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Stammeleer L, Xifra P, Serrano SI, Rishniw M, Daminet S, Peterson ME. Blood pressure in hyperthyroid cats before and after radioiodine treatment. J Vet Intern Med 2024; 38:1359-1369. [PMID: 38440934 PMCID: PMC11099771 DOI: 10.1111/jvim.17032] [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] [Received: 08/28/2023] [Accepted: 02/16/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Hyperthyroid cats commonly have systemic hypertension, with a reported prevalence of 7% to 48%. Although hypertension might be expected to resolve once treatment restores euthyroidism, it can persist or only first develop after treatment. OBJECTIVES To determine the proportion of hyperthyroid cats with hypertension (systolic blood pressure [SBP] ≥160 mm Hg), persistence or first development of hypertension after successful radioiodine treatment, and correlation of post-treatment hypertension with azotemia or hypothyroidism. ANIMALS Four hundred one hyperthyroid nonazotemic cats were included in the study. METHODS Prospective, cross-sectional and before-and-after studies. All hyperthyroid cats had SBP measured by Doppler; 255 had SBP rechecked 6 months after successful radioiodine (131I) treatment. RESULTS Of untreated hyperthyroid cats, 108/401 (27%) were hypertensive. A higher proportion of hypertensive cats were nervous/excited compared with normotensive cats (47% vs 12%; P < .001). Of the initially hypertensive cats, 87/108 cats were reexamined after 131I treatment; 43/87 (49%) cats normalized SBP, whereas 44/87 (51%) remained hypertensive. Of the initially normotensive cats, 16/168 (9.5%) first developed hypertension after successful 131I treatment. 7/60 (12%) of the 131I-treated hypertensive cats were azotemic and 9/60 (15%) were hypothyroid. A higher proportion of cats remaining hypertensive had nervous/excited demeanor than did normotensive cats (50% vs 17%; P < .001). CONCLUSIONS/CLINICAL IMPORTANCE Hypertension, when present, resolves in many hyperthyroid cats after successful treatment. Hyperthyroid cats uncommonly develop new hypertension after treatment. Persistent or newly detected hypertension was unrelated to azotemia or iatrogenic hypothyroidism. More frequently perceived nervousness/anxiety in radioiodine-treated hypertensive cats suggests that many of these cats might have "situational" hypertension, as hyperthyroid-induced hypertension should resolve after treatment.
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Affiliation(s)
- Lisa Stammeleer
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | | | | | | | - Sylvie Daminet
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Mark E. Peterson
- Cornell UniversityIthacaNew YorkUSA
- Animal Endocrine ClinicNew YorkNew YorkUSA
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Knies M, Teske E, Kooistra H. Comparison of Doppler ultrasonic sphygmomanometry, oscillometry and high-definition oscillometry for non-invasive blood pressure measurement in conscious cats. J Feline Med Surg 2024; 26:1098612X241231471. [PMID: 38546192 PMCID: PMC10983607 DOI: 10.1177/1098612x241231471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Systemic arterial hypertension is a common occurrence and can have serious adverse consequences in cats. Therefore, measuring blood pressure is very important. There are many indirect blood pressure measurement devices available. This study compared Doppler, oscillometric (petMAP Graphic II, SunTech Vet20, the Cardell Insight-X0000) and high-definition oscillometry devices for the non-invasive measurement of blood pressure in conscious cats. METHODS In this prospective study, blood pressure was measured in 32 cats using the different devices according to the recommendations of the American College of Veterinary Internal Medicine Consensus Statement. Blood pressures (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP]), time to complete measurements, number of attempts needed, coefficient of variation (CV) between the blood pressure measurements of the different devices, ease of completing measurements and apparent stress level of the cat were assessed. RESULTS There was a significant difference between devices in the time taken to obtain blood pressure readings and the number of attempts necessary to obtain six reliable measurements. The CV of the Doppler device was significantly smaller than that of the rest of the devices, but there were no other differences between the devices. The mean SBP, DBP and MAP measured by the petMAP device were significantly higher than the measurements from the other devices. The perceived ease of measurement was not significantly different between the various machines. The perceived level of stress of measurement with the Doppler device was significantly higher compared with the other devices but did not lead to an increased SBP. CONCLUSIONS AND RELEVANCE Using a Doppler device to measure blood pressure in conscious cats is fast, relatively easy and gives reliable results. A disadvantage is that the Doppler device can only measure SBP, while oscillometric devices also provide DBP and MAP. However, in veterinary medicine, systolic hypertension is considered the most relevant.
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Affiliation(s)
- Marieke Knies
- AniCura Veterinary Referral Centre Haaglanden, Dordrecht, The Netherlands
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Erik Teske
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Hans Kooistra
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Beckwith-Cohen B, Petersen-Jones SM. Manifestations of systemic disease in the retina and fundus of cats and dogs. Front Vet Sci 2024; 11:1337062. [PMID: 38444779 PMCID: PMC10912207 DOI: 10.3389/fvets.2024.1337062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
The fundus is unique in that it is the only part of the body that allows for a noninvasive and uninterrupted view of vasculature and nervous tissue. Utilization of this can be a powerful tool in uncovering salient incidental findings which point to underlying systemic diseases, and for monitoring response to therapy. Retinal venules and arterioles allow the clinician to assess changes in vascular color, diameter, outline, and tortuosity. The retina and optic nerve may exhibit changes associated with increased or decreased thickness, inflammatory infiltrates, hemorrhages, and detachments. While some retinal manifestations of systemic disease may be nonspecific, others are pathognomonic, and may be the presenting sign for a systemic illness. The examination of the fundus is an essential part of the comprehensive physical examination. Systemic diseases which may present with retinal abnormalities include a variety of disease classifications, as represented by the DAMNIT-V acronym, for Degenerative/Developmental, Anomalous, Metabolic, Neoplastic, Nutritional, Inflammatory (Infectious/Immune-mediated/ischemic), Toxic, Traumatic and Vascular. This review details systemic illnesses or syndromes that have been reported to manifest in the fundus of companion animals and discusses key aspects in differentiating their underlying cause. Normal variations in retinal anatomy and morphology are also considered.
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Affiliation(s)
- Billie Beckwith-Cohen
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Simon M. Petersen-Jones
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
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Mahadappa P, Jeyaraja K, Thirunavakkarasu PS, Krishnaswamy N. Association between systolic blood pressure and target organ damage in naturally occurring cases of systemic hypertension in the dog. Top Companion Anim Med 2024; 58:100843. [PMID: 37979614 DOI: 10.1016/j.tcam.2023.100843] [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] [Received: 01/31/2023] [Revised: 10/17/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
Chronic elevation in the systolic blood pressure (SBP) adversely affects the lifespan in the dog by causing injury to the eye, heart, kidney and brain. Understanding the association between SBP and target organ damage (TOD) helps in risk categorization and treatment planning. Therefore, a prospective study was undertaken to find the association between SBP and renal resistive index (RI) in naturally occurring cases of canine systemic hypertension. Based on the ACVIM guidelines 2018, dogs (n=135) were categorized into four risk groups of SBP, viz., A (minimal), B (low), C (moderate), and D (high). Ophthalmoscopy and echocardiography were used to assess ocular and cardiac changes, respectively. Nephrosonography, urinalysis, and RI were used to assess kidney damage. Odds ratio (OR) was used to quantify the risk of TOD for different categories of SBP. One-way Anova with Tukey's post-hoc test was used to test the effect of different SBP risk groups on urine protein creatinine ratio (UPC) and RI as well as the effect of number of TOD on the RI. Pearson's correlation test was done to see the relation of SBP with UPC and RI. Tortuous retinal vessels were common in group B with an OR of 11 (95% CI: 0.59-207). Retinal hemorrhage and left ventricular hypertrophy were common in group D with an OR of 13 (95% CI: 0.67-234) and 11 (95% CI: 0.61-207), respectively. A significant strong positive correlation of SBP with UPC (R2=0.65) and RI (R2=0.58) was observed. The renal RI significantly increased when the number of TOD was ≥ 2. It was concluded that SBP and RI are associated with the number and severity of TOD and might be valuable in risk classification in hypertensive dogs.
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Affiliation(s)
- Priyanka Mahadappa
- Indian Veterinary Research Institute, Hebbal Campus, Bengaluru, 560024, India.
| | - K Jeyaraja
- Madras Veterinary College, TANUVAS, Chennai, 600007, India
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Uematsu S, Summers S, Keys D, Quimby J. Effect of audible static on blood pressure measurement by Doppler ultrasonic sphygmomanometry in cats. J Feline Med Surg 2023; 25:1098612X231197084. [PMID: 37751181 PMCID: PMC10812029 DOI: 10.1177/1098612x231197084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES The aim of the present study was to determine whether the use of headphones to eliminate audible static during Doppler ultrasonic sphygmomanometry affects blood pressure (BP) measurement in conscious young adult (aged 1-6 years) and mature adult/senior (aged ⩾7 years) cats. METHODS A randomized crossover study was conducted. Healthy client-owned cats (>1 year) were enrolled. Blood pressure measurements were obtained twice, 14 days apart, with or without the use of headphones worn by a veterinarian. A fear, anxiety and stress (FAS) score (0 = relaxed; 4 = severe signs) was recorded. A linear mixed-effects model was used to compare the effect of wearing headphones on BP measurement. RESULTS In total, 18 young adult and 14 mature adult and senior cats with a median age of 5 years (range 1-14 years) were enrolled. Of the cats, 47% (15/32) had an average BP measurement that was at least 10 mmHg higher when using headphones compared with when not using headphones, of which a majority (11/15, 73%) were young adult cats. The average BP measurement was not different when using headphones compared with when not using headphones (mean difference -7 mmHg; 95% confidence interval -14 to 0.6; P = 0.07). When compared within age groups, the average BP measurement taken when using headphones (125 ± 15 mmHg) was lower compared with the measurement taken when not using headphones (137 ± 17 mmHg) in young adult cats (P = 0.02). CONCLUSIONS AND RELEVANCE The reduction in the average BP measurement with the use of headphones suggests this method may be helpful in reducing situational hypertension, particularly in young adult cats. Our findings also highlight the importance of consistent use of headphones when comparing serial measurements in a cat.
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Affiliation(s)
- Sayaka Uematsu
- Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
| | - Stacie Summers
- Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
| | | | - Jessica Quimby
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
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Chang L, Wang XL, Yu C, Liu CH, Zhang Q, Wu Y, Jia R, Ma Q, Pan G, Tong D, Wang X. Chronic kidney disease in a giant panda (Ailuropoda melanoleuca): a case report. BMC Vet Res 2023; 19:131. [PMID: 37612662 PMCID: PMC10464369 DOI: 10.1186/s12917-023-03663-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common cause of morbidity and mortality in captive wildlife species. However, CKD has been rarely documented in giant pandas. CASE PRESENTATION The following report describes a case of an eight-year-old female giant panda showing clinical signs of epistaxis, bloody diarrhea, polyuria, azotemia and anemia. The animal died despite of supportive treatments. Necropsy was performed. Grossly, both kidneys were shrunken and scarred with pallor. Subcutis edema and petechia on the epicardium of the heart were observed. The tissue samples were made into paraffin sections and stained by H.E and special staining including Periodic Acid-Schiff (PAS), von Kossa, Masson's trichrome, Phosphotungstic acid-hematoxylin (PTAH), and Congo red. Histopathology examination revealed severe chronic tubulointerstitial nephritis with marked interstitial fibrosis, glomerulosclerosis, tubular atrophy and calcification in kidneys, and acute necrotizing hemorrhagic myocarditis with calcification in heart. Other lesions included intestinal hemorrhage, hepatic fatty degeneration and necrosis with hemosiderin, and splenic hemosiderin. CONCLUSIONS In summary, chronic kidney disease was finally diagnosed based on the association of clinical, gross, and histopathological findings. Heart failure secondary to CKD is the leading cause of death in this giant panda. The potential cause of CKD in this animal is possibly due to long term and uncontrolled hypertension. Blood pressure monitoring is essential in establishing the diagnosis and management of hypertension in giant panda.
