Assisted feeding through an oesophagostomy tube in patients with chronic kidney disease and uraemic syndrome: impact on body condition score, renal function and survival

La dietoterapia rappresenta il primo strumento terapeutico nel paziente in presenza di danno renale acuto e malattia renale cronica. Tuttavia la maggior parte di tali pazienti non è in grado di alimentarsi volontariamente e nel quantitativo adeguato ai propri fabbisogni. Obiettivo del presente studio è di valutare BCS, parametri di funzionalità renale e sopravvivenza in pazienti in crisi uremica sottoposti o meno ad alimentazione assistita. Lo studio è stato condotto su quattordici cani con pregressa CKD e in fase di riacutizzazione o scompenso. Sette pazienti sono stati gestiti mediante impiego di feeding tube (FT), 7 mediante terapia medica tradizionale (GC). Per ciascuno dei due gruppi, BCS, creatinina, urea, e fosforo sierici e sopravvivenza, sono stati valutati a T0 e ad uno (T1) e due mesi (T2). I dati sono stati elaborati statisticamente. Il GC presentava una differenza significativa di BCS (p=0,04), creatinina (p=0,001), urea (p=0,005) e fosforo (p=0,04) a diversi controlli. Il FT presentava una differenza significativa di BCS (p=0,03), valori sierici di creatinina (p=0,006), urea (p=0,0001) e fosforo (p=0,02) ai diversi controlli. Il FT mostrava una sopravvivenza alla crisi uremica maggiore (p=0,01) del GC. Le evidenze del presente studio riportano un significativo miglioramento di BCS, parametri di funzionalità renale e sopravvivenza nei pazienti gestiti con feeding rispetto agli altri. Il feeding tube sembra rappresentare un ausilio terapeutico estremamente utile nella gestione medica del paziente in crisi uremica.Introduction – A renal diet is a fundamental part of the medical management of patients with acute and chronic kidney disease. Unfortunately, most patients are not able to eat a sufficient amount of a renal diet to achieve an adequate calorie intake. The aim of this study was to evaluate the Body Condition Score (BCS), renal function and survival rate in a group of uraemic patients managed with a feeding tube and compare the findings with those in a comparable group managed without a feeding tube. Materials and Methods – Fourteen dogs with acute-on-chronic kidney disease formed the study population. Seven dogs were managed with the use of a feeding tube (FT group) and seven were managed without a feeding tube (control group). BCS, serum creatinine, urea and phosphate concentrations and survival rate were evaluated in both groups at time 0 (T0), after 1 month (T1) and after 2 months (T2). Data were analysed statistically. Results – There were significant differences in BCS (p=0.04), creatinine (p=0.001), urea (p=0,005) phosphate (p=0.04) at the different time points in the control group. The FT group also had significant difference in BCS (p=0.03), creatinine (p=0.006), urea (p=0.0001) and phosphate (p=0.02) at the different time points. The survival rate was higher in the FT group than in the control group (p=0.01). Discussion – The results of the present study show significant improvements in BCS, renal function and survival in patients managed with a feeding tube, compared to those in which a feeding tube was not used. A feeding tube seems to be a very useful therapeutic instrument for the management of patients with uraemic syndrome

Evaluation of urinary γ-glutamyl transferase and serum creatinine in non-azotaemic hospitalised dogs

Urinary and blood biomarkers for diagnosis of acute kidney injury (AKI) in hospitalised dogs were evalueted. This prospective study included 97 dogs, classified according to the International Renal Interest Society classification into no AKI and AKI grade 1 (48-hour increase in serum creatinine≥0.3 mg/dl and/or urinary production <1 ml/kg/hour for at least six hours). A total of 62 of 97 dogs (64 per cent) were classified as AKI 1. A statistically significant difference was found between no AKI and AKI 1 in urine protein to creatinine ratio, urinary γ-glutamyl transferase (uGGT) and uGGT/cu (P<0.0001). Thirteen of 97 dogs (13.4 per cent) that developed increased creatinine and change in AKI grade showed high mortality (n=9/13; 69.2 per cent). The receiver operating characteristic (ROC) curve analysis of uGGT/cu index as a marker for AKI grade 1 had an area under the ROC curve of 0.78; optimal cut-off point was 57.50 u/g, with sensitivity and specificity of 75.4 per cent and 75.6 per cent, respectively. Overall intensive care unit mortality was 23.7 per cent (23/97), 13.4 per cent (13/97) of which died during hospitalisation and 10.3 per cent (10/97) within 28 days after discharge. uGGT is an acceptable marker for distinguishing between AKI 1 and no AKI

Evaluation of a prognostic scoring system for dogs managed with hemodialysis

Objective: To investigate prognostic models in a cohort of dogs with acute kidney injury (AKI) and acute on chronic kidney disease (AKI/CKD) managed by hemodialysis. Design: Retrospective study from July 2011 to November 2014. Setting: University Veterinary Teaching Hospital. Animals: Forty dogs with historical, clinical, imaging, and laboratory findings consistent with AKI or AKI/CKD managed with intermittent hemodialysis were included. Interventions: Scoring system models previously established by Segev et al for outcome prediction in dogs with AKI were applied to all dogs. Results: Models A, B, and C correctly classified outcomes in 68%, 83%, and 85% of cases, respectively. In our cohort Model A showed sensitivity of 58% and specificity of 86%, Model B showed sensitivity of 79% and specificity of 87%, Model C showed sensitivity of 86% and specificity of 84%. The presence of anuria (P < 0.0002), respiratory complications (P < 0.0001), disseminated intravascular coagulation (DIC) (P = 0.0004), grade of AKI (P = 0.0023), pancreatitis (P = 0.0001), and systemic inflammatory response syndrome (SIRS) (P = 0.0001) was significantly higher in nonsurvivors compared with survivors. Conclusions: In our cohort of patients, Segev's model C showed the best sensitivity and specificity for predicting prognosis, while model A had lower sensitivity. In our cohort of dialysis patients, the presence of respiratory complications, DIC, SIRS, and pancreatitis at hospitalization, were correlated with a poor prognosis

