Prognostic factors of chronic kidney disease (CKD) in dogs

Negli ultimi anni si è assistito ad un miglioramento della qualità di vita dei piccoli animali che, oltre ad aumentarne l'aspettativa di vita, ha determinato un aumento della frequenza di patologie associate all'età medio-avanzata, quali le patologie renali croniche. Il presente studio si fonda sulla necessità, sempre più sentita nella pratica clinica veterinaria, di poter fornire al proprietario del paziente affetto da CKD, una serie di parametri che, oltre a fungere da target terapeutico, possano aiutare a comprenderne la prognosi. Lo studio ha valutato una popolazione di cani affetti da CKD e ne ha seguito o ricostruito il follow-up, per tutto il periodo di sopravvivenza fino al momento dell’exitus. Di tali soggetti sono stati raccolti dati relativi ad anamnesi, esame clinico, misurazione della pressione arteriosa, diagnostica per immagini, esami ematochimici, analisi delle urine ed eventuale esame istologico renale. È stato possibile individuare alcuni importanti fattori prognostici per la sopravvivenza in pazienti con CKD. Oltre a fattori ben noti in letteratura, come ad esempio elevati valori di creatinina e fosforo, o la presenza di proteinuria, è stato possibile anche evidenziare il ruolo prognostico negativo di alcuni parametri meno noti, ed in particolare delle proteine di fase acuta positive e negative, e del rapporto albumina/globuline. Una possibile spiegazione del valore prognostico di tali parametri risiede nel ruolo prognostico negativo dell’infiammazione nel paziente con CKD: tale ruolo è stato suggerito e dimostrato nell’uomo e avrebbe alla base numerosi possibili meccanismi (sviluppo di anemia, complicazioni gastroenteriche, neoplasie, etc.), ma dati analoghi sono mancanti in medicina veterinaria. Una seconda possibile spiegazione risiede nel fatto che potenzialmente i livelli delle proteine di fase acuta possono essere influenzati dalla presenza di proteinuria nel paziente con CKD e di conseguenza potrebbero essere una conferma di come la proteinuria influenzi negativamente l'outcome.In recent years there has been an improvement in the quality of life of small animals. In addition of increasing life expectancy, this has led to an increase in the frequency of diseases associated with elderly, such as chronic kidney disease. The present study is based on the need, in the veterinary practice, to be able to provide the owner of a patient with CKD some parameters which can help to understand the prognosis, besides being useful as a therapeutic target. The study evaluated a population of dogs with CKD and followed these dogs or rebuilt the follow-up, until the exitus. We collected data on medical history, clinical examination, blood pressure measurement, diagnostic imaging, blood tests, urinalysis and, when possible, renal histology. It was possible to identify important prognostic factors for survival in patients with CKD. The prognostic role of high levels of creatinine and phosphorus, or the presence of proteinuria is well known in the literature. It was also possible to emphasize the negative prognostic role of some less known parameters, such as acute phase proteins and albumin to globulin ratio. One possible explanation of the prognostic value of these parameters lies in the negative prognostic role of inflammation in patients with CKD: this role has been suggested and demonstrated in humans and has many possible underlying mechanisms (development of anemia, gastrointestinal complications, cancer, etc.), but similar data are missing in veterinary medicine. A second possible explanation lies in the fact that the levels of acute phase proteins may be influenced by the presence of proteinuria in the patient with CKD and therefore may be a confirmation of how proteinuria negatively affects the outcome

