine, but it can be cost prohibitive. The aim of the study was to determine the ability of a urinalysis and lower urinary tract signs (LUTS) to predict urine culture results in cats with AKI. METHODS Ninety-seven cats with AKI were included in this study. This was a retrospective, observational study. Medical records from 2008 to 2018 were reviewed to identify cats with AKI that had a paired urinalysis and urine bacterial culture. The sensitivity, specificity, positive predictive value and negative predictive values of microscopic bacteriuria, pyuria, hematuria and the presence of LUTS for predicting urine culture results was calculated. RESULTS Thirty-two percent of cats (n = 31) had a positive urine culture. Of these, 28 (90%) had bacteriuria, 21 (68%) had pyuria, 13 (42%) had hematuria and 10 (32%) had LUTS. Of the 42 cats without hematuria or pyuria, seven had a positive urine culture (17%). Bacteriuria had a high sensitivity (90%) and specificity (92%) for predicting urine culture bacterial growth. The absence of bacteriuria had a high negative predictive value for no bacterial growth (95%). The odds of a positive urine culture were increased with bacteriuria (odds ratio [OR] 114, 95% confidence interval [CI] 29-621; P <0.001), pyuria (OR 21, 95% CI 7-70; P <0.001) and LUTS (OR 5, 95% CI 1.7-16; P = 0.004). Hematuria was not associated with a positive culture (sensitivity 42%, specificity 52%). CONCLUSIONS AND RELEVANCE Microscopic bacteriuria and pyuria on urine sediment evaluation and LUTS can be helpful for predicting bacterial culture results in cats with AKI and in settings where submitting a urine culture may not be financially feasible.
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Affiliation(s)
- Kenneth Siu
- Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Amanda Diaz
- Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | | | - Deborah Keys
- Kaleidoscope Statistical Consulting, Athens, GA, USA
| | - Sarah Shropshire
- Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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Strachan NA, Hales EN, Fischer JR. Prevalence of positive urine culture in the presence of inactive urine sediment in 1049 urine samples from dogs. J Vet Intern Med 2022; 36:629-633. [PMID: 35108434 PMCID: PMC8965268 DOI: 10.1111/jvim.16378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Urinalysis (UA) is often used to screen for bacterial cystitis, regardless of sediment results, and followed up by quantitative urine culture (UC) for definitive diagnosis. Objectives Determine prevalence of positive UCs in dogs with inactive urine sediments on routine UA. Animals A total of 1049 urine samples with inactive urine sediments and UCs collected from dogs presented to a veterinary specialty hospital between January 2018 and February 2020. Methods Retrospective study of dogs with an inactive urine sediment on routine UA and follow‐up UCs. Signalment, UA findings, proteinuria, and UC results were recorded. Associations among these findings were assessed using multivariate logistic regression carried out using a backward stepwise method. Results Overall prevalence of positive UC was 3.4% (95% confidence interval [CI], 2.4‐4.8). Escherichia coli was the most commonly isolated bacteria. Only naturally voided samples were associated with increased prevalence of positive culture when compared to collection by cystocentesis or a non‐specified method. No statistically significant association with culture positivity was found for urine protein‐to‐creatinine ratio, urine specific gravity, urine pH, breed, age, or sex. Conclusions and Clinical Importance Based on the low prevalence (3.4%) of positive culture in urine samples from dogs with inactive sediment on routine UA and the relatively high cost of UC and sensitivity, cost‐benefit analysis including clinical suspicion of lower urinary tract disease should inform testing decisions, rather than routinely performing cultures on urine samples without active sediments.
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Affiliation(s)
- Nicole A Strachan
- Internal Medicine, Veterinary Specialty Hospital of San Diego, San Diego, California, USA
| | - Erin N Hales
- Scientific Programs, Morris Animal Foundation, Denver, Colorado, USA
| | - Julie R Fischer
- Internal Medicine, Veterinary Specialty Hospital of San Diego, San Diego, California, USA
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Machado L, de Oliveira MC, Barbieri CR, Riboldi CI, Leotti VB, González FHD, Valle SDF, Siqueira FM, Pöppl ÁG. Clinical and microbiological characterization of subclinical bacteriuria and sporadic bacterial cystitis in dogs with spontaneous hypercortisolism. Comp Immunol Microbiol Infect Dis 2021; 75:101624. [PMID: 33609989 DOI: 10.1016/j.cimid.2021.101624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 12/25/2022]
Abstract
Study's aims were to characterize subclinical bacteriuria (SB) and sporadic bacterial cystitis (SBC) in dogs with spontaneous hypercortisolism (HC). Prospective cross-sectional design divided patients as newly diagnosed (n = 27), poorly controlled (n = 21), well controlled (n = 34), and controls (n = 19). Urine culture positive results were identified by MALDI-TOF and submitted to antibiogram. Escherichia coli was the most common microorganism (36%). The majority of positive cultures in HC were SB (12.2%). All 4.1% SBC cases were in well controlled HC cases. Bacteriuria correlated with low urine specific gravity and low lymphocyte count. HC degree of control correlated with leukocyturia. SB/SBC cases were treated based in antimicrobial susceptibility leading to microbiological cure in 75% of HC cases. Persistent infections occurred only in SB cases, all by E. coli which became more resistant. SB/SBC prevalence in canine HC is actually lower. Further evidence for current ISCAID guideline contraindication for SB treatment due to HC were provided.
