Clinical, clinicopathological and histological changes observed in 14 cats treated with glucocorticoids

Hypoalbuminaemia and its association with disease and clinical outcomes in cats

OBJECTIVES

To report the incidence of feline hypoalbuminaemia and characterise the distribution of presenting disease categories and pathoaetiologies of hypoalbuminaemia in cats. The secondary aim was to evaluate the relationship between hypoalbuminaemia and clinical outcomes.

MATERIALS AND METHODS

Medical records of cats with hypoalbuminaemia (<28.0 g/L, reference interval: 28.0 to 39.0 g/L) presenting to a veterinary teaching hospital over 5 years were retrospectively reviewed. The severity of hypoalbuminaemia was further stratified into mild (24.0 to 27.9 g/L), moderate (20.0 to 23.9 g/L) and severe (≤19.9 g/L) groups. The median albumin and severity groups were compared between the determined disease categories, pathoaetiologies and clinical outcomes.

RESULTS

The incidence of hypoalbuminaemia was 32.7% (533/1632). Gastrointestinal disease was the most common disease category associated with hypoalbuminaemia [154/533 (28.9%)], of which, 49.4% (76/154) of cats had gastrointestinal neoplasia. Neoplastic [159/533 (29.8%)] and inflammatory conditions [158/533 (29.6%)] were common pathoaetiologies noted. Statistically significant differences in the serum albumin between individual disease and pathoaetiological categories were found. Cats with moderate to severe hypoalbuminaemia had a statistically significantly longer hospitalisation period, cost of treatment and increased odds of death (odds ratio 2.4, 95% confidence interval: 1.3 to 4.6 and odds ratio 3.2, 95% confidence interval: 1.5 to 6.6, respectively).

CLINICAL SIGNIFICANCE

The incidence of feline hypoalbuminaemia in our study surpasses previous canine reports. Our findings support albumin as a negative acute phase protein in cats, with hypoalbuminaemia frequently associated with inflammatory disease. Hypoalbuminaemia also features prominently in cats with gastrointestinal neoplasia, indicating careful appraisal of the presence of protein-losing enteropathy is required in these cases. Finally, albumin is found to be a prognostic indicator in this study.

Effects of prednisolone on 1,2-O-dilauryl-rac-glycero glutaric acid-(60-methylresorufin) ester-lipase activity and pancreatic lipase immunoreactivity in healthy cats

BACKGROUND

Corticosteroids are among the most commonly used drugs in cats and are increasingly discussed as a treatment for feline pancreatitis. However, its effects on serum lipase in healthy cats remain unknown.

OBJECTIVES

To evaluate the effects of prednisolone on serum lipase activity and pancreatic lipase immunoreactivity (PLI) in cats.

ANIMALS

Seven clinically healthy colony cats, aged 4 to 7 years, with unremarkable CBC/biochemistry panel were studied.

METHODS

Prospective study: Prednisolone (1.1-1.5 mg/kg, median 1.28 mg/kg PO) was given daily for 7 consecutive days. Lipase activity (LIPC Roche; RI, 8-26 U/L) and PLI (Spec fPL; RI, 0-3.5 μg/L) were determined at day 1 before first treatment and at days 2, 3, 8, 10, and 14. Cats were examined daily. An a priori power analysis indicated that 6 cats were needed to find a biological relevant effect at 1-β = 0.8. Statistical analyses comprised the Friedman test, random intercept regression, and repeated-measures linear regression.

RESULTS

Median (range) day 1 lipase activities and PLI were 22 U/L (14-52 U/L) and 3.2 μg/L (2.3-15.7 μg/L). One cat with abnormally high lipase activity (52 U/L) and PLI (15.7 μg/L) at day 1 continued having elevated lipase activities and PLI throughout the study. Lipase activities and PLI concentrations did not differ significantly among time points regardless of whether the cat with elevated values was included or not. All cats remained healthy throughout the study.

CONCLUSIONS AND CLINICAL IMPORTANCE

Administration of prednisolone in anti-inflammatory doses does not significantly increase serum lipase activity and PLI concentration.

Oral dexamethasone sodium phosphate solution significantly reduces pruritus and clinical lesions in feline hypersensitivity dermatitis: an open-label study

BACKGROUND

There are no liquid oral glucocorticoids labelled for management of pruritus and clinical lesions of feline hypersensitivity dermatitis (feline HD).

HYPOTHESIS

First, to demonstrate that dexamethasone sodium phosphate (DexSP, DexajectSP, Henry Schein; Dublin, OH, USA; 4 mg/mL), an intravenous glucocorticoid, can be absorbed by healthy cats when administered orally. Second, to demonstrate the efficacy of orally administered DexSP for reducing pruritus and clinical lesions in patients with feline HD.