FELINE HEINZ BODIES INTERFERENCE ON COMPLETE BLOOD COUNT USING SIEMENS ADVIA 2120: A DESCRIPTION OF TWO CASES

Introduction: Heinz bodies (HBs) in erythrocytes are a frequent finding in cats. Larger or multiple HBs can be related to haemolytic anaemia, mainly due to a severe oxidative damage. In these cases, an elevated number of circulating HBs can affect the results of laser haematology analysers, however veterinary literature on this topic is lacking. The purpose of this study was to report two cases of feline HBs detection significantly affecting complete blood count (CBC). Methods: EDTA blood samples collected from two cats affected by acute oxidative drug toxicity (case A) and diabetic ketoacidosis (case B) were processed on a routine basis at a veterinary clinical pathology laboratory. Blood samples were analysed using ADVIA 2120. Blood smears were stained with Romanovsky and new methylene blue staining and microscopically examined. HBs and white blood cell (WBC) concentrations were manually estimated. Results: Basophil/lobularity WBC count (BASO, cells/\u3bcL), peroxidase staining WBC count (PEROX, cells/\u3bcL), and \u394BASO-PEROX were 549240, 56160 and 493080 in case A, and 15680, 11430 and 4250 in case B, respectively. The WBC microscopic estimation on the blood smear confirms the PEROX results in both cases. Measured haemoglobin concentration (mHGB, g/dL), cellular haemoglobin concentration (cHGB, g/dL), and \u394mHGB-cHGB were 15.8, 9.4, and 6.4 in case A, and 10.7, 9.2, and 1.5 in case B, respectively. Mean corpuscular haemoglobin concentration (MCHC, g/dL), cellular haemoglobin concentration mean (CHCM, g/dL) and \u394MCHC-CHCM were 55.3, 33.0, and 22.3 in case A, and 41.9, 36.1, and 5.8 in case B, respectively. HBs estimation on blood smear was 950/1000 cells in case A and 200/1000 in case B. A cluster of cells lying at the bottom threshold of BASO cytogram, losing the typical configuration, was observed in both cases. These artefacts gradually disappeared during the follow-up, in agreement with the reduction of HBs number. Conclusions: An elevated number of HBs in feline erythrocytes significantly affects haematological results of ADVIA 2120, in particular relatively to the WBC count and haemoglobin indices. However, a careful interpretation of the indices and cytograms, combined with the blood smear examination, allows to obtain accurate results

Serum amyloid A in the diagnosis of feline sepsis

Systemic inflammatory response syndrome (SIRS) and sepsis can be challenging to diagnose in cats. Retrospectively, we investigated the diagnostic and prognostic potential of serum amyloid A (SAA), a major feline acute-phase protein (APP), in a population of critically ill cats with SIRS related to trauma or sepsis. A total of 56 SIRS cats (trauma n = 27; sepsis n = 29) were included and compared with healthy controls (n = 18). SAA concentration was significantly increased in SIRS cats compared to controls, confirming its potential for the detection of systemic inflammation in this species. Significantly higher values of SAA were detected in cats belonging to the sepsis group; however, according to the results of the receiver operating characteristic curve analysis, the value of using SAA (>81 mg/L) to discriminate septic cats was only moderate (AUC = 0.76). Additionally, cats with sepsis had significantly higher serum bilirubin concentrations and toxic neutrophil changes compared to the trauma group. Overall, 38 of 56 cats were survivors; 18 of 56 were non-survivors, with 83% of the non-survivors (15 of 18) belonging to the sepsis group. Serum bilirubin concentration, but not SAA, was able to predict outcome. Prospective studies are needed to assess the potential of SAA in the diagnosis of feline sepsis and outcome prediction

