Linda A. Ross

Guidelines for the Identification, Evaluation, and Management of Systemic Hypertension in Dogs and Cats

Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide veterinarians with guidelines regarding the pathophysiology, diagnosis, or treatment of animal diseases. The foundation of the Consensus Statement is evidence-based medicine, but if such evidence is conflicting or lacking, the panel provides interpretive recommendations on the basis of their collective expertise. The Consensus Statement is intended to be a guide for veterinarians, but it is not a statement of standard of care or a substitute for clinical judgment. Topics of statements and panel members to draft the statements are selected by the Board of Regents with input from the general membership. A draft prepared and input from Diplomates is solicited at the ACVIM Forum and via the ACVIM Web site and incorporated in a final version. This Consensus Statement was approved by the Board of Regents of the ACVIM before publication.

Acute Kidney Injury in Dogs and Cats

The term acute kidney injury (AKI) has replaced the historical term acute renal failure for renal damage occurring over a short period of time (hours to days) because it is thought to better describe the pathophysiologic changes and duration of the different phases of injury. There are many potential causes of AKI in dogs and cats, and the prognosis has been shown to vary with the cause as well as with therapy. This article reviews current concepts of the pathophysiology, causes, clinical presentation, approach to diagnosis, and medical management of AKI in dogs and cats.

Plasma disappearance of creatinine as a renal function test in the dog

The serum concentration of creatinine at 120 minutes (SC120) after intravenous injection of 88 mg kg-1 of creatinine, the plasma half-life (t1/2) and the plasma clearance of creatinine (PCC) were evaluated as renal function tests in 30 healthy adult dogs and six adult dogs with known or suspected renal disease. The mean SC120 in the normal dog was 0.31 +/- 0.08 mmol litre-1 and in the clinical cases 0.71 +/- 0.19 mmol litre-1. The correlation coefficients between SC120 and renal creatinine clearance (RCC) for the normal dogs and the clinical cases were -0.76 and -0.69, respectively. At 120 minutes after injection, 95 per cent of normal dogs would be predicted to have a serum creatinine concentration below 0.46 mmol litre-1. The mean plasma t1/2 of creatinine for the normal dogs was 107.7 +/- 17.96 minutes, while the clinical cases had a wide range of values (148.8 to 620.1 minutes). Plasma t1/2 of creatinine was correlated with RCC for both the normal dogs and the clinical cases (r = -0.55, r = -0.91, respectively). The mean PCC for the normal dogs was 7.42 +/- 2.22 ml min-1 kg-1 (range 4.95 to 13.28 ml min-1 kg-1). There was a good correlation between RCC and PCC (r = 