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Affiliation(s)
- Lingling Chang
- College of Veterinary Medicine, Northwest A&F University, Yangling, China
| | - Xiangyang L Wang
- College of Veterinary Medicine, Northwest A&F University, Yangling, China
| | - Chenfei Yu
- College of Veterinary Medicine, Northwest A&F University, Yangling, China
| | - Chen-Hsuan Liu
- Graduate Institute of Molecular and Comparative Pathobiology, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Qiang Zhang
- Qinling Giant Panda Research Center, Xi'an, China
| | - Yaping Wu
- Qinling Giant Panda Research Center, Xi'an, China
| | - Ruoyi Jia
- Qinling Giant Panda Research Center, Xi'an, China
| | - Qingyi Ma
- Qinling Giant Panda Research Center, Xi'an, China
| | - Guanglin Pan
- Qinling Giant Panda Research Center, Xi'an, China.
| | - Dewen Tong
- College of Veterinary Medicine, Northwest A&F University, Yangling, China.
| | - Xinglong Wang
- College of Veterinary Medicine, Northwest A&F University, Yangling, China.
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Knies M, Kooistra HS, Teske E. Prevalence of persistent hypertension and situational hypertension in a population of elderly cats in The Netherlands. J Feline Med Surg 2023; 25:1098612X231172629. [PMID: 37278217 PMCID: PMC10811978 DOI: 10.1177/1098612x231172629] [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: 06/07/2023]
Abstract
OBJECTIVES Systemic arterial hypertension is increasingly recognised and can have serious adverse consequences in cats. Unfortunately, the act of measuring blood pressure itself may cause an increase in blood pressure, known as situational hypertension. It is currently unknown how often this phenomenon occurs. The aim of this study was to evaluate the prevalence of persistent hypertension and situational hypertension in an elderly population of cats in a first-opinion clinic and to assess which factors were associated with systolic hypertension. METHODS In this prospective study, systolic blood pressure was measured in 185 cats aged ⩾10 years using the Doppler sphygmomanometry method according to the recommendations of the American College of Veterinary Internal Medicine consensus statement. Age, sex, body weight, body condition score, position during blood pressure measurement and apparent stress level were assessed. If a systolic blood pressure >160 mmHg was found, measurements were repeated to evaluate if persistent hypertension or situational hypertension was present. The first set of blood pressure measurements were used for all the statistical analyses. RESULTS The median systolic blood pressure for this population was 140 mmHg. The prevalence of persistent hypertension was at least 14.6% and situational hypertension at least 5.4%. Factors significantly associated with hypertension were age, higher apparent stress levels and a sitting position during measurement. Sex, body weight or body condition score did not significantly influence systolic blood pressure. CONCLUSIONS AND RELEVANCE Both persistent hypertension and situational hypertension are common in elderly cats. There are no reliable parameters to distinguish between the two, underlining the importance of a standard protocol and repeating measurements during a follow-up visit when hypertension is found. Age, demeanour and body position during blood pressure measurement influenced blood pressure in this population of elderly cats.
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Affiliation(s)
- Marieke Knies
- AniCura Clinic Drechtstreek, Dordrecht, The Netherlands
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Hans S Kooistra
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Erik Teske
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Cirla A, Drigo M, Ballerini L, Trucco E, Barsotti G. Effects of pupil dilation with topical 0.5% tropicamide on retinal vascular parameters assessed by VAMPIRE® software in healthy cats. Res Vet Sci 2023; 160:50-54. [PMID: 37267768 DOI: 10.1016/j.rvsc.2023.05.008] [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: 03/08/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023]
Abstract
Our study investigates the effects of mydriasis obtained with topical 0.5% tropicamide on retinal vascular parameters evaluated in cats using the retinal imaging software: Vascular Assessment and Measurement Platform for Images of the Retina (VAMPIRE®). Forty client-owned healthy adult cats were included in the study. Topical 0.5% tropicamide was applied to dilate only the right pupil. The left eye was used as a control. Before dilation (T0), infrared pupillometry of both pupils was performed and fundus oculi images were taken from both eyes. Right eye fundus images were then captured 30 min after topical application of tropicamide (T30), when mydriasis was achieved. The retinal vessel widths (3 arteries and 3 veins) were measured with VAMPIRE® in four standard measurement areas (SMA) identified with the letters A, B, C, D. Average value of the 3 vessel widths was used. After normality assessment, the t-test was used to analyse the mean difference in vascular parameters of the left and right eyes at T0 and T30, with p set <0.05. The two eyes showed no statistical differences in pupil and vascular parameter measurements at T0. At T30, only one artery measurement of the right eye (SMA A-peripapillary area) showed a small but statistically significant mean vasoconstriction of approximately 4%. The results indicate that local application of 0.5% tropicamide seems to be associated with a small retinal arteriolar vasoconstriction as assessed by VAMPIRE® in cats. However, this change is minimal, and should not affect the interpretation of the results when VAMPIRE® is used.
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Affiliation(s)
- Alessandro Cirla
- Department of Ophthalmology, San Marco Veterinary Clinic and Laboratory, Veggiano, PD, Italy.
| | - Michele Drigo
- Department of Animal Medicine, Production and Health, University of Padova -, Legnaro, PD, Italy
| | | | - Emanuele Trucco
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Giovanni Barsotti
- Department of Veterinary Science, University of Pisa, S. Piero a Grado, PI, Italy
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Moretto L, Beckmann K, Günther C, Herzig R, Rampazzo A, Suter A, Steffen F, Glaus T. Manifestations of hypertensive encephalopathy in cats. J Feline Med Surg 2023; 25:1098612X231153357. [PMID: 36802953 PMCID: PMC10812077 DOI: 10.1177/1098612x231153357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVES Hypertensive encephalopathy in cats is an important entity but is underestimated in clinical practice. This could be explained, in part, by non-specific clinical signs. The objective of this study was to characterise the clinical manifestations of hypertensive encephalopathy in cats. METHODS Cats with systemic hypertension (SHT) recognised by routine screening, associated with underlying predisposing disease or a clinical presentation suggestive of SHT (neurological or non-neurological), were prospectively enrolled over a 2-year period. Confirmation of SHT was based on at least two sets of measurements of systolic blood pressure >160 mmHg by Doppler sphygmomanometry. RESULTS Fifty-six hypertensive cats with a median age of 16.5 years were identified; 31 had neurological signs. In 16/31 cats, neurological abnormalities were the primary complaint. The other 15 cats were first presented to the medicine or ophthalmology service, and neurological disease was recognised based on the cat's history. The most common neurological signs were ataxia, various manifestations of seizures and altered behaviour. Individual cats also showed paresis, pleurothotonus, cervical ventroflexion, stupor and facial nerve paralysis. In 28/30 cats, retinal lesions were detected. Of these 28 cats, six presented with a primary complaint of visual deficits, and neurological signs were not the primary complaint; nine presented with non-specific medical issues, without suspicion of SHT-induced organ damage; in 13 cats, neurological issues were the primary complaint and fundic abnormalities were detected subsequently. CONCLUSIONS AND RELEVANCE SHT is common in older cats and the brain is an important target organ; however, neurological deficits are commonly ignored in cats with SHT. Gait abnormalities, (partial) seizures and even mild behavioural changes should prompt clinicians to consider the presence of SHT. A fundic examination in cats with suspected hypertensive encephalopathy is a sensitive test to support the diagnosis.
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Affiliation(s)
- Laura Moretto
- Department of Cardiology, University of Zurich, Zürich, Switzerland
| | - Katrin Beckmann
- Department of Neurology, University of Zurich, Zürich, Switzerland
| | | | - Robert Herzig
- Department of Neurology, University of Zurich, Zürich, Switzerland
| | - Antonella Rampazzo
- Department of Ophthalmology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Anja Suter
- Department of Ophthalmology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Frank Steffen
- Department of Neurology, University of Zurich, Zürich, Switzerland
| | - Tony Glaus
- Department of Cardiology, University of Zurich, Zürich, Switzerland
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Navarro I, Summers S, Rishniw M, Quimby J. Cross-sectional survey of non-invasive indirect blood pressure measurement practices in cats by veterinarians. J Feline Med Surg 2022; 24:1195-1202. [PMID: 35109690 PMCID: PMC10812353 DOI: 10.1177/1098612x211067015] [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] [Accepted: 11/28/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This survey of small animal veterinarians endeavored to: (1) determine current methods of indirect blood pressure measurement; (2) detail techniques used to reduce situational hypertension; and (3) better understand the obstacles to performing blood pressure measurement in cats. METHODS An online survey was produced and circulated to members of the Veterinary Information Network. A total of 733 veterinarians who saw cats in their practice and had access to at least one indirect blood pressure device completed the entirety of the survey. RESULTS Ninety-six percent (703/733) of veterinarians who completed the survey reported measuring indirect blood pressure in cats in their practice, with veterinary technicians conducting most (600/703; 85.3%) of these measurements. Few veterinarians (30/733; 4.1%) did not measure blood pressure, with these veterinarians citing several obstacles including: difficulty interpreting results with the occurrence of fear, anxiety and stress in cats (20/30; 66.7%); difficulty performing measurements in cats (17/30; 56.7%); and technical staff being uncomfortable performing measurements (12/30; 40.0%). Most veterinarians (300/435; 69.0%) in this survey preferred an ultrasonic Doppler flow detector with sphygmomanometry, with many (272/300; 90.7%) perceiving that the results obtained with this device were more trustworthy compared with results obtained with oscillometry. Ninety percent (633/703) of veterinarians employed techniques to reduce situational hypertension in cats. Techniques perceived to be most helpful among veterinarians included: using a quiet location (454/633; 71.7%); minimizing restraint (316/633; 49.9%); performing blood pressure prior to other procedures (eg, phlebotomy, cystocentesis) (302/633; 47.7%); avoiding other animals (219/633; 34.6%); and allowing time for acclimation (167/633; 26.4%). CONCLUSIONS AND RELEVANCE This survey study of veterinarians helps clarify obstacles to routine blood pressure measurement in conscious cats. Veterinarians reported several strategies that they felt reduced situational hypertension in cats. The data inform modifications of techniques to increase the frequency and perceived reliability of blood pressure measurement in at-risk cats.
