Audrey K. Cook

Clinical and pathological features of protein-losing glomerular disease in the dog: a review of 137 cases (1985-1992).

Medical records of 137 dogs with protein-losing glomerular disease (PLGD) were evaluated. Cases with amyloidosis (23%) were more likely to be azotemic at presentation, with significantly greater proteinuria and hypoalbuminemia than those cases with glomerulonephritis (GN; 77%). The prognosis for all cases was poor, with a median survival time of just 28 days. The most common causes of death in cases with idiopathic disease were chronic renal failure (69.5%) or thromboembolic complications (22.2%). Progression of glomerular disease was unpredictable, with no apparent correlation between survival time and biochemical parameters at presentation.

AAHA Diabetes Management Guidelines for Dogs and Cats

Diabetes mellitus (DM) is a treatable condition that requires a committed effort by veterinarian and client. This document provides current recommendations for the treatment of diabetes in dogs and cats. Treatment of DM is a combination of art and science, due in part to the many factors that affect the diabetic state and the animal’s response. Each animal needs individualized, frequent reassessment, and treatment may be modified based on response. In both dogs and cats, DM is caused by loss or dysfunction of pancreatic beta cells. In the dog, beta cell loss tends to be rapid and progressive, and it is usually due to immune-mediated destruction, vacuolar degeneration, or pancreatitis.1 Intact females may be transiently diabetic due to the insulin-resistant effects of the diestrus phase. In the cat, loss or dysfunction of beta cells is the result of insulin resistance, islet amyloidosis, or chronic lymphoplasmacytic pancreatitis.2 Risk factors for both dogs and cats include insulin resistance caused by obesity, other diseases (e.g., acromegaly in cats, hyperadrenocorticism in dogs), or medications (e.g., steroids, progestins). Genetics is a suspected risk factor, and certain breeds of dogs (Australian terriers, beagles, Samoyeds, keeshonden3) and cats (Burmese4) are more susceptible. Regardless of the underlying etiology, diabetic dogs and cats are hyperglycemic and glycosuric, which leads to the classic clinical signs of polyuria, polydipsia (PU/PD), polyphagia, and weight loss. Increased fat mobilization leads to hepatic lipidosis, hepatomegaly, hypercholesterolemia, hypertriglyceridemia, and increased catabolism. Eventually, hyperketonemia, ketonuria, and ketoacidosis develop and result in progressive compromise of the animal.

The prevalence of hypocobalaminaemia in cats with spontaneous hyperthyroidism.

OBJECTIVES To determine the prevalence of hypocobalaminaemia in cats with moderate to severe hyperthyroidism and to investigate the relationship between cobalamin status and selected haematologic parameters. METHODS Serum cobalamin concentrations were measured in 76 spontaneously hyperthyroid cats [serum thyroxine (T(4) ) concentration ≥100 nmol/L] and 100 geriatric euthyroid cats. Erythrocyte and neutrophil counts in hyperthyroid cats with hypocobalaminaemia were compared with those in hyperthyroid cats with adequate serum cobalamin concentrations (≥290 ng/L). RESULTS The median cobalamin concentration in hyperthyroid cats was lower than the control group (409 versus 672 ng/L; P=0·0040). In addition, 40·8% of hyperthyroid cats had subnormal serum cobalamin concentrations compared with 25% of controls (P=0·0336). Weak negative correlation (coefficient: -0·3281) was demonstrated between serum cobalamin and T(4) concentrations in the hyperthyroid population, and the median cobalamin concentration was lower in cats with T(4) above the median of 153 nmol/L compared with cats with T(4) below this value (P=0·0281). Hypocobalaminaemia was not associated with neutropenia or anaemia in hyperthyroid cats. CLINICAL SIGNIFICANCE This study indicates that a substantial proportion of cats with T(4) ≥100 nmol/L are hypocobalaminaemic and suggests that hyperthyroidism directly or indirectly affects cobalamin uptake, excretion or utilisation in this species.

Evaluation of the use of baseline cortisol concentration as a monitoring tool for dogs receiving trilostane as a treatment for hyperadrenocorticism

OBJECTIVE To determine whether a single measurement of cortisol concentration can be used to monitor dogs receiving trilostane for hyperadrenocorticism. DESIGN Controlled drug efficacy trial. ANIMALS 103 client-owned dogs. PROCEDURES Results of ACTH stimulation tests before and during trilostane treatment were evaluated. Each cortisol concentration after ACTH stimulation was classified as indicative of excessive, acceptable, or inadequate control of adrenal gland function, as outlined by the trilostane manufacturer. Baseline cortisol concentrations before and during trilostane treatment were evaluated; target variables were defined, and sensitivity, specificity, and predictive values were determined. RESULTS Results of 103 and 342 ACTH stimulation tests before and during treatment were evaluated. In this population, baseline cortisol concentrations ≥ 1.3 µg/dL accurately excluded excessive suppression (defined by cortisol concentration after ACTH stimulation < 1.5 µg/dL) in 254 of 259 (98%) dogs. In addition, baseline cortisol concentrations ≤ 2.9 µg/dL correctly excluded inadequate control (defined by cortisol concentration after ACTH stimulation > 9.1 µg/dL) in 200 of 211 (95%) dogs. During trilostane treatment, baseline cortisol concentrations between 1.3 and either 2.9 µg/dL or ≤ 50% of the pretreatment baseline cortisol concentration correctly predicted acceptable control of adrenal gland function in 147 of 168 (88%) dogs. CONCLUSIONS AND CLINICAL RELEVANCE Evaluation of a baseline cortisol concentration collected 4 to 6 hours after trilostane administration in dogs with hyperadrenocorticism provided clinically useful information about control of adrenal gland function. Many dogs receiving trilostane may be adequately monitored without the expense and inconvenience of an ACTH stimulation test.

