Borrelli, Antonio

Bruno, Barbara

Citi, Simonetta

Giannoni, Elena

Guidi, Grazia

Lippi, Ilaria

Perondi, Francesca

Although the International Renal Interest Society (IRIS) bases on serum creatinine to stage dogs with chronic kidney disease (CKD), renal ultrasound plays a fundamental role in the diagnostic and prognostic evaluation of dogs with CKD. In human medicine, a significant correlation between the degree of kidney dysfunction and renal ultrasound abnormalities was documented. The aims of the present study were 1) to retrospectively assess the  most frequent  renal  ultrasound  abnormalities  for  each  IRIS  stage  of  CKD, and 2) to evaluate correlation of ultrasound abnormalities with progression of CKD. We retrospectively included 865  dogs  (January  2010  to  December  2016)  with  diagnosis  of  CKD  at  different  IRIS  stage, which presented an abdominal ultrasound evaluation within 15 days from biochemistry panel. Dogs with diagnosis of acute kidney injury (AKI) or CKD dogs with no ultrasound examination or with an ultrasound examination over 15 days from biochemistry panel were excluded from the study. Dogs in IRIS stage 1 of CKD were excluded from the study, due to the low number of cases. The following ultrasound parameters were considered: renal profile, cortico-medullary  junction,  cortico-medullary  ratio,  echogenicity  of  the  cortex,  echogenicity  of  the medulla,  echotexture,  presence  of  cysts,  mineralization,  infarcts,  pelvic  dilation,  peri-renal effusion.  337  dogs  (39%)  were  in  IRIS  stage  2,  295  (34%)  were  in  IRIS  stage  3  and  233 (27%)  dogs were in  IRIS stage 4. The  most common renal ultrasound abnormalities were related to cortical echogenicity, cortico-medullary junction and dilatation of the pelvis. With the worsening of the IRIS  stage,  the  number  of  ultrasound  alterations statistically increased (p&lt;0.0001). According to the IRIS stage, a statistically significant difference was found in the percentage of dogs presenting  alterations of the renal profile  (p=0.0185),  cortical  medullary junction  (p=0.0035),  cortical  medullary  ratio  (p=0.0049),  cortical  echogenicity  (p&lt;0.0001), 
medullary  echogenicity  (p=0.0018),  echostructure  (p=0.0030)  and pelvic  dilation  (p=0.0018). 
No correlation between elevated Ca  X  P product  (&gt;60  mg2/dl2) and presence of kidney mineralization was found. The  percentage  of  dogs  presenting  kidney  mineralization  was  not statistically different among the different IRIS groups.  Despite association between elevation in Ca x P product and mortality has been demonstrated  in  CKD  dogs,  in  our  cohort  of  dogs  elevated  Ca  x  P  product  was  not associated  with  increased  risk  of  kidney  mineralization. Although  the  number  of  renal ultrasound abnormalities increases with the progression of CKD, ultrasound abnormalities  do not seem to be helpful for the clinician to discriminate the severity of CKD

Ultrasonographic alterations in dogs at different stage of CKD

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