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Enache AE, Dietrich UM, Drury O, Trucco E, MacGillivray T, Syme H, Elliott J, Chang YM. Changes in retinal vascular diameters in senior and geriatric cats in association with variation in systemic blood pressure. J Feline Med Surg 2021; 23:1129-1139. [PMID: 33739170 DOI: 10.1177/1098612x21997629] [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 Early diagnosis of arterial hypertension is essential to prevent target organ damage. In humans, retinal arteriolar narrowing predicts hypertension. This blinded prospective observational study investigated the retinal vessel diameters in senior and geriatric cats of varying systolic blood pressure (SBP) status and evaluated retinal vascular changes in hypertensive cats after treatment. METHODS Cats with a median age of 14 years (range 9.1-22 years) were categorised into five groups: group 1, healthy normotensive (SBP <140 mmHg; n = 40) cats; group 2, pre-hypertensive (SBP 140-160 mmHg; n = 14) cats; group 3, cats with chronic kidney disease (CKD) and normotensive (n = 26); group 4, cats with CKD and pre-hypertensive (n = 13); and group 5, hypertensive cats (SBP >160 mmHg, n = 15). Colour fundus images (Optibrand ClearView) were assessed for hypertensive lesions. Retinal vascular diameters and bifurcation angles were annotated and calculated using the Vascular Assessment and Measurement Platform for Images of the Retina annotation tool (VAMPIRE-AT). When available, measurements were obtained at 3 and 6 months after amlodipine besylate treatment. RESULTS Ten hypertensive cats had retinal lesions, most commonly intraretinal haemorrhages and retinal exudates. Arteriole and venule diameters decreased significantly with increasing age (-0.17 ± 0.05 pixels/year [P = 0.0004]; -0.19 ± 0.05 pixels/year). Adjusted means ± SEM for arteriole and venule diameter (pixels) were 6.3 ± 0.2 and 8.9 ± 0.2 (group 1); 7.6 ± 0.3 and 10.1 ± 0.4 (group 2); 6.9 ± 0.2 and 9.5 ± 0.3 (group 3); 7.4 ± 0.3 and 10.0 ± 0.4 (group 4); and 7.0 ± 0.3 and 9.8 ± 0.4 (group 5). Group 1 arteriole and venule diameters were significantly lower than those of groups 2 and 4. Group 2 arteriole bifurcation angle was significantly narrower than those of groups 1 and 3. Post-treatment, vessel diameters decreased significantly at 3 and 6 months in seven hypertensive cats. CONCLUSIONS AND RELEVANCE Increased age was associated with reduced vascular diameters. Longitudinal studies are required to assess if vessel diameters are a risk indicator for hypertension in cats.
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Affiliation(s)
- Andra-Elena Enache
- North Downs, Specialist Referrals, 3 & 4 The Brewerstreet Dairy Business Park, Brewer Street, Bletchingley, UK
| | | | - Oscar Drury
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - Emanuele Trucco
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Tom MacGillivray
- VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Harriet Syme
- Department of Clinical Sciences and Services, Queen Mother Hospital for Animals, Royal Veterinary College, London, UK
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - Yu-Mei Chang
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
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Baka RD, Soubasis N, Oevermann A, Koutinas CK, Polizopoulou ZS. Severity of neurological signs in feline hypertensive encephalopathy may be reflected through brain histopathological lesions. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rania D. Baka
- School of Veterinary Medicine Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Nektarios Soubasis
- School of Veterinary Medicine Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Anna Oevermann
- Department of Clinical Research and Veterinary Public Health Vetsuisse Faculty University of Bern Bern Switzerland
| | - Christos K. Koutinas
- School of Veterinary Medicine Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Zoe S. Polizopoulou
- School of Veterinary Medicine Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
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13
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Lawson JS, Jepson RE. Feline comorbidities: The intermingled relationship between chronic kidney disease and hypertension. J Feline Med Surg 2021; 23:812-822. [PMID: 34428941 DOI: 10.1177/1098612x211037872] [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] [Indexed: 02/06/2023]
Abstract
PRACTICAL RELEVANCE Chronic kidney disease (CKD) is a highly prevalent disorder of senior cats. CKD is frequently diagnosed in association with hypertension, and the two conditions have an intermingled cause-and-effect relationship. Hypertensive target organ damage (TOD) to the eye, brain, heart and kidney significantly impacts the welfare of cats suffering from this comorbidity. Hypertension also drives proteinuria, which is an independent risk factor for progression and mortality in cats with CKD. Blood pressure monitoring and institution of effective antihypertensive treatment, where indicated, is therefore crucial in effective management of the feline CKD patient. Current guidelines recommend a target systolic blood pressure of <160 mmHg to minimise risk of TOD. Both amlodipine besylate and telmisartan are effective antihypertensive agents for use in these patients. CLINICAL CHALLENGES Clinical signs of hypertension may not be apparent to owners of affected cats until severe hypertensive TOD is present. Despite this, blood pressure monitoring in cats with CKD is still infrequently performed, and hypertension likely remains underdiagnosed in this population. EVIDENCE BASE This review is based upon evaluation of the currently available published literature, including relevant consensus statements. There is a large body of evidence supporting the association between hypertension and CKD in cats. However, significant aspects, such as the mechanisms behind this association, and effect of hypertension and antihypertensive treatment on mortality and progression of CKD, remain unclear. Further research is therefore required in order to improve understanding of these conditions.
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Affiliation(s)
- Jack S Lawson
- Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - Rosanne E Jepson
- Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
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14
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Ray M, Carney HC, Boynton B, Quimby J, Robertson S, St Denis K, Tuzio H, Wright B. 2021 AAFP Feline Senior Care Guidelines. J Feline Med Surg 2021; 23:613-638. [PMID: 34167339 DOI: 10.1177/1098612x211021538] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The '2021 AAFP Feline Senior Care Guidelines' are authored by a Task Force of experts in feline clinical medicine and serve as an update and extension of those published in 2009. They emphasize the individual patient evaluation and the process of aging, with references to other feline practice guidelines for a more complete discussion of specific diseases. Focusing on each cat encourages and empowers the owner to become a part of the cat's care every step of the way. A comprehensive discussion during the physical examination and history taking allows for tailoring the approach to both the cat and the family involved in the care. Videos and analysis of serial historical measurements are brought into the assessment of each patient. These Guidelines introduce the emerging concept of frailty, with a description and methods of its incorporation into the senior cat assessment. Minimum database diagnostics are discussed, along with recommendations for additional investigative considerations. For example, blood pressure assessment is included as a minimum diagnostic procedure in both apparently healthy and ill cats. Cats age at a much faster rate than humans, so practical timelines for testing frequency are included and suggest an increased frequency of diagnostics with advancing age. The importance of nutrition, as well as senior cat nutritional needs and deficiencies, is considered. Pain is highlighted as its own syndrome, with an emphasis on consideration in every senior cat. The Task Force discusses anesthesia, along with strategies to allow aging cats to be safely anesthetized well into their senior years. The medical concept of quality of life is addressed with the latest information available in veterinary medicine. This includes end of life considerations like palliative and hospice care, as well as recommendations on the establishment of 'budgets of care', which greatly influence what can be done for the individual cat. Acknowledgement is given that each cat owner will be different in this regard; and establishing what is reasonable and practical for the individual owner is important. A discussion on euthanasia offers some recommendations to help the owner make a decision that reflects the best interests of the individual cat.
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Affiliation(s)
| | - Hazel C Carney
- WestVet Emergency and Specialty Center, Garden City, ID, USA
| | - Beth Boynton
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, USA
| | - Jessica Quimby
- The Ohio State University, Department of Veterinary Clinical Sciences, Columbus, OH, USA
| | - Sheilah Robertson
- Senior Medical Director, Lap of Love Veterinary Hospice, Lutz, FL, USA
| | | | - Helen Tuzio
- Forest Hills Cat Hospital, Middle Village, NY, USA
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15
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Cirla A, Drigo M, Andreani V, Barsotti G. Ocular fundus abnormalities in cats affected by systemic hypertension: Prevalence, characterization, and outcome of treatment. Vet Ophthalmol 2021; 24:185-194. [PMID: 33512084 DOI: 10.1111/vop.12862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the prevalence of ocular fundus abnormalities in cats with a diagnosis of systemic hypertension, to characterize the abnormalities observed, and to evaluate ophthalmoscopic evolution during treatment with amlodipine besylate. ANIMALS STUDIED Cats diagnosed as affected by SHP in a 2-year period. PROCEDURES Systemic hypertension was assessed by oscillometric blood pressure measurement, and its etiology was also established. All the cats received an ophthalmic examination, and ocular lesions were classified with a score from 0 (no abnormalities) to 4 (severe abnormalities). All cats received amlodipine besylate by mouth, and those that showed fundus abnormalities were regularly rechecked from 7 to 365 days after diagnosis. Data were statistically analyzed to compare Psys and Pdia with all the variables and to correlate Psys and Pdia with the fundus score. RESULTS A total of 225 cats were enrolled in the study, and the prevalence of fundus abnormalities was 58.6% (21.2%: grade 1; 18.2%: grade 2; 36.4%: grade 3; and 24.2%: grade 4). Systemic hypertension was diagnosed concurrently with chronic renal failure (60.4%), hyperthyroidism (28.9%), both chronic renal failure and hyperthyroidism (7.6%), and hypertrophic myocardiopathy (3.1%). A significant effect of Psys values on the fundus score was detected. Amlodipine therapy improved fundus abnormalities in 50% of cases at the 21-day follow-up. CONCLUSIONS This study showed that fundus abnormalities are common in hypertensive cats at the time of the systemic diagnosis, and most of the abnormalities are moderate to severe. Treatment with amlodipine appeared to improve ophthalmic lesions over time.
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Affiliation(s)
- Alessandro Cirla
- Department of Ophthalmology, San Marco Veterinary Clinic and Laboratory, Veggiano, Italy
| | - Michele Drigo
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Italy
| | | | - Giovanni Barsotti
- Department of Veterinary Science, University of Pisa, S. Piero a Grado, Italy
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16
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Moretto L, Lavaud A, Suter A, Günther C, Pot S, Glaus T. Reliability of detecting fundus abnormalities associated with systemic hypertension in cats assessed by veterinarians with and without ophthalmology specialty training. J Feline Med Surg 2021; 23:921-927. [PMID: 33438504 DOI: 10.1177/1098612x20983265] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Systemic hypertension (SHT) causes severe target organ damage (TOD) and blood pressure (BP) measurement should be routine in at-risk populations. Fundoscopy is a tool to corroborate acute clinical relevance of high BP results and to decide on immediate therapy. Not every cat with a high BP result can be examined by an ophthalmologist. The study objective was to determine the reliability of fundoscopy in cats with SHT performed by a veterinarian without ophthalmology specialty training. METHODS Cats with suspicion of hypertensive TOD or belonging to a risk population for SHT with a first measurement of elevated BP >160 mmHg were enrolled. Indirect ophthalmoscopy was performed by a recent graduate veterinarian followed by a veterinary ophthalmologist. Confirmation of SHT was based on two additional sets of systolic BP measurements >160 mmHg by Doppler sphygmomanometry. RESULTS Thirty-three cats were included. SHT was confirmed in 27 cats. SHT was detected on routine examinations in 12/27 cats; fundoscopic lesions were observed in 9/12 by the non-trained veterinarian and in 11/12 by an ophthalmologist. Nine of 27 cats were neurological patients; fundoscopic lesions were detected in 4/9 by the non-trained veterinarian and in 7/9 by an ophthalmologist. Six of 27 cats were presented for acute blindness; fundus lesions were detected in all six cats by the non-trained veterinarian and ophthalmologist. SHT was not confirmed and fundoscopic lesions were not detected by either examiner in 6/33 cats. Compared with a veterinary ophthalmologist, reliability of detecting fundus abnormalities by the non-trained veterinarian was 72% (13/18) for cats with, and 100% (6/6) for cats without, vision. CONCLUSIONS AND RELEVANCE Fundus examination by a non-specialty trained veterinarian has reasonably high reliability for the detection of ocular TOD. Private practice veterinarians are encouraged to perform an initial fundic examination in suspected hypertensive cats.