ANIMALS

Seven healthy and 12 client-owned cats with HD.

METHODS AND MATERIALS

Healthy cats were administered a single dose of 0.2 mg/kg DexSP p.o. and serum concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Feline HD patients were assessed with SCORing Feline Allergic Dermatitis (SCORFAD) and pruritus Visual Analog Scale (pVAS) at Visit 1 (V1) and after 20-31 days of receiving 0.2 mg/kg/day DexSP p.o. (V2). Complete blood cell counts, serum chemistry profile, and urinalysis were performed in 50% of feline HD patients at both visits.

RESULTS

Healthy cats had detectable serum concentrations of DexSP following oral administration; concentrations ranged from 0.7 to 92.3 ng/mL. Feline HD patients showed significant decreases in SCORFAD and pVAS scores from V1 to V2.

CONCLUSIONS

DexSP was absorbed when administered orally to healthy cats and 0.2 mg/kg/day DexSP is an efficacious dose to rapidly improve the pruritus and clinical lesions associated with feline HD.

Evaluation of Targeted Bupivacaine, Bupivacaine-lidocaine-epinephrine, Dexamethasone, and Meloxicam for Reducing Acute Postoperative Pain in Cats Undergoing Routine Ovariohysterectomy

This study compared bupivacaine (BUP), bupivacaine-lidocaine-epinephrine (BLE), dexamethasone (DEX), and meloxicam (MEL) targeted at specific, potentially painful sites for reducing acute postoperative pain in cats undergoing elective ovariohysterectomy. One hundred fifty-one cats were included in a prospective, randomized, double-blinded clinical trial. Anesthesia consisted of a standardized protocol including buprenorphine, ketamine, dexmedetomidine, and isoflurane. A ventral midline ovariohysterectomy was performed, and cats were administered targeted injections of 0.5% bupivacaine (2 mg/kg); a combined 0.25% bupivacaine (1 mg/kg), 1% lidocaine (2 mg/kg), and 1:100,000 epinephrine (0.005 mg/kg); dexamethasone (0.125 mg/kg); or meloxicam (0.2 mg/kg) intraoperatively at the ovarian suspensory ligaments, uterine body, and incisional subcutaneous tissues. A 0-10 Numeric Pain Rating Scale (NRS) was used to assess cats postoperatively, 1 hour and 3 hours after anesthesia recovery prior to a same day discharge. Pain scores among evaluators were in good agreement with an overall Intraclass Correlation Coefficient (ICC) of 0.7897 (95% Confidence Interval 0.795-0.8313).  In all groups, overall pain scores 1-hour post anesthesia recovery were significantly higher than scores 3 hours post anesthesia recovery (P < .0001). Averaged pain scores compared among treatment groups did not differ at 1 hour post recovery. At 3-hours post anesthesia recovery, MEL group cats had significantly lower pain scores than the BLE group (P = .018). Study results indicate that early postoperative pain scores were similar for cats receiving local infiltrations of BUP, BLE, DEX, and MEL as part of a multimodal pain therapy for routine ovariohysterectomies. MEL showed somewhat better results 3 hours post anesthesia recovery, gaining significance over the BLE group.

Hepatopatia esteroidal em gatas após terapia com prednisolona: aspectos laboratoriais, tomográficos e histopatológicos

RESUMO Glicocorticoides são amplamente utilizados na clínica de pequenos animais, entretanto seu uso contínuo pode causar efeitos colaterais. Os gatos são considerados menos susceptíveis a esses efeitos do que outras espécies, mas existem poucos trabalhos abordando os efeitos adversos em felinos. O objetivo deste estudo foi avaliar possíveis alterações laboratoriais, histopatológicas e do grau de atenuação radiográfica do parênquima hepático de gatas submetidas à terapia com prednisolona. Um ensaio clínico foi realizado em quatro gatas hígidas, as quais receberam prednisolona, por via oral, na dose de 3mg/kg, durante 60 dias consecutivos. Nos achados histopatológicos após 60 dias de tratamento, observou-se desorganização dos cordões de hepatócitos e degeneração vacuolar, além de necrose de hepatócitos, porém não foram observados sinais de fibrose no parênquima hepático. Os dados da tomografia computadorizada demonstram aumento do grau de atenuação do parênquima hepático a partir do 30º dia da administração de prednisolona, que persistiu até o final do experimento. No presente estudo, foi possível caracterizar a existência de hepatopatia esteroidal em gatos em estágios precoces da terapia com prednisolona.

Echocardiographic and biomarker evidence of plasma volume expansion after short-term steroids administered orally in cats

Background

Steroids administered PO and intramuscularly are associated with development of congestive heart failure in cats without prior signs of heart disease, but criteria to identify cats at increased risk for steroid‐induced heart failure are not established.