Clinical utility of urine kidney injury molecule-1 (KIM-1) and gamma-glutamyl transferase (GGT) in the diagnosis of canine acute kidney injury

The aim of the present study was to evaluate the sensitivity and specificity of urine KIM-1 and urine GGT for the detection of naturally-occurring AKI, compared to healthy control dogs, dogs with stable chronic kidney disease (CKD), and dogs with lower urinary tract disorders (LUTD). The study included AKI grade 1 (n = 21), AKI grade 2 to 5 (n = 11), stable CKD (n = 11), LUTD (n = 15), and healthy dogs (n = 37). Urine KIM-1 (ng/mg) and GGT (U/l) were normalized to urine creatinine (uCr). Statistically significant difference in KIM/uCr (p = 0.0007) and GGT/uCr (p < 0.0001) was found among the study groups. Area under the curve (AUC) for KIM-1/uCr and GGT/uCr as predictors of AKI was 0.81 and 0.91 respectively. Values of KIM-1/uCr of 0.73 ng/mg and of GGT/uCr of 54.33 showed the best combination of sensitivity and specificity (75% and 75.6%; 85.7% and 89.1% respectively). A significant positive correlation (p < 0.0001) between KIM-1/uCr and GGT/uCr was found. Both urine KIM-1/uCr and GGT/uCr seemed to be potentially good markers for the diagnosis of AKI. Dogs with AKI showed significantly higher levels of urine KIM-1/uCr and urine GGT/uCr, compared with healthy dogs. Caution should be used in the evaluation of elevated urine KIM-1/uCr and GGT/uCr in dogs with pre-existing CKD and/or LUTD. Urine KIM-1/uCr and GGT/uCr might have a significant clinical utility, as complementary test, particularly in diagnosis early, non-azotemic stages of AKI

Alterations of selected serum biochemical and urinary parameters in dogs with chronic enteropathy

Background: No specific study on concurrent nephropathy has been conducted in dogs with chronic enteropathy (CE), except for soft-coated Wheaten Terriers. Moreover, limited information exists regarding the urinary profile in dogs with CE.Aim: To describe, compare, and discuss the alterations in selected serum biochemical and urinary parameters in dogs with CE.Methods: Multicentric retrospective study on dogs with CE diagnosed after exclusion of extra-gastrointestinal diseases. In addition, dogs with azotemia and lower urinary tract diseases were excluded. Information on canine chronic enteropathy clinical activity index (CCECAI) score, muscular condition score (MCS), presence of glycosuria, proteinuria [urine protein-to-creatinine (UPC) ratio > 0.5], and/or cylindruria (>1–2 casts/hpf) at diagnosis were gleaned from the medical records. Dogs were retrospectively classified as food-responsive enteropathy, immunosuppressant-responsive enteropathy, or nonresponsive enteropathy based on the presence of gastrointestinal histological inflammation and the treatment response. In addition, based on the serum albumin concentration (ALB), dogs were classified as having protein-losing enteropathy (PLE).Results: Ninety CE dogs were included. Fifty-two dogs had mild-to-severely decreased MCS and 38 dogs showed altered urinary parameters. No significant associations were found between CCECAI and altered urinary parameters. No significant association was found between PLE dogs and altered urinary parameters. PLE dogs showed higher prevalence of proteinuria than non-PLE dogs (p = 0.03; OR = 2.8; 95% CI = 1–6.8).Conclusion: Despite the presence of altered urinary profile in dogs with CE, further studies are needed to explore a possible link between gastrointestinal and renal inflammation

Evans syndrome and antibody deficiency: an atypical presentation of chromosome 22q11.2 deletion syndrome

We report a case of an 8-year-old male patient with Evans syndrome and severe hypogammaglobulinemia, subsequently in whom the 22q11.2 deletion syndrome (22q11.2 DS) was diagnosed. No other clinical sign of 22q11.2 DS was present with the exception of slight facial dysmorphism. The case is of particular interest because it suggests the need to research chromosome 22q11.2 deletion in patients who present with autoimmune cytopenia and peculiar facial abnormalities, which could be an atypical presentation of an incomplete form of 22q11.2 DS

Ultrasonographic Diagnosis of Urachal Anomalies in Cats and Dogs: Retrospective Study of 98 Cases (2009–2019)

This retrospective study investigated the prevalence of different urachal anomalies (UA) in cats (n = 60) and dogs (n = 38) and their association with clinical symptoms and urinalysis alterations. Among UA, the vesicourachal diverticulum was the most prevalent UA diagnosed in both cats (96.7%) and dogs (89.5%): the intramural vesicourachal diverticulum was diagnosed in 76.7% of cats and 71.1% of dogs, followed by extramural vesicourachal diverticulum (20.0% and 18.4% respectively). In both cats and dogs, bladder wall diffuse or regional thickening was the most prevalent alteration. The most common alterations of the urinary bladder content were urolithiasis sediment in cats (33.3%) and in dogs (31.6%). Dogs with UA were more often asymptomatic (p = 0.01). No difference was found in cats. Stranguria, hematuria, and urethral obstruction were the most frequently reported clinical signs, while hematuria and leukocyturia were the most prevalent abnormalities at urinalysis. In conclusion, our study confirmed UA as uncommon, and often incidental findings, with a high prevalence of animals without clinical signs