Early orthopaedic symptoms in a dog with systemic aspergillosis

Del Magno S., Gruarin M., Foglia A., Agnoli C., Dondi F., Pisoni L. EARLY ORTHOPAEDIC SYMPTOMS IN A DOG WITH SYSTEMIC ASPERGILLOSIS Introduction Systemic aspergillosis is a rare disease in dogs. The unusual orthopaedic presentation in this case report could be helpful in the timely diagnosis of the pathology. Case description A female, 1.5 years old, mixed-breed dog, was presented for lameness in the left hindlimb. A periosteal proliferation was present on radiographs on the left ileal wing and gluteal enthesistis was suspected. After therapy with NSAID the clinical condition worsened with generalized enlargement of the lymph nodes, azotemia and pyelonephritis. Fungal hyphae were detected in the urine and in the lymph nodes. MRI of the pelvis reveals a severe lesion involving muscle and the bone of the left ileal wing, resulting in osteolysis. Surgical biopsy demonstrated a mycotic myositis and osteomyelitis. Culture from urine and lymph nodes were indicative of infection by Aspergillus spp, group Aspergillus terreus. The antymycogram showed sensibility to itraconazole, voriconazole and amphotericin B. Itraconazole (10 mg/kg 24q) was started and the clinical situation improved. After 1 month the dog had evidence of discospondylitis of L1-L2 and a worsening of the dilatation of the renal pelvis and of the ureters. The dosage of the itraconazole was elevated to 7 mg/kg 12q. After 16 months the dog was euthanized because of severe osteomyelitis of the left femur .The necropsy confirmed the mycotic osteomyelitis of the left ileal wing, of the femur, discospondylitis and pyelonephritis. Discussion Systemic mycosis usually are promoted by immunosuppression and the route of entrance for Aspergillus are believed to be either pulmonary or gastroenteric. In the case reported the dog did not have any demonstrated predisposing factor to immunosuppression. A primary local infection of the iliac wing is not probable because no surgery or wound was detected. Systemic infection by Aspergillus has major incidence in young female German Sheperd dogs and the dog of the present case was may have been related to this breed. MRI was performed because in humans it is considered one of the best advanced diagnostic imaging techniques at detecting the soft tissue involvement in mycotic osteomyelitis. The surgical curettage of mycotic osteomyelitis was not performed because of the generalized nature of the infection, and only a biopsy was performed surgically in the iliac region. The sensibility shown in vitro by the fungus to itraconazole, was not sufficient in vivo, even at high dosage, to eliminate the infection. Other drugs like voriconzole were not used because of the relatively high costs, while amphotericin B was considered risky in such an azotemic patient. Nevertheless the survival of the dog was of 16 months from diagnosis and can be considered satisfactory in comparison to the outcome reported in literature

Urine neutrophil gelatinase-associated lipocalin to diagnose and characterize acute kidney injury in dogs

Background Urine neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker of acute kidney injury (AKI) in dogs. Objectives To evaluate the utility of urinary NGAL for characterizing AKI according to volume responsiveness, presence of inflammation and sepsis, and prognosis. Animals Dogs with AKI (n = 76) and healthy controls (n = 10). Methods Prospective study. Clinical and clinicopathologic data including absolute urine NGAL concentration (uNGAL) and NGAL normalized to urine creatinine concentration (uNGALC) were measured upon admission. Dogs were graded according to International Renal Interest Society (IRIS) AKI guidelines and compared based on AKI features: volume-responsive (VR-) AKI vs. intrinsic (I-) AKI based on IRIS criteria; VR-AKI and I-AKI based on urine chemistry; inflammatory versus noninflammatory; septic versus nonseptic; and survivors versus nonsurvivors. Nonparametric statistics were calculated, and significance set at P < .05. Results Urinary NGAL was significantly higher in dogs with AKI compared to controls, regardless of AKI grade. Urinary NGAL did not differ between dogs with VR-AKI and I-AKI based on IRIS criteria, whereas higher uNGALC was recorded in dogs with I-AKI based on urine chemistry. Urinary NGAL was significantly higher in dogs with inflammatory AKI, whereas no difference with respect to sepsis or outcome was identified. Conclusions and Clinical Importance Urinary NGAL is a sensitive marker for AKI in dogs, but its specificity is affected by systemic inflammation. Increased urinary NGAL in both I-AKI and VR-AKI also suggests the presence of tubular damage in transient AKI. Combining urine chemistry data with IRIS criteria could facilitate AKI characterization in dogs