Hypothesis

Cats administered steroids PO for 5 to 7 days will develop increased N terminal pro‐B‐type natriuretic peptide (NT‐proBNP) concentration and heart size.

Animals

Ten client‐owned cats.

Methods

Observational cohort study. Cats intended to initiate at least a 5‐day course of steroids administered PO were consecutively recruited.

Results

Steroids administered PO to cats are not associated with differences in absolute concentration of NT‐proBNP (baseline: 49 pmol/L [range, 24‐1013]; after steroids: 85 pmol/L [range, 46‐1367]; P = .23), blood pressure (baseline: 145 mm Hg [range, 116‐163]; after steroids: 145 mm Hg [range, 115‐230]; P = .94), nor blood glucose concentration (baseline: 125 mg/dL [range, 92‐254]; after steroids: 144 mg/dL [range, 114‐307]; P = .43), but are associated with increased median left atrial dimension (baseline: 1.26 cm [range, 0.96‐2.03; after steroids: 1.38 [range, 1.03‐2.20]; P = .02) and mean left ventricular internal diameter (baseline: 1.55 cm [standard deviation—SD, 0.28; after steroids: 1.72 cm [SD, 0.28]; P = .03). Six of 10 (60%) cats had a percentile change in NT‐proBNP >60% after steroids, and 3 of 8 (38%) cats with baseline BNP <100 pmol/L had an NT‐proBNP >100 pmol/L after steroids.

Conclusions and Clinical Importance

Increased heart size and percentage change in individual NT‐proBNP concentration suggests plasma volume expansion secondary to steroids administered PO in cats. A serial assessment of an individual cat's change in NT‐proBNP might be clinically useful for judging risk for volume expansion.

Effect of dietary supplementation with ultramicronized palmitoylethanolamide in maintaining remission in cats with nonflea hypersensitivity dermatitis: a double-blind, multicentre, randomized, placebo-controlled study

Background

Feline nonflea hypersensitivity dermatitis (NFHD) is a frequent cause of over‐grooming, scratching and skin lesions. Multimodal therapy often is necessary.

Hypothesis/Objectives

To investigate the efficacy of ultramicronized palmitoylethanolamide (PEA‐um) in maintaining methylprednisolone‐induced remission in NFHD cats.

Animals

Fifty‐seven NFHD cats with nonseasonal pruritus were enrolled originally, of which 25 completed all study requirements to be eligible for analysis.

Methods and materials

Cats were randomly assigned to PEA‐um (15 mg/kg per os, once daily; n = 29) or placebo (n = 28) while receiving a 28 day tapering methylprednisolone course. Cats responding favourably to methylprednisolone were then administered only PEA‐um (n = 21) or placebo (n = 23) for another eight weeks, followed by a four week long treatment‐free period. Cats were maintained in the study until relapse or study end, whichever came first. Primary outcome was time to relapse. Secondary outcomes were pruritus Visual Analog Scale (pVAS), SCORing Feline Allergic Dermatitis scale (SCORFAD) and owner Global Assessment Score (GAS).

Results

Mean relapse time was 40.5 days (±7.8 SE) in PEA‐um treated cats (n = 13) and 22.2 days (±3.7 SE) for placebo (n = 12; P = 0.04). On Day 28, the severity of pruritus was lower in the PEA‐um treated cats compared to placebo (P = 0.03). Mean worsening of pruritus at the final study day was lower in the PEA‐um group compared to placebo (P = 0.04), whereas SCORFAD was not different between groups. Mean owner GAS at the final study day was better in the PEA‐um than the placebo‐treated group (P = 0.05).

Conclusion and clinical importance

Ultramicronized palmitoylethanolamide could represent an effective and safe option to delay relapse in NFHD cats.

Retrospective Study on the Effects of Long-Term Use of Methylprednisolone Acetate on the Blood Work of 25 Cats

Twenty-five cats at a private animal sanctuary received multiple nonimmunosuppressive doses of parenteral methylprednisolone acetate for at least 3 yr. Complete blood count, chemistry, and T4 results from these cats were examined to look for statistically significant changes. Results found significant changes in triglycerides, amylase, and monocytes. However, these changes remained within the reference interval. All other values showed no significant changes. These results suggest that after 3 yr of chronic parenteral administration of nonimmunosuppressive doses of methylprednisolone acetate, the complete blood count, chemistry, and T4 values in 25 cats were not significantly affected and did not result in abnormal laboratory values.

Hypochloremia in cats - prevalence and associated diseases

OBJECTIVE

To describe the prevalence and possible causes of hypochloremia in the local hospital cat population.