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Affiliation(s)
- Laura Moretto
- Division of Cardiology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Arnold Lavaud
- Division of Ophthalmology Section, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Anja Suter
- Division of Ophthalmology Section, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Christian Günther
- Division of Neurology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Simon Pot
- Division of Ophthalmology Section, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Tony Glaus
- Division of Cardiology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
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17
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Cole LP, Jepson R, Dawson C, Humm K. Hypertension, retinopathy, and acute kidney injury in dogs: A prospective study. J Vet Intern Med 2020; 34:1940-1947. [PMID: 32677736 PMCID: PMC7517860 DOI: 10.1111/jvim.15839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Systemic hypertension (SH) is a potential complication of acute kidney injury (AKI) in dogs. OBJECTIVE To describe the prevalence of SH and hypertensive retinopathy in dogs with AKI, to investigate the relationship between SH and severity of AKI and to assess possible factors associated with SH. ANIMALS Fifty-two dogs with AKI. METHODS Prospective observational study of dogs presenting to a tertiary referral center that fulfilled the International Renal Interest Society (IRIS) guidelines for the diagnosis of AKI. Systolic blood pressure measurement, urine protein/creatinine ratio (UPCR), urine output, presence of hypertensive retinopathy and fluid overload (FO), survival to discharge and duration of hospitalization were subsequently assessed. The prevalence of SH was calculated and the relationship between SH and recorded factors was examined by nonparametric statistics. RESULTS The prevalence of SH (≥160 mm Hg) on admission or during hospitalization was 75% (39/52) and in 56% (22/39) of cases this was severe (≥180 mm Hg). Sixteen percent (7/43) of dogs had evidence of hypertensive retinopathy and 77% (24/31) dogs had UPCR >0.5. Forty-two percent (22/52) dogs had FO on admission or during hospitalization. There was no association between SH and IRIS AKI grade, oligo/anuria, survival to discharge, duration of hospitalization or proteinuria. Dogs with FO on presentation were more likely to be hypertensive at admission compared to dogs without FO (P = .02). Dogs that did not survive to discharge were more likely to have FO (P = .007). CONCLUSIONS AND CLINICAL IMPORTANCE Systemic hypertension is common in dogs with AKI. Systemic hypertension might be associated with FO, which itself is associated with nonsurvival. Monitoring for SH and FO is therefore warranted in dogs with AKI.
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Affiliation(s)
- Laura Pearl Cole
- Clinical Science & Services, Royal Veterinary CollegeHatfieldUnited Kingdom
| | - Rosanne Jepson
- Clinical Science & Services, Royal Veterinary CollegeHatfieldUnited Kingdom
| | - Charlotte Dawson
- Clinical Science & Services, Royal Veterinary CollegeHatfieldUnited Kingdom
| | - Karen Humm
- Clinical Science & Services, Royal Veterinary CollegeHatfieldUnited Kingdom
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18
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Cerna P, Archontakis PE, Cheuk HO, Gunn-Moore DA. Comparison of Doppler ultrasonic and oscillometric devices (with or without proprietary optimisations) for non-invasive blood pressure measurement in conscious cats. J Feline Med Surg 2020; 23:121-130. [PMID: 32580610 PMCID: PMC7838334 DOI: 10.1177/1098612x20932407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives This study compared Doppler and oscillometric (PetMAP+) devices (with or without proprietary optimisations) for the non-invasive measurement of blood pressure in conscious cats. Methods Twenty-three cats were enrolled; however, five were excluded as fewer than five measurements were obtained for each assessment. All measurements were obtained according to American College of Veterinary Internal Medicine consensus guidelines. Oscillometric device modes A and B were operated according to the manufacturer’s guidelines. Doppler and oscillometric devices were used alternately as the first device. Results Systolic arterial blood pressure (SAP) measurements were obtained by Doppler (SAPd) and oscillometry; the mean of each set of five values was used for statistical analysis. There was a significant difference between SAPd and SAP measurements in oscillometric modes A (P <0.001) and B (P <0.001). While both modes measured SAP higher than SAPd, B had a smaller bias (+15.72 mmHg) and narrower limits of agreement (LOA). There was also a significant difference between SAPd and mean arterial pressure (MAP) on oscillometric modes A (P = 0.002) and B (P <0.001). Both modes’ MAP readings were lower than SAPd and oscillometric A MAP was closer to SAPd (–14.94 mmHg), with a smaller bias and narrower LOA. Conclusions and relevance The findings support that Doppler and oscillometric devices cannot be used interchangeably, with or without proprietary optimisations. Methodology should always be taken into account and reference intervals (RIs) need to be defined for the different methodologies. Until methodology-specific RIs are published, definitive diagnosis of hypertension and sub-staging of patients with kidney disease according to the International Renal Interest Society guidelines remains challenging.
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Affiliation(s)
- Petra Cerna
- Department of Internal Medicine, Hospital for Small Animals, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, UK.,The University of Veterinary and Pharmaceutical Sciences Brno, Czech Republic
| | - Panos E Archontakis
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
| | | | - Danièlle A Gunn-Moore
- Department of Internal Medicine, Hospital for Small Animals, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, UK.,The Roslin Institute, University of Edinburgh, Edinburgh, UK
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19
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Abstract
Hypertension is a common problem, particularly in older cats. Hypertension secondary to a concurrent disease is the most common form of hypertension in cats, particularly in association with chronic kidney disease or hyperthyroidism. However, idiopathic hypertension may account for up to 24% of cases. Any form of persistent hypertension risks target organ damage (TOD), therefore measurement of blood pressure is vital in at-risk cats to identify occult hypertension before TOD occurs. This article addresses when and how to perform blood pressure measurement in cats, TOD that has been documented in this species, and our evidence basis for treating hypertension.
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Affiliation(s)
- Rebecca F Geddes
- Queen Mother Hospital for Animals, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, UK.
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20
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Carter J. Hypertensive ocular disease in cats: A guide to fundic lesions to facilitate early diagnosis. J Feline Med Surg 2020; 21:35-45. [PMID: 30763152 DOI: 10.1177/1098612x18818668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PRACTICAL RELEVANCE Systemic hypertension is common in older cats and can result in damage to organs with a rich arteriolar supply such as the eyes, kidneys, myocardium and brain. Hypertensive disease in these organs is known as target organ damage (TOD). Disease in the eye resulting from hypertension is the most easily identifiable form of TOD and can often be the reason the cat is presented to the veterinarian. Routine blood pressure measurement and fundic examination allows cats with hypertensive ocular lesions to be detected early in the course of the disease, when the lesions have the best chance of responding to treatment. CLINICAL CHALLENGES Detecting early evidence of TOD in the fundus requires a veterinarian to be competent in recognising lesions associated with mild hypertensive disease, as well as the more easily recognised advanced lesions that frequently result in impaired vision and blindness. AUDIENCE This review is written for all veterinarians who treat cats. It provides information and images to facilitate and guide veterinarians performing fundoscopy in cats, in particular in those over 7 years of age, with the aim of diagnosing hypertensive ocular lesions when they are present. EQUIPMENT The clinical manifestations of hypertensive ocular disease can be detected non-invasively with inexpensive equipment. A summary of the equipment available for general practitioners to perform fundoscopy is provided. EVIDENCE BASE This is a comprehensive review of the literature on hypertensive ocular disease in cats. The author has also included images of hypertensive ocular lesions taken in general practice to highlight the variety of lesions that can be detected.
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21
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Abstract
Across China and Southeast Asia, over 17,000 bears are currently farmed for bile, predominantly for traditional Chinese medicines. Bears on farms in China are cage confined and undergo repeated daily bile extraction facilitated by surgically implanted catheters or gallbladder fistulas. Numerous health problems have been reported in bile-farmed bears including peritonitis, abdominal hernias, and extraction site abscessation. Between 2009 and 2014, five Asiatic black bears ( Ursus thibetanus) and one Asiatic black/Eurasian brown bear ( Ursus arctos arctos) hybrid, rescued from the bear bile industry in China, died from ruptured and/or dissecting aortic aneurysm. Medical records were reviewed and two bears exhibited no clinical signs prior to death. In four bears, clinical findings varied and included increased stereotypic behavior prior to death, epistaxis, retinal lesions, dysphagia, weight loss, and acute onset of hyporexia. On postmortem examination, hemopericardium with dissection and/or rupture of the ascending aorta and left ventricular wall hypertrophy were present in all cases. No evidence of infectious disease, connective tissue disorders, or congenital cardiac disease was identified. Based on these observations screening thoracic radiography was performed on all bears at the rescue center and aortic dilation was identified in 73 of 134 (54.5%) bile-extracted bears. To the authors' knowledge, aortic aneurysm, rupture, and/or dissection have not been previously reported in any bear species and the high prevalence in this population of bears suggests an association with bile-farming practices. Future studies are needed to investigate the etiopathogenesis of this condition to aid in early diagnosis and improved management of bears being rescued from bile farms across Asia.
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22
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Coleman AE, Brown SA, Traas AM, Bryson L, Zimmering T, Zimmerman A. Safety and efficacy of orally administered telmisartan for the treatment of systemic hypertension in cats: Results of a double-blind, placebo-controlled, randomized clinical trial. J Vet Intern Med 2019; 33:478-488. [PMID: 30851066 PMCID: PMC6430933 DOI: 10.1111/jvim.15429] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/16/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Information regarding the efficacy of telmisartan for feline systemic arterial hypertension is limited. OBJECTIVES To evaluate the safety and efficacy of PO administered telmisartan solution in hypertensive cats. ANIMALS Client-owned cats with indirect systolic arterial blood pressure (SBP) of 160-200 mm Hg, based on multiple measurements. METHODS This multicenter trial consisted a 28-day, prospective, randomized, double-blind, placebo-controlled, parallel group, efficacy phase and a 154-day extended-use telmisartan phase. Hypertensive cats were randomly assigned to receive 1.5 mg telmisartan/kg PO q12h for 14 days, followed by 2 mg telmisartan/kg PO q24h, or equivalent volume of placebo. Systolic blood pressure was measured on days 0, 14, and 28. Change in SBP compared to baseline was calculated for days 14 and 28. Telmisartan efficacy was defined as significant decrease in SBP at day 14 compared to placebo and a clinically relevant (>20 mm Hg) decrease in SBP at day 28. RESULTS Two-hundred twenty-one cats were included. On day 14, least squares mean (95% confidence interval) SBP decrease was significantly larger in telmisartan-treated (-23.3 mm Hg [-28.2 to -18.3]) versus placebo-treated (-7.5 mm Hg [-13.6 to -1.5]) cats (P = .0005). On day 28, telmisartan treatment resulted in a clinically relevant SBP decrease (-23.9 mm Hg [-27.8 to -20.0]), whereas placebo did not (-11.6 mm Hg [-17.4 to -5.9 mm Hg]). The decrease in SBP persisted over the 6-month trial in telmisartan-treated cats. CONCLUSIONS AND CLINICAL IMPORTANCE Telmisartan significantly decreased SBP to a clinically relevant extent and was well tolerated in hypertensive cats.