Clinical findings in dogs with incidental adrenal gland lesions determined by ultrasonography: 151 cases (2007-2010)

OBJECTIVE To determine the prevalence of and clinical features associated with incidental adrenal gland lesions (IAGLs) discovered during abdominal ultrasonography in dogs. DESIGN Retrospective case series. ANIMALS 151 dogs with an IAGL and 400 control dogs. PROCEDURES Reports of ultrasonographic examinations of the abdomen of dogs performed during a 3.5-year period were reviewed. Adrenal glands were classified as having an IAGL if a nodule or mass was described or the width of either gland was ≥ 10 mm. For dogs with an IAGL, information regarding signalment, concurrent disorders, and outcome was obtained from the medical record. Findings were compared with those in a control population of 400 dogs examined during the same period. RESULTS An IAGL was detected in 151 of 3,748 (4%) dogs. Dogs with an IAGL were significantly older (median age, 11.25 years) and heavier (median body weight, 21 kg [46.2 lb]) than the control population (median age, 9.5 years; median body weight, 14 kg [30.8 lb]). Malignant tumors were reported in 6 of 20 (30%) dogs that underwent adrenal glandectomy or necropsy and had a maximum IAGL dimension that ranged from 20 to 46 mm; benign lesions all had a maximum dimension < 20 mm. Various coincidental conditions were reported in dogs with an IAGL, including nonadrenal gland malignant neoplasia in 43 (28.5%) dogs. CONCLUSIONS AND CLINICAL RELEVANCE IAGLs were more likely in dogs ≥ 9 years of age. On the basis of this small data set, malignancy should be suspected for IAGLs ≥ 20 mm in maximum dimension.

Prevalence and prognostic impact of hypocobalaminemia in dogs with lymphoma

OBJECTIVE To determine the prevalence of hypocobalaminemia in dogs with multicentric lymphoma and to investigate any relationship between serum cobalamin concentration and disease outcome. DESIGN Cohort study. ANIMALS 58 dogs with multicentric lymphoma. PROCEDURES Serum cobalamin concentrations were measured in 58 dogs with multicentric lymphoma. Clinical signs, stage, and immunophenotype for dogs with hypocobalaminemia were compared with those for dogs with serum cobalamin concentrations above the lower end of the reference range. Survival times for dogs undergoing a cyclic multidrug chemotherapy protocol (n = 53) were similarly compared. Serum cobalamin concentrations for treated dogs that died or were euthanized before day 60 were compared with those of dogs still alive at day 60. RESULTS Serum cobalamin concentrations ranged from < 150 to 1,813 ng/L, with a median concentration of 401 ng/L. Nine of the 58 (16%) dogs had hypocobalaminemia (serum cobalamin concentration < 252 ng/L). Three of 9 dogs with hypocobalaminemia survived to at least day 60, compared with 40 of 44 (91%) dogs without hypocobalaminemia (serum cobalamin concentration >or= 252 ng/L). Ten (10/53 [19%]) dogs undergoing a cyclic multidrug chemotherapy protocol died before day 60, and the median serum cobalamin concentration for these dogs (232 ng/L) was significantly lower than for those still alive at the end point of the study (556 ng/L). CONCLUSIONS AND CLINICAL RELEVANCE Hypocobalaminemia was relatively uncommon in this population of dogs with multicentric lymphoma, but was associated with a poor outcome. Serum cobalamin concentrations may provide prognostic information in dogs with multicentric lymphoma.

Likelihood and outcome of esophageal perforation secondary to esophageal foreign body in dogs

OBJECTIVE To determine the likelihood and outcome of esophageal perforation secondary to an esophageal foreign body (EFB) in dogs. DESIGN Retrospective observational study. ANIMALS 125 dogs evaluated for EFB at 2 veterinary teaching hospitals from January 2005 through December 2013. PROCEDURES Data were retrieved from the medical record of each dog regarding variables hypothesized to be associated with esophageal perforation, whether esophageal perforation was present, and survival to hospital discharge. Variables were examined for associations with various outcomes. RESULTS Bones (55/125 [44%]) and fishhooks (37/125 [30%]) were the most common types of EFBs. Fifteen (12%) dogs had an esophageal perforation (10 with a fishhook EFB and 5 with a bone EFB). No association was identified between dog body weight and esophageal perforation. Esophageal perforation was more likely in dogs with a fishhook EFB (10/37 [27%]) versus other EFBs (5/88 [6%]; OR, 6.1; 95% confidence interval, 1.9 to 9.6). Median interval from fishhook or bone ingestion to initial evaluation was significantly longer for dogs with (12 and 96 hours, respectively) versus without (1 and 24 hours, respectively) perforation. Thirteen of 15 (87%) dogs with esophageal perforation survived to hospital discharge, including all 10 dogs with perforation secondary to fishhook ingestion. Eight survivors with esophageal perforation required no surgical intervention. CONCLUSIONS AND CLINICAL RELEVANCE Esophageal perforation was uncommon in the evaluated dogs with an EFB, and no surgical intervention was required for a large proportion of them. Fishhooks and delay between EFB ingestion and initial evaluation were risk factors for perforation.