MATERIAL AND METHODS

Retrospective study consisting of two parts. Data were collected from the local electronic medical records database using the search terms "chloride" and "cats" (part A), and "blood gas analysis" and "cats" (part B). The medical records of the hypochloremic cats were then reviewed to determine prior treatment or infusions and to identify major underlying disease processes. Part A included an age and gender matched non-hypochloremic control group, whereas in part B acid-base status was assessed.

RESULTS

Hypochloremia was detected in 367 (27%) of 1363 blood samples. The application of a correction formula to adjust for free water changes decreased the number of hypochloremic cats to 253 (19%). Only a minority had received glucocorticoids or loop diuretics and the prevalence of vomiting was 44%. Common associated disorders were gastrointestinal and respiratory diseases, as well as azotemia and diabetes mellitus. Polyuria/polydipsia, dehydration, prednisolone or furosemide pretreatment, azotemia and diabetes mellitus increased, whereas fluid therapy and the diagnosis of neoplasia decreased the prevalence of hypochloremia. An inverse correlation was found between corrected chloride and standardized base excess (rs = -0.597, p = 0.001) as well as anion gap (rs = -0.4, p = 0.026). 99% of the hypochloremic cats had derangements of acid-base balance.

CONCLUSION

Hypochloremia is a common electrolyte disorder in the local cat population. The correction formula is necessary to adjust for changes in plasma osmolality. Although associated with metabolic alkalosis, most of the hypochloremic cats have a normal or decreased pH. The inverse correlation of chloride and anion gap als well as the high proportion of azotemic or diabetic animals support the concept of compensatory acidosis induced hypochloremia.

CLINICAL RELEVANCE

Hypochloremia should prompt the clinician to performe blood-gas analysis. Diabetes mellitus (especially ketoacidosis) and renal disease should be included in current algorithms for the evaluation of hypochloremic patients.

Efficacy of Cyclosporine for Chronic, Refractory Stomatitis in Cats: A Randomized, Placebo-Controlled, Double-Blinded Clinical Study

Sixteen cats with chronic stomatitis, that had previously undergone premolar-molar or full-mouth extractions, were randomly assigned a group to receive 2.5 mg/kg cyclosporine or placebo orally twice daily. Neither the clinician nor the clients were aware of the group assignments. Cats were evaluated prior to treatment and every 2 weeks for 6 weeks using a 30 point Stomatitis Disease Activity Index (SDAI) score. Mean improvement in SDAI scores among cats in the treatment group after 6 weeks was 52.7 %. This was significantly different from the mean improvement (12.2 %) of cats in the placebo group. During the 6 week study period, 7 of the 9 cats in the treatment group (77.8 %) showed a > 40 % improvement in SDAI score, while 1 of 7 cats in placebo group (14.3 %) showed a > 40 % improvement in SDAI score. This difference was statistically significant. Individual variability in the absorption of orally-administered cyclosporine was high. Trough whole-blood cyclosporine levels ranged from 32.1 ng/ml to 1,576.2 ng/ml. At the end of the 6 week observation period, there was a statistically significant difference among cats with trough whole-blood cyclosporine levels > 300 ng/ml (72.3 % improvement) compared with cats with cyclosporine levels < 300 ng/ml (28.2 % improvement). Whole-blood cyclosporine levels > 300 ng/ml were associated with significant improvement in oral inflammation in cats with chronic stomatitis that had previously undergone premolar-molar or full-mouth extraction.

Low apparent risk of CCNU (lomustine)-associated clinical hepatotoxicity in cats

The purpose of this study was to evaluate the prevalence of serum alanine transaminase (ALT) increases in cats treated with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU, lomustine). The medical records of 95 cats treated with CCNU were reviewed, 29 of which met study criteria (at least one treatment with CCNU as a single agent, and at least one pretreatment and one post-treatment complete biochemical profile). Cats that received concurrent prednisone or dexamethasone were included, but those that received concurrent hepatoprotective or hepatotoxic medications were excluded. Cats included in the study were diagnosed with hepatic carcinoma, mammary carcinoma, lymphoma, mast cell tumor, plasma cell tumor and gastrointestinal leiomyoma. CCNU was given as a single agent at 31-60 mg/m(2), once every 4-8 weeks. Serum alanine transaminase (ALT) activity was measured after at least one dose of CCNU. Four cats (13.7%) had increased ALT activity above the reference interval before starting treatment. Two additional cats (6.8%) developed increased ALT activity above the reference interval 1 month after treatment with CCNU. One cat developed clinical signs potentially associated with hepatotoxicity, without a concurrent increase in ALT, 3 weeks following the final dose of CCNU. No association between dosing frequency, cumulative dose, initial starting dose or concurrent medications, and increases in ALT were found. Clinically significant hepatic injury is seemingly uncommon in cats treated with CCNU.