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Affiliation(s)
- Amanda E. Coleman
- Department of Small Animal Medicine and SurgeryUniversity of Georgia College of Veterinary MedicineAthensGeorgia
| | - Scott A. Brown
- Department of Small Animal Medicine and SurgeryUniversity of Georgia College of Veterinary MedicineAthensGeorgia
- Department of Physiology and PharmacologyUniversity of Georgia College of Veterinary MedicineAthensGeorgia
| | - Anne M. Traas
- Pharmaceutical Clinical Research and Development, Boehringer Ingelheim Vetmedica, Inc.St. JosephMissouri
| | - Lawrence Bryson
- Pharmaceutical Clinical Research and Development, Boehringer Ingelheim Vetmedica, Inc.St. JosephMissouri
| | - Tanja Zimmering
- Global PetVet Business Unit, Boehringer Ingelheim Vetmedica GmbHIngelheim am RheinGermany
| | - Alicia Zimmerman
- Pharmaceutical Clinical Research and Development, Boehringer Ingelheim Vetmedica, Inc.St. JosephMissouri
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23
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Cirla A, Drigo M, Ballerini L, Trucco E, Barsotti G. VAMPIRE
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fundus image analysis algorithms: Validation and diagnostic relevance in hypertensive cats. Vet Ophthalmol 2019; 22:819-827. [DOI: 10.1111/vop.12657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Alessandro Cirla
- Department of Ophthalmology San Marco Veterinary Clinic and Laboratory Veggiano Italy
- Department of Veterinary Science University of Pisa Pisa Italy
| | - Michele Drigo
- Department of Animal Medicine, Production and Health University of Padova Legnaro Italy
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24
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Hori Y, Heishima Y, Yamashita Y, Iguchi M, Nakamura K, Isayama N, Onodera H, Kitade A, Kanno N, Hirakawa A, Katagi M, Ibaragi T, Yamano S, Aramaki Y, Sawada T. Epidemiological study of indirect blood pressure measured using oscillometry in clinically healthy cats at initial evaluation. J Vet Med Sci 2019; 81:513-516. [PMID: 30745524 PMCID: PMC6483917 DOI: 10.1292/jvms.18-0187] [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] [Indexed: 11/22/2022] Open
Abstract
We investigated the clinical characteristics of healthy cats in accordance with the target organ damage (TOD) risk category, on the basis of systolic blood pressure (SBP). This prospective multi-center study included 137 healthy cats. Indirect blood pressure was measured using an oscillometric technique. The median SBP in all cats was 147 mmHg (interquartile range: 134-158). On the basis of the TOD risk category, 57.7, 19.7, 21.9, and 0.7% of the cats were classified into categories I-IV, respectively. Age, sex, and body weight did not affect the SBP. This study provides basic information on the distribution of TOD risk categories in clinically healthy cats.
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Affiliation(s)
- Yasutomo Hori
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midori-machi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
| | - Yasuhiro Heishima
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midori-machi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan.,Heisei Animal Hospital, 2-1-1 Futago-cho, Kasugai, Aichi 486-0955, Japan
| | - Yohei Yamashita
- Ebisu Animal Hospital, 3-3-43 Nishitaga, Taihaku, Sendai, Miyagi 982-0034, Japan
| | - Masayuki Iguchi
- Iguchi Animal Hospital, 6-2-34 Kamijima, Naka, Hamamatsu, Shizuoka 433-8122, Japan
| | - Kensuke Nakamura
- University of Miyazaki, 1-1 Gakuenkibanadai-nishi, Miyazaki 889-2192 Japan
| | - Noriko Isayama
- Uenonomori Animal Clinic, 1-5-11 Yanaka Taito, Tokyo 110-0001, Japan
| | - Hideyuki Onodera
- Onodera Animal Hospital, 1-10-4 Chuou, Rifu-cho, Miyagi, Miyagi 981-0104, Japan
| | - Akihito Kitade
- Kitade Animal Hospital, 2 Ichishichotajiri, Tsu, Mie 515-2516, Japan
| | - Nobuyuki Kanno
- Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-8510, Japan
| | - Atsushi Hirakawa
- Pet Clinic Hallelujah, 2544-1 Nakabaru, Kasuya-machi, Kasuya, Fukuoka 811-2304, Japan
| | - Michio Katagi
- Katagi Animal Hospital, 565-5 Matoba, Kawagoe, Saitama 350-1101, Japan
| | - Toshiki Ibaragi
- Miyoshi Inter Animal Hospital, 27-103 Neura Fukuya-cho, Miyoshi, Aichi 470-0217, Japan
| | - Shigeki Yamano
- Ueda Animal Clinic, 2-202 Ueda, Tenpaku, Nagoya, Aichi 465-0081, Japan
| | - Yoshitaka Aramaki
- Bay Veterinary Hospital, 5-6-7 Ujinanishi, Minami, Hiroshima, Hiroshima 734-0014, Japan
| | - Tamotsu Sawada
- Kitanomori Animal Hospital, 17-1-35 11-Jyou, Shin-kotoni, Kita, Sapporo, Hokkaido 001-0911, Japan
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25
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Glaus TM, Elliott J, Herberich E, Zimmering T, Albrecht B. Efficacy of long-term oral telmisartan treatment in cats with hypertension: Results of a prospective European clinical trial. J Vet Intern Med 2018; 33:413-422. [PMID: 30561059 PMCID: PMC6430888 DOI: 10.1111/jvim.15394] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 11/15/2018] [Indexed: 12/28/2022] Open
Abstract
Background Efficacy of telmisartan in treating hypertension (HT) in cats has not been largely investigated. Objective Telmisartan oral solution effectively controls systolic arterial blood pressure (SABP) in hypertensive cats. Animals Two‐hundred eighty‐five client‐owned cats with systemic HT. Methods Prospective, multicenter, placebo‐controlled, randomized, double‐blinded study. Hypertensive cats diagnosed with SABP ≥160 mmHg and ≤200 mmHg without target‐organ‐damage were randomized (2 : 1 ratio) to receive 2 mg/kg telmisartan or placebo q24 PO. A 28‐day efficacy phase was followed by a 120‐day extended use phase. Efficacy was defined as significant difference in mean SABP reduction between telmisartan and placebo on Day 14 and group mean reduction in SABP of > 20 mmHg by telmisartan on Day 28 compared to baseline. Results Two‐hundred fifty‐two cats completed the efficacy and 144 cats the extended use phases. Mean SABP reduction at Day 14 differed significantly between groups (P < .001). Telmisartan reduced baseline SABP of 179 mmHg by 19.2 (95% confidence interval [CI]: 15.92‐22.52) and 24.6 (95% CI: 21.11‐28.14) mmHg at Days 14 and 28. The placebo group baseline SABP of 177 mmHg was reduced by 9.0 (95% CI: 5.30‐12.80) and 11.4 (95% CI: 7.94‐14.95) mmHg, respectively. Of note, 52% of telmisartan‐treated cats had SABP <150 mmHg at Day 28. Mean SABP reduction by telmisartan in severe (≥180 mmHg) and moderate HT (160‐179 mmHg) was comparable and persistent over time. Conclusions and Clinical Importance Telmisartan solution (PO) was effective in reducing SABP in hypertensive cats with SABP ≥160 mmHg and ≤200 mmHg.
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Affiliation(s)
| | - Jonathan Elliott
- The Department of Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
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Acierno MJ, Brown S, Coleman AE, Jepson RE, Papich M, Stepien RL, Syme HM. ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med 2018; 32:1803-1822. [PMID: 30353952 PMCID: PMC6271319 DOI: 10.1111/jvim.15331] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022] Open
Abstract
An update to the 2007 American College of Veterinary Internal Medicine (ACVIM) consensus statement on the identification, evaluation, and management of systemic hypertension in dogs and cats was presented at the 2017 ACVIM Forum in National Harbor, MD. The updated consensus statement is presented here. The consensus statement aims to provide guidance on appropriate diagnosis and treatment of hypertension in dogs and cats.
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Affiliation(s)
- Mark J Acierno
- Department of Medicine, College of Veterinary Medicine, Midwestern University, 5715 W. Utopia Rd, Glendale Arizona 85308
| | - Scott Brown
- College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Amanda E Coleman
- College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Rosanne E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Mark Papich
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Rebecca L Stepien
- Department of Medical Sciences, University of Wisconsin School of Veterinary Medicine, Madison, Wisconsin
| | - Harriet M Syme
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
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Young WM, Zheng C, Davidson MG, Westermeyer HD. Visual outcome in cats with hypertensive chorioretinopathy. Vet Ophthalmol 2018; 22:161-167. [DOI: 10.1111/vop.12575] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Whitney M Young
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
| | - Chaowen Zheng
- Department of Statistics; North Carolina State University; Raleigh NC USA
| | - Michael G Davidson
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
| | - Hans D Westermeyer
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
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Coleman AE, Brown SA, Stark M, Bryson L, Zimmerman A, Zimmering T, Traas AM. Evaluation of orally administered telmisartan for the reduction of indirect systolic arterial blood pressure in awake, clinically normal cats. J Feline Med Surg 2018. [PMID: 29513155 DOI: 10.1177/1098612x18761439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to compare the effects of multiple once- or twice-daily oral dosage rates of the angiotensin II, type-1 receptor blocker, telmisartan (TEL), or placebo (PLA) on indirect systolic arterial blood pressure (SBP) in awake, clinically normal cats. METHODS Utilizing an incomplete crossover design and following a 14 day acclimation period, 28 healthy laboratory cats were randomized to undergo treatment with three of the following 14 day treatment protocols, each separated by a 1 week washout period: oral PLA q24h, oral TEL at a dosage of 1, 1.5, 2 or 3 mg/kg q24h, or oral TEL at a dosage of 1 or 1.5 mg/kg q12h. Using the Doppler ultrasound method, indirect SBP was measured daily during each treatment period, and daily during the first 5 days of each washout period, approximately 3 h after administration of the morning treatment. RESULTS Each treatment protocol was administered to a total of 12 cats. A statistically significant effect of treatment period was identified for the entire study; therefore, only data from the first treatment period (four cats per treatment group) were used for further analysis. Compared with PLA, during the first treatment period, SBP values were significantly lower in cats treated with TEL at all tested dosages by the second week of treatment. SBP remained significantly lower than in PLA-treated animals for 2 days following administration of the last dose in all TEL treatment groups. No clinical signs of hypotension were noted in any group. CONCLUSIONS AND RELEVANCE These results suggest that treatment with TEL at a total daily dose of 1-3 mg/kg - administered as a single dose, or split into two equal doses administered 12 h apart - results in a significant, relatively long-lasting reduction of SBP in clinically normal cats. TEL appears to be well tolerated by normal cats at the dosages tested.
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Affiliation(s)
- Amanda E Coleman
- 1 Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Scott A Brown
- 1 Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA.,2 Department of Physiology and Pharmacology, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Marcus Stark
- 3 Boehringer Ingelheim Animal Health, Rheinland-Pfalz, Germany
| | | | | | - Tanja Zimmering
- 3 Boehringer Ingelheim Animal Health, Rheinland-Pfalz, Germany
| | - Anne M Traas
- 4 Boehringer Ingelheim Vetmedica, St Joseph, MO, USA
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Secrest S, Sharma A, Bugbee A. Computed Tomographic Angiography of the Pancreas in Cats with Chronic Diabetes Mellitus Compared to Normal Cats. J Vet Intern Med 2018; 32:962-966. [PMID: 29498098 PMCID: PMC5980261 DOI: 10.1111/jvim.14899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/24/2017] [Accepted: 11/15/2017] [Indexed: 12/01/2022] Open
Abstract
Background Diabetes mellitus (DM) is a common endocrinopathy in cats. No known diagnostic test or patient characteristic at the time of diagnosis can predict likely disease course, unlike in people in whom computed tomographic angiography (CTA) is used. No published data exist regarding the CTA appearance of the pancreas in cats with DM, and thus, it is unknown what if any CTA variables should be further assessed for associations with pancreatic endocrine function. Hypothesis/Objectives A significant difference in pancreatic attenuation, volume, and size will be identified between normal cats and those with chronic DM on CTA. Animals Ten healthy control cats and 15 cats with naturally occurring DM present for >12 months. Methods Prospective cross‐sectional study comparing pancreatic attenuation, enhancement pattern, size, volume, pancreatic volume‐to‐body weight ratio (V:BW), pancreatic arterial: portal phase ratio (A:P), time‐to‐arterial enhancement, and time‐to‐peak portal enhancement on CTA between sedated healthy control cats and those with chronic DM. Results The pancreas in cats with chronic DM was significantly larger, had higher volume, higher V:BW, and shorter time‐to‐peak portal enhancement on CTA when compared to normal cats. Conclusions and Clinical Importance Peak portal enhancement time, pancreatic size, pancreatic volume, and V:BW can be used to differentiate normal sedated cats from those with chronic DM by CTA. These variables warrant further investigation to identify possible associations with endocrine function.