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Affiliation(s)
- Letícia Machado
- Veterinary Sciences Post-Graduation Program, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Milena Cleff de Oliveira
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Cláudia Ruga Barbieri
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Camila Impérico Riboldi
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Vanessa Bielefeldt Leotti
- Department of Statistics, Mathematics and Statistics Institute, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9500, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Félix Hilário Díaz González
- Veterinary Sciences Post-Graduation Program, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil; Department of Veterinary Clinical Pathology, School of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Stella de Faria Valle
- Veterinary Sciences Post-Graduation Program, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil; Department of Veterinary Clinical Pathology, School of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Franciele Maboni Siqueira
- Veterinary Sciences Post-Graduation Program, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil; Department of Veterinary Clinical Pathology, School of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Álan Gomes Pöppl
- Veterinary Sciences Post-Graduation Program, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil; Department of Animal Medicine, School of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil.
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Tinoco-Najera A, Steiner JM, Suchodolski JS, Lidbury JA. Risk factors for urinary bacterial growth in dogs with congenital portosystemic shunts: 66 cases (1997-2019). J Small Anim Pract 2021; 62:359-364. [PMID: 33491792 DOI: 10.1111/jsap.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify risk factors for urinary bacterial growth in dogs with confirmed congenital portosystemic shunts on which a quantitative urine culture was performed. MATERIALS AND METHODS Sixty-six dogs were included in this retrospective cross-sectional study. Medical records were reviewed from 1997 through 2019. Variables of interest included age, sex and sexual status, clinical signs for a urinary tract infection, blood urea concentration, urinalysis abnormalities, ultrasound abnormalities of the urinary tract, and previous treatment. Univariable and multivariable analyses were performed. RESULTS The median age of the dogs was one year (range: 0.2-11.0 years). Urinary tract ultrasound abnormalities (cystic calculi and cystic debris) were reported in 50 dogs (75.7%). Abnormalities on urinalysis included pyuria in nine dogs (13.6%), bacteriuria in 13 dogs (19.7%), and haematuria in 26 dogs (39.4%). The median urine specific gravity was 1.021 (range: 1.004-1.052). Sixteen dogs (24.2%) had a positive quantitative urine culture. Based on multivariable analysis, bacteriuria (Odds ratio, 116; 95% CI, 9.6-1393; P = < 0.001) was the only variable significantly associated with a significantly increased odds for a positive quantitative urine culture. CLINICAL SIGNIFICANCE Clinical and subclinical bacteriuria can occur in dogs with congenital portosystemic shunts. In this group of dogs, bacteriuria was a risk factor for urinary bacterial growth.
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Affiliation(s)
- A Tinoco-Najera
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, 77843-4474, USA
| | - J M Steiner
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, 77843-4474, USA
| | - J S Suchodolski
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, 77843-4474, USA
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Grimes M, Heseltine JC, Nabity MB, Lawhon SD, Wheeler L, Cigarroa A, Lidbury JA. Characteristics associated with bacterial growth in urine in 451 proteinuric dogs (2008-2018). J Vet Intern Med 2020; 34:770-776. [PMID: 31951043 PMCID: PMC7096599 DOI: 10.1111/jvim.15691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/19/2019] [Indexed: 11/14/2022] Open
Abstract
Background Urine cultures are frequently recommended to rule out infection as a postrenal cause of proteinuria. Objective Identify characteristics associated with bacterial growth in urine in proteinuric dogs. Animals Four hundred and fifty‐one dogs admitted to a teaching hospital between January 2008 and January 2018 with urine protein‐to‐creatinine ratios (UPCs) >0.5. Methods Retrospective study included dogs with a UPC, urinalysis, and quantitative urine culture (QUC) performed within a 72‐hour period by searching electronic records. Dogs with recent antimicrobial therapy, urine collected by methods other than cystocentesis, or UPC ≤0.5 were excluded. Signalment, comorbidities, serum BUN and creatinine concentrations, urinalysis findings, and QUC results were recorded. The association between these characteristics and presence of bacterial growth in urine was assessed by univariable and multivariable analysis. Results Thirty of four hundred fifty‐one dogs (6.7%) had bacterial growth in urine. Of these, 18 (60.0%) had active urine sediment. Bacterial growth in urine was associated with pyuria (odd ratio [OR] 25.1, 95% confidence interval [CI] 7.9‐79.6, P < .001), bacteriuria (OR 11.1, 95% CI 3.2‐39.1, P < .001), and lower urinary tract disease (OR 6.7, 95% CI 1.9‐23.0; P = .0028). If QUC was prompted based on these criteria, 8/451 (1.8%) of proteinuric dogs would have had undetected bacterial growth. Conclusions and Clinical Importance The proportion of proteinuric dogs with both inactive urine sediment and bacterial growth in urine was low, suggesting that QUC might not be necessary in the evaluation of all proteinuric dogs. An active urine sediment or lower urinary tract disease should prompt QUC for proteinuric dogs.
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Affiliation(s)
- Millie Grimes
- Department of Small Animal Clinical Sciences, Texas A&M University College of Veterinary Medicine and Biomedical Sciences, Texas
| | - Johanna C Heseltine
- Department of Small Animal Clinical Sciences, Texas A&M University College of Veterinary Medicine and Biomedical Sciences, Texas
| | - Mary B Nabity
- Department of Veterinary Pathobiology, Texas A&M University College of Veterinary Medicine and Biomedical Sciences, Texas
| | - Sara D Lawhon
- Department of Veterinary Pathobiology, Texas A&M University College of Veterinary Medicine and Biomedical Sciences, Texas
| | - Lance Wheeler
- Department of Small Animal Clinical Sciences, Texas A&M University College of Veterinary Medicine and Biomedical Sciences, Texas
| | - Annalis Cigarroa
- Department of Small Animal Clinical Sciences, Texas A&M University College of Veterinary Medicine and Biomedical Sciences, Texas
| | - Jonathan A Lidbury
- Department of Small Animal Clinical Sciences, Texas A&M University College of Veterinary Medicine and Biomedical Sciences, Texas
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