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Affiliation(s)
- S Secrest
- Department of Veterinary Biosciences and Diagnostic Imaging, University of Georgia College of Veterinary Medicine, Athens, GA
| | - A Sharma
- Department of Veterinary Biosciences and Diagnostic Imaging, University of Georgia College of Veterinary Medicine, Athens, GA
| | - A Bugbee
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA
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Moreira MV, Teixeira Neto RL, Langohr IM, Ecco R. Prospective study of ocular and periocular diseases in animals: 188 cases. PESQUISA VETERINARIA BRASILEIRA 2018. [DOI: 10.1590/1678-5150-pvb-5044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT: Histopathology of the ocular and periocular tissues submitted for diagnosis and research is still incipient in Brazil, in contrast to veterinary clinical ophthalmology. In this study, ocular and periocular tissues from domestic and wild animal species, mainly from the state of Minas Gerais, Brazil, were evaluated between February 2012 and September 2015. The samples were analyzed grossly and microscopically. Histochemistry and immunohistochemistry were performed on some of the samples. The frequency, type of ocular alteration, affected animal species, and affected ocular or periocular tissues were recorded. One hundred eighty-eight ocular and periocular tissues from domestic and, occasionally, wild animals were examined. Nine animals presented two concurrent alterations, adding up to 197 alterations. Proliferative lesions were the most frequent (92), followed by traumatic (43), inflammatory (37), degenerative (18), developmental (4) and vascular/hemorrhagic diseases (3). The globe was the most affected structure (112), followed by eyelids (52), third eyelid (17), bulbar conjunctiva (14) and retrobulbar region (2). Neoplasms arising from periocular tissues were the most frequent alteration (60), possibly related to a more active surgical service and histopathologic evaluation request. Many animals presented ocular lesions that reflected systemic diseases, which were diagnosed by necropsy and examination of other organs. Particularly in cases of neoplasia, early detection and surgical treatment can prevent systemic involvement. Ocular histopathologic evaluation can provide better characterization and prognosis of the clinical-pathological condition of the patient as well.
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Hori Y, Heishima Y, Yamashita Y, Isayama N, Kanno N, Nakamura K, Iguchi M, Ibaragi T, Onodera H, Aramaki Y, Hirakawa A, Yamano S, Katagi M, Kitade A, Sawada T. Relationship between indirect blood pressure and various stages of chronic kidney disease in cats. J Vet Med Sci 2018; 80:447-452. [PMID: 29311521 PMCID: PMC5880824 DOI: 10.1292/jvms.17-0620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic kidney disease (CKD) is a common cause of secondary systemic hypertension in cats. We investigated the relationship between indirect blood pressure and the prevalence of systemic hypertension in various CKD
stages in cats. Client-owned cats (24 control cats and 77 cats with CKD) were included. Biochemical examinations of plasma were conducted by a commercial laboratory. Diseased cats were divided into two groups based on
the International Renal Interest Society (IRIS) guidelines (II and III–IV). Indirect blood pressure was measured using an oscillometric technique. Severe hypertension was diagnosed if systolic blood pressure (SBP) was
≥180 mmHg. Indirect blood pressures were significantly higher in IRIS stage III–IV than in the control cats. Of 77 cats with CKD, 25 (32.5%) had severe hypertension. The frequency of severe hypertension increased with an
increase in IRIS stage; 0% in the controls, 27.6% in the IRIS stage II, and 47.4% in the IRIS stage III–IV, respectively. The indirect SBP was weakly correlated with urea nitrogen (r=0.27) and creatinine
(r=0.23) concentrations in plasma. Binary logistic regression analysis showed that if plasma creatinine concentration is >3.7 mg/dl, cats with CKD had an increased risk for
developing severe hypertension (P<0.001). Our results suggest that indirect blood pressure was correlated with the severity of CKD, and the prevalence of severe hypertension increased in cats with
severe CKD. The risk of severe hypertension may be high in cats with severe CKD.
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Affiliation(s)
- Yasutomo Hori
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midori-machi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
| | - Yasuhiro Heishima
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midori-machi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan.,Heisei Animal Hospital, 2-1-1 Futago-cho, Kasugai, Aichi 486-0955, Japan
| | - Yohei Yamashita
- Ebisu Animal Hospital, 3-3-43 Nishitaga, Taihaku, Sendai, Miyagi 982-0034, Japan
| | - Noriko Isayama
- Uenonomori Animal Clinic, 1-5-11 Yanaka Taito, Tokyo 110-0001, Japan
| | - Nobuyuki Kanno
- Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-8510, Japan
| | - Kensuke Nakamura
- Organization for Promotion of Tenure Track, University of Miyazaki, 1-1 Gakuenkibanadai-nishi, Miyazaki 889-2192 Japan
| | - Masayuki Iguchi
- Iguchi Animal Hospital, 6-2-34 Kamijima, Naka, Hamamatsu, Shizuoka 433-8122, Japan
| | - Toshiki Ibaragi
- Miyoshi Inter Animal Hospital, 27-103 Neura Fukuya-cho, Miyoshi, Aichi 470-0217, Japan
| | - Hideyuki Onodera
- Onodera Animal Hospital, 1-10-4 Chuou, Rifu-cho, Miyagi, Miyagi 981-0104, Japan
| | - Yoshitaka Aramaki
- Bay Veterinary Hospital, 5-6-7 Ujinanishi, Minami, Hiroshima, Hiroshima 734-0014, Japan
| | - Atsushi Hirakawa
- Pet Clinic Hallelujah, 2544-1 Nakabaru, Kasuya-machi, Kasuya, Fukuoka 811-2304, Japan
| | - Shigeki Yamano
- Ueda Animal Clinic, 2-202 Ueda, Tenpaku, Nagoya, Aichi 465-0081, Japan
| | - Michio Katagi
- Katagi Animal Hospital, 565-5 Matoba, Kawagoe, Saitama 350-1101, Japan
| | - Akihito Kitade
- Kitade Animal Hospital, 2 Ichishichotajiri, Tsu, Mie 515-2516, Japan
| | - Tamotsu Sawada
- Kitanomori Animal Hospital, 17-1-35 11-Jyou, Shin-kotoni, Kita, Sapporo, Hokkaido 001-0911, Japan
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Sandhas E, Merle R, Eule JC. Consider the eye in preventive healthcare – ocular findings, intraocular pressure and Schirmer tear test in ageing cats. J Feline Med Surg 2017; 20:1063-1071. [DOI: 10.1177/1098612x17742528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives Geriatric health screening in cats is highly recommended. However, information about normal and abnormal findings is scarce, especially regarding the eyes of ageing cats. This prospective study examined the influence of the ageing process on vision and ocular structures in older cats. Methods A total of 209 cats (aged 9–24 years) underwent physical examination, vision assessment, slit lamp biomicroscopy and ophthalmoscopy. Systolic blood pressure (SBP) measurement, Schirmer tear test (STT) reading and rebound tonometry were performed. Systemic disease was not a criterion for exclusion. Results Vision was good in 157/209 cats (75.1%) and impaired in 52/209 cats (24.9%). Increasing age and the occurrence of vision impairment were not statistically associated ( P = 0.053). Retinal oedema, retinal haemorrhage and/or retinal detachment (19 cats) and glaucoma (12 cats) were the most common findings in vision impaired cats. Increasing age was significantly associated with the occurrence of lenticular sclerosis ( P = 0.01) and attenuated retinal vessels ( P = 0.02). Increasing age and SBP were significantly associated with the occurrence of retinal detachment, haemorrhage and oedema ( P <0.001 each). In cats without evidence of hypertensive ocular damage, younger cats had a tendency for higher SBP values than older cats, although this difference was not significant. Mean intraocular pressure (IOP) was 16.5 ± 5.0 mmHg. Age did not significantly affect the IOP values ( P = 0.54). Mean STT was 15.8 ± 4.8 mm/min. The STT was found to increase with age ( P = 0.025). Conclusions and relevance Although vision impairment is not a clinical sign of old age in cats, age-related changes may contribute to vision-threatening diseases. This study contributes to preventive healthcare by examining the influence of the ageing process on vision and ocular structures in older cats.
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Affiliation(s)
- Ellen Sandhas
- Small Animal Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Germany
| | - Roswitha Merle
- Department of Veterinary Epidemiology and Biometry, Freie Universität Berlin, Germany
| | - J Corinna Eule
- Small Animal Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Germany
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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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Leclerc A, Trehiou-Sechi E, Greunz EM, Damoiseaux C, Bouvard J, Chetboul V. Systemic arterial hypertension secondary to chronic kidney disease in two captive-born large felids. J Vet Cardiol 2017; 19:308-316. [PMID: 28435002 DOI: 10.1016/j.jvc.2017.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 10/20/2016] [Accepted: 02/23/2017] [Indexed: 01/18/2023]
Abstract
Systemic arterial hypertension (SHT) has been widely described in the domestic cat (Felis catus). In these feline patients, SHT is considered as the most common vascular disorder of middle-aged to older animals, and secondary SHT related to chronic kidney disease (CKD) represents the most common form of the disease. We describe here the first two cases of spontaneous SHT in large felids, i.e. one 18-year old, 34.4 kg, male North-Chinese leopard (Panthera pardus japonensis, case #1) and one 20-year old, 28.7 kg, female snow leopard (Panthera uncia, case #2), both captive-bred and previously diagnosed with CKD. Both animals underwent complete echocardiographic examination under general anesthesia due to abnormal cardiac auscultation (heart murmur and/or gallop sound), and recurrent lethargy in case #1. The combination of left ventricular remodeling with moderate aortic regurgitation of high velocity was highly suggestive of SHT, which was confirmed by indirect blood pressure measurement (systolic arterial blood pressure of 183 mmHg for case #1 and 180 mmHg for case #2). Amlodipine was prescribed (0.35-0.70 mg/kg/day orally) for 31 and 6 months respectively after the initial diagnosis. In case #1, concurrent amlodipine and benazepril treatment was associated with decreased heart murmur grade and reduced aortic insufficiency severity. These reports illustrate that, similarly to domestic cats, SHT should be suspected in old large felids with CKD and that amlodipine is a well-tolerated antihypertensive drug in these species.
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Affiliation(s)
- A Leclerc
- Parc Zoologique et de Loisirs de Thoiry, 78770, Thoiry, France.
| | - E Trehiou-Sechi
- Unité de Cardiologie d'Alfort (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, 7 avenue Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - E M Greunz
- Parc Zoologique et de Loisirs de Thoiry, 78770, Thoiry, France
| | - C Damoiseaux
- Unité de Cardiologie d'Alfort (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, 7 avenue Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - J Bouvard
- Unité de Cardiologie d'Alfort (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, 7 avenue Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - V Chetboul
- Unité de Cardiologie d'Alfort (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, 7 avenue Général de Gaulle, 94704, Maisons-Alfort Cedex, France; INSERM, U955, Equipe 03, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France
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Taylor SS, Sparkes AH, Briscoe K, Carter J, Sala SC, Jepson RE, Reynolds BS, Scansen BA. ISFM Consensus Guidelines on the Diagnosis and Management of Hypertension in Cats. J Feline Med Surg 2017; 19:288-303. [DOI: 10.1177/1098612x17693500] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Practical relevance: Feline hypertension is a common disease in older cats that is frequently diagnosed in association with other diseases such as chronic kidney disease and hyperthyroidism (so-called secondary hypertension), although some cases of apparent primary hypertension are also reported. The clinical consequences of hypertension can be severe, related to ‘target organ damage’ (eye, heart and vasculature, brain and kidneys), and early diagnosis followed by appropriate therapeutic management should help reduce the morbidity associated with this condition. Clinical challenges: Despite being a common disease, routine blood pressure (BP) monitoring is generally performed infrequently, probably leading to underdiagnosis of feline hypertension in clinical practice. There is a need to: (i) ensure BP is measured as accurately as possible with a reproducible technique; (ii) identify and monitor patients at risk of developing hypertension; (iii) establish appropriate criteria for therapeutic intervention; and (iv) establish appropriate therapeutic targets. Based on current data, amlodipine besylate is the treatment of choice to manage feline hypertension and is effective in the majority of cats, but the dose needed to successfully manage hypertension varies between individuals. Some cats require long-term adjuvant therapy and, occasionally, additional therapy is necessary for emergency management of hypertensive crises. Evidence base: These Guidelines from the International Society of Feline Medicine (ISFM) are based on a comprehensive review of the currently available literature, and are aimed at providing practical recommendations to address the challenges of feline hypertension for veterinarians. There are many areas where more data is required which, in the future, will serve to confirm or modify some of the recommendations in these Guidelines.
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Affiliation(s)
| | | | - Katherine Briscoe
- Animal Referral Hospital, 250 Parramatta Road, Homebush, Sydney, NSW 2140, Australia
| | - Jenny Carter
- PO Box 128209, Remuera, Auckland 1541, New Zealand
| | | | - Rosanne E Jepson
- Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | | | - Brian A Scansen
- Associate Professor, Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO 80523, USA
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Failure in Cardiac Action: Comparing Humans, Dogs, Cats, and Horses. Comp Med 2017. [DOI: 10.1007/978-3-319-47007-8_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Payne JR, Brodbelt DC, Luis Fuentes V. Blood Pressure Measurements in 780 Apparently Healthy Cats. J Vet Intern Med 2016; 31:15-21. [PMID: 27906477 PMCID: PMC5259628 DOI: 10.1111/jvim.14625] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 10/05/2016] [Accepted: 11/02/2016] [Indexed: 11/30/2022] Open
Abstract
Background Mean systolic blood pressure in apparently healthy cats has been reported as approximately 125 mmHg using direct assessment, but there is greater variability in reported values using indirect assessment. Increasing age and the white‐coat effect are associated with increased systolic blood pressure. Hypothesis/Objectives To report Doppler‐derived blood pressure measurements from a large population of apparently healthy cats and to assess epidemiologic factors associated with recorded blood pressures. Animals A total of 780 cats in rehoming centers enrolled in a screening program for heart murmurs and cardiac disease. Methods Cats were considered healthy based on history and physical examination. Cats with known hypertension, hyperthyroidism, or clinical signs of systemic disease and pregnant or nursing queens were excluded. After an acclimatization period, systolic blood pressure was measured using the Doppler sphygmomanometry method following the recommendations of the ACVIM Consensus Statement. General linear model analysis was performed to identify factors associated with variation in systolic blood pressure. Results Median (interquartile range, IQR) systolic blood pressure for the group was 120.6 (110.4–132.4) mmHg. Factors significantly associated with higher systolic blood pressure in a general linear model were increased age, increased nervousness, male sex, neutering, or history of being a stray. The model explained 29.2% of the variation in systolic blood pressure. Conclusions and Clinical Importance The age, demeanor, sex, neuter status and history of being a stray should be taken into account when assessing systolic blood pressure in apparently healthy cats.
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Affiliation(s)
- J R Payne
- Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - D C Brodbelt
- Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - V Luis Fuentes
- Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
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Jepson RE, Hartley V, Mendl M, Caney SME, Gould DJ. A comparison of CAT Doppler and oscillometric Memoprint machines for non-invasive blood pressure measurement in conscious cats. J Feline Med Surg 2016; 7:147-52. [PMID: 15922221 DOI: 10.1016/j.jfms.2004.08.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2004] [Indexed: 11/23/2022]
Abstract
Indirect blood pressure measurements were compared in 28 conscious cats using Doppler and oscillometric blood pressure-measuring devices. Ten cats were used to compare Doppler measurements between two examiners and 18 cats were used to compare Doppler and oscillometric measurements. The Doppler machine obtained systolic and diastolic blood pressure readings in 100% and 51% of attempts, respectively. With the oscillometric machine, systolic and diastolic blood pressure readings were obtained in 52% of the attempts. With the Doppler, measures of mean systolic blood pressure between two examiners were positively correlated, but there was no correlation for diastolic blood pressure measures. When comparing the results obtained by Doppler and oscillometric machines there was no significant difference between mean systolic blood pressure readings, but the oscillometric machine produced significantly higher estimates of diastolic blood pressure. In both cases, the standard deviations for the oscillometric machine were considerably larger than those for the Doppler machine. The first reading of systolic blood pressure obtained with the Doppler machine was an excellent predictor of the mean of five readings, but this was not so for the oscillometric machine. It took less than 5 min to obtain five readings in 37.5% of cases with the Doppler machine but this was true for only 5% of cases with the oscillometric machine. Two cats with ophthalmological lesions consistent with systemic hypertension were identified. In these two patients, systolic blood pressure measurements were between 200 and 225 mmHg when measured by Doppler, and between 140 and 150 mmHg when measured by the oscillometric machine. This suggests that a lower reference range for normal systolic blood pressure values should be used for the oscillometric device.
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Affiliation(s)
- Rosanne E Jepson
- Department of Clinical Veterinary Science, University of Bristol, Langford House, Bristol BS40 5DU, UK
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40
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Quimby JM. Update on Medical Management of Clinical Manifestations of Chronic Kidney Disease. Vet Clin North Am Small Anim Pract 2016; 46:1163-81. [DOI: 10.1016/j.cvsm.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Nguyen P, Reynolds B, Zentek J, Paßlack N, Leray V. Sodium in feline nutrition. J Anim Physiol Anim Nutr (Berl) 2016; 101:403-420. [PMID: 27550521 DOI: 10.1111/jpn.12548] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/09/2016] [Indexed: 11/27/2022]
Abstract
High sodium levels in cat food have been controversial for a long time. Nonetheless, high sodium levels are used to enhance water intake and urine volume, with the main objective of reducing the risk of urolithiasis. This article is a review of current evidence of the putative risks and benefits of high dietary sodium levels. Its secondary aim is to report a possible safe upper limit (SUL) for sodium intake. The first part of the manuscript is dedicated to sodium physiology, with a focus on the mechanisms of sodium homeostasis. In this respect, there is only few information regarding possible interactions with other minerals. Next, the authors address how sodium intake affects sodium balance; knowledge of these effects is critical to establish recommendations for sodium feed content. The authors then review the consequences of changes in sodium intake on feline health, including urolithiasis, blood pressure changes, cardiovascular alterations and kidney disease. According to recent, long-term studies, there is no evidence of any deleterious effect of dietary sodium levels as high as 740 mg/MJ metabolizable energy, which can therefore be considered the SUL based on current knowledge.
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Affiliation(s)
- P Nguyen
- Nutrition and Endocrinology Unit, LUNAM Université, Oniris, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - B Reynolds
- Clinical Research Unit, University of Toulouse, INP, National Veterinary School of Toulouse, Toulouse, France
| | - J Zentek
- Institute of Animal Nutrition, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - N Paßlack
- Institute of Animal Nutrition, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - V Leray
- Nutrition and Endocrinology Unit, LUNAM Université, Oniris, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France
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42
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Conti LM, Champion T, Guberman ÚC, Mathias CH, Fernandes SL, Silva EG, Lázaro MA, Lopes AD, Fortunato VR. Evaluation of environment and a feline facial pheromone analogue on physiologic and behavioral measures in cats. J Feline Med Surg 2016; 19:165-170. [PMID: 26662036 DOI: 10.1177/1098612x15621107] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives This study assessed behavioral and physiologic stress parameters in cats placed in two environments: home and the veterinary hospital. With a widely used scale, several parameters were assessed, including respiratory rate (RR), heart rate (HR), systolic blood pressure (SBP), vagosympathetic responses using calculated intervals (heart rate variability [HRV]10, HRV20 and vasovagal tonus index [VVTI]) and 'stress attitude', such as struggling, vocalization and agitation during handling. In addition, we evaluated whether a feline facial pheromone analogue (FFPA) had an effect on any of these measures in either environment. Methods Using a placebo and a pheromone substance, we evaluated 30 adult and healthy cats at home and in veterinary hospitals. Statistical analyses were performed using the Shapiro-Wilk, Kruskal-Wallis, and Dunn or ANOVA and Tukey tests, as well as Spearman's correlation ( P <0.05). Results We found that exposure to FFPA did not reduce the effects of stress. Some parameters presented differences with regard to environment: the RR was 45 and 70 breaths/min and stress attitude score was 1.3 and 0.0 for cats evaluated at home and at the hospital, respectively. The HR and two vagosympathetic responses were also different between the two environments, with a HR of 160 and 187 beats/min, HRV10 of 14.24 and 14.00, and HRV20 of 14.89 and 14.65 in cats at home and the hospital, respectively. There was no variation in SBP and VVTI parameters between the environments. Conclusions and relevance Exposure to FFPA does not reduce the physiologic and behavioral changes measured in this study. Furthermore, environmental change, physical restraint and manipulation during the physical examination alter RR, HR, HRV and behavior but not SBP and VVTI. This study is relevant because physiologic and behavioral stress can affect the quality and interpretation of physical examination results. This study presents detailed data that show the effects of environment and manipulation on such parameters. Furthermore, this study shows a lack of effect of FFPA on any of these parameters.
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Affiliation(s)
- Laura Mc Conti
- 1 Veterinary Medicine, Vila Velha University (UVV), Vila Velha, Brazil
| | - Tatiana Champion
- 2 Veterinary Medicine, Federal University of South Frontier (UFFS), Realeza, Brazil
| | - Úrsula C Guberman
- 1 Veterinary Medicine, Vila Velha University (UVV), Vila Velha, Brazil
| | - Carlos Ht Mathias
- 1 Veterinary Medicine, Vila Velha University (UVV), Vila Velha, Brazil
| | | | | | - Monique A Lázaro
- 1 Veterinary Medicine, Vila Velha University (UVV), Vila Velha, Brazil
| | - Aline Dcg Lopes
- 1 Veterinary Medicine, Vila Velha University (UVV), Vila Velha, Brazil
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43
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Brown CA, Munday JS, Mathur S, Brown SA. Hypertensive Encephalopathy in Cats with Reduced Renal Function. Vet Pathol 2016; 42:642-9. [PMID: 16145210 DOI: 10.1354/vp.42-5-642] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The clinical, hemodynamic, and pathologic features of hypertensive encephalopathy in two cats with reduced renal mass are described. The cats developed a progressive syndrome of lethargy, ataxia, blindness, stupor, and seizures following an abrupt increase in blood pressure associated with a surgical reduction in renal mass. The cats had severe gross brain edema, evidenced by cerebellar changes of caudal coning and cranial displacement over the corpora quadrigemina and cerebral changes of widening and flattening of the gyri. Histologically, interstitial edema was most pronounced in the cerebral white matter. Hypertensive vascular lesions were present as hyaline arteriolosclerosis in one cat and hyperplastic arteriolosclerosis in the other. Rare foci of parenchymal microhemorrhages and necrosis were also observed. Systemic hypertension (especially severe or rapidly developing) accompanied by neurologic signs and the pathologic findings of diffuse brain edema with cerebral arteriolosclerosis are consistent with an etiologic diagnosis of hypertensive encephalopathy.
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Affiliation(s)
- C A Brown
- Athens Diagnostic Laboratory, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.
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44
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Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I, Langston C, Lefebvre HP, White J, Quimby J. ISFM Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease. J Feline Med Surg 2016; 18:219-39. [DOI: 10.1177/1098612x16631234] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Practical relevance: Chronic kidney disease (CKD) is one of the most commonly diagnosed diseases in older cats. In most cats, CKD is also a progressive disease and can be accompanied by a wide range of clinical and clinicopathological changes. These ISFM Consensus Guidelines have been developed by an independent panel of clinicians and academics to provide practical advice on the diagnosis and management of this complex disease. Clinical challenges: Although CKD is a common clinical problem in cats, the manifestations of disease vary between individuals. Thus there is a need for careful and repeat evaluation of cats with CKD and adjustment of therapy according to individual needs. In addition to addressing problems arising from CKD and improving quality of life (QoL) for the patient, therapy may also target slowing the underlying progression of disease and hence prolonging life. While maintaining QoL is of paramount importance in our patients, this can be challenging when multiple therapies are indicated. In some cases it is necessary to prioritise therapy, given an understanding of what is likely to most benefit the individual patient. Evidence base: In preparing these Guidelines, the Panel has carefully reviewed the existing published literature, and has also graded the quality of evidence for different interventions to help to provide practical recommendations on the therapeutic options for feline CKD. This is a field of veterinary medicine that has benefited from some excellent published clinical research and further research findings will undoubtedly modify the recommendations contained in these Guidelines in the future.
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Affiliation(s)
| | | | - Serge Chalhoub
- Faculty of Veterinary Medicine, University of Calgary, Canada
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, UK
| | - Natalie Finch
- Bristol Renal, School of Clinical Sciences, University of Bristol, UK
| | | | | | - Hervé P Lefebvre
- Clinical Research Unit, National Veterinary School of Toulouse (ENVT), France
| | - Joanna White
- Small Animal Specialist Hospital, Sydney, Australia
| | - Jessica Quimby
- Department of Clinical Veterinary Sciences, Colorado State University, USA
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45
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Brown CA, Elliott J, Schmiedt CW, Brown SA. Chronic Kidney Disease in Aged Cats: Clinical Features, Morphology, and Proposed Pathogeneses. Vet Pathol 2016; 53:309-26. [PMID: 26869151 DOI: 10.1177/0300985815622975] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chronic kidney disease (CKD) is the most common metabolic disease of domesticated cats, with most affected cats being geriatric (>12 years of age). The prevalence of CKD in cats exceeds that observed in dogs, and the frequency of the diagnosis of CKD in cats has increased in recent decades. Typical histologic features include interstitial inflammation, tubular atrophy, and fibrosis with secondary glomerulosclerosis. In contrast to people and dogs, primary glomerulopathies with marked proteinuria are remarkably rare findings in cats. Although a variety of primary renal diseases have been implicated, the disease is idiopathic in most cats. Tubulointerstitial changes, including fibrosis, are present in the early stages of feline CKD and become more severe in advanced disease. A variety of factors-including aging, ischemia, comorbid conditions, phosphorus overload, and routine vaccinations-have been implicated as factors that could contribute to the initiation of this disease in affected cats. Factors that are related to progression of established CKD, which occurs in some but not all cats, include dietary phosphorus intake, magnitude of proteinuria, and anemia. Renal fibrosis, a common histologic feature of aged feline kidneys, interferes with the normal relationship between peritubular capillaries and renal tubules. Experimentally, renal ischemia results in morphologic changes similar to those observed in spontaneous CKD. Renal hypoxia, perhaps episodic, may play a role in the initiation and progression of this disease.
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Affiliation(s)
- C A Brown
- Athens Veterinary Diagnostic Laboratory, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - J Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK
| | - C W Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - S A Brown
- Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
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46
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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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47
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Telle MR, Betbeze C. Hyphema: Considerations in the Small Animal Patient. Top Companion Anim Med 2015; 30:97-106. [PMID: 26494501 PMCID: PMC7173179 DOI: 10.1053/j.tcam.2015.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/03/2015] [Indexed: 12/01/2022]
Abstract
Classification, diagnosis, and treatment of hemorrhage into the anterior chamber of the eye, or hyphema, can be a challenging and frustrating process for many practitioners, especially in emergency situations. This review outlines an inclusive list of causes, diagnostics, and treatments for traumatic and nontraumatic hyphema in both canine and feline patients. The review is tailored to small animal practitioners, especially in emergency practice, and is designed to provide concise but thorough descriptions on investigating underlying causes of hyphema and treating accordingly.
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Affiliation(s)
- Mary Rebecca Telle
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee Veterinary Medical Center, Knoxville, TN, USA
| | - Caroline Betbeze
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA.
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48
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Ferreira A, Sottiaux J, Mandara MT, Motta L. Ascending haemorrhagic myelomalacia associated with systemic hypertension in a hyperthyroid cat. JFMS Open Rep 2015; 1:2055116915589840. [PMID: 28491365 PMCID: PMC5362925 DOI: 10.1177/2055116915589840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 12/30/2022] Open
Abstract
CASE SUMMARY An 8-year-old domestic shorthair neutered male cat was presented with acute onset of paraplegia, absent nociception on the pelvic limbs, tail and perianal area, and a previous history of uncontrolled hyperthyroidism (even after thyroidectomy) and chronic hypertension. The magnetic resonance findings (heterogeneous intramedullary ill-defined area, isointense on T1-weighted and hyperintense on short tau inversion recovery and T2-weighted scans between T12 and L5 spinal cord segments) were consistent with ascending haemorrhagic myelomalacia, which was confirmed by histopathology. It also revealed myelomalacia associated with diffuse arteriolar hyalinosis, similar to the reports found with hypertensive encephalopathy. RELEVANCE AND NOVEL INFORMATION Myelomalacia should be considered as a possible outcome in cats with hypertension. Considering that hypertension is a common consequence of hyperthyroidism, emphasis should be given to blood pressure monitoring, especially after treatment of this condition. We describe the histopathological changes occurring in the spinal cord associated with a state of hypertension.
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Affiliation(s)
| | - Jacques Sottiaux
- Cardiology Department, Grange Pierre, Saint Andre de Corcy, France
| | | | - Luca Motta
- ChesterGates Veterinary Specialists, Neurology Department, Chester, UK
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49
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Huhtinen M, Derré G, Renoldi HJ, Rinkinen M, Adler K, Aspegrén J, Zemirline C, Elliott J. Randomized placebo-controlled clinical trial of a chewable formulation of amlodipine for the treatment of hypertension in client-owned cats. J Vet Intern Med 2015; 29:786-93. [PMID: 25857394 PMCID: PMC4895406 DOI: 10.1111/jvim.12589] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 01/21/2015] [Accepted: 03/10/2015] [Indexed: 11/29/2022] Open
Abstract
Background There is an unmet clinical need for a cat‐specific formulation of amlodipine to treat hypertensive cats. Objectives To assess the efficacy of chewable amlodipine tablets in reducing systolic blood pressure (SBP) in cats diagnosed with systemic arterial hypertension. Animals Seventy‐seven client‐owned cats with systemic hypertension were included (median age 14 years). Methods The study was randomized, double‐blinded, and placebo‐controlled. Forty‐two cats received 0.125–0.50 mg/kg amlodipine once daily for 28 days; 35 cats received placebo. After 28 days all cats continued with amlodipine for 2–3 months in an open‐label phase. Blood pressure was measured using high definition oscillometry. A responder was defined as a cat showing a decrease of SBP to <150 mmHg at 28 days or a decrease from baseline ≥15%. Results Sixty‐one cats completed the study. The responder rate was 63% in amlodipine group and 18% in placebo group. Cats receiving amlodipine were 7.9 (95% CI 2.6–24.1) times more likely to be classified as responders when compared to those receiving placebo (P < .001). From a mean (±SD) baseline value of 181 (±12) mmHg, SBP decreased to 154 (±17) mmHg with amlodipine and to 170 (±21) mmHg with placebo (P < .001). The voluntary acceptance rate of amlodipine formulation was 73%. Conclusions and Clinical Importance The chewable amlodipine tablet effectively reduced SBP compared with placebo in hypertensive cats, and was well‐tolerated. It can be used concomitantly with angiotensin‐converting enzyme inhibitors and in cats with chronic kidney disease.
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Affiliation(s)
- M Huhtinen
- Orion Corporation Orion Pharma, Turku, Finland
| | - G Derré
- Clinique Vétérinaire de la Plage, Marseille, France
| | | | | | - K Adler
- Klifovet AG, Munich, Germany
| | - J Aspegrén
- Orion Corporation Orion Pharma, Turku, Finland
| | | | - J Elliott
- Royal Veterinary College, London, UK
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50
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Ghys LFE, Paepe D, Duchateau L, Taffin ERL, Marynissen S, Delanghe J, Daminet S. Biological validation of feline serum cystatin C: The effect of breed, age and sex and establishment of a reference interval. Vet J 2015; 204:168-73. [PMID: 25900195 DOI: 10.1016/j.tvjl.2015.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 12/16/2014] [Accepted: 02/18/2015] [Indexed: 11/18/2022]
Abstract
Chronic kidney disease (CKD) is common in cats, but the routine renal markers, serum creatinine (sCr) and urea, are not sensitive or specific enough to detect early CKD. Serum cystatin C (sCysC) has advantages over sCr, both in humans and dogs, and sCysC concentration is significantly higher in cats with CKD than in healthy cats. The objective of this study was to determine the effect of age, sex and breed on feline sCysC and to establish a reference interval for feline sCysC. In total, 130 healthy cats aged 1-16 years were included. sCysC was determined using a validated particle-enhanced nephelometric immunoassay. sCr, urea, urine specific gravity, urinary protein:creatinine ratio (UPC) and systolic blood pressure (SBP) were also measured. No significant differences in sCysC concentration were observed among young, middle-aged and geriatric cats, female intact, female neutered cats, male intact and male neutered cats, or among purebred and domestic short-or longhaired cats. The 95% reference interval for feline sCysC was determined to be 0.58-1.95 mg/L. sCr was significantly higher in geriatric cats than young cats. Serum urea in geriatric cats was significantly higher than in middle-aged and young cats (P = 0.004 and P <0.001, respectively). SBP in geriatric cats was significantly higher than in both middle-aged and young cats (P = 0.004 and P = 0.040, respectively). Male neutered and female neutered cats had significantly higher serum urea concentrations than female intact cats (P = 0.003 and P = 0.006, respectively). Male intact cats had a significantly higher UPC than female intact and female neutered cats (P = 0.02 for each comparison). There were no significant differences among sex groups for USG. It is of concern that sCysC in the majority of cats with CKD in previous studies falls within the reference interval calculated in this study. Further studies are warranted to evaluate the diagnostic value of sCysC as a renal marker in cats.
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Affiliation(s)
- L F E Ghys
- Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium.
| | - D Paepe
- Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium
| | - L Duchateau
- Department of Comparative Physiology and Biometrics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - E R L Taffin
- Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium
| | - S Marynissen
- Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium
| | - J Delanghe
- Department of Clinical Chemistry, Microbiology and Immunology, Faculty of Health Medicine and Life Sciences, Ghent University, De Pintelaan 184, B-9000 Ghent, Belgium
| | - S Daminet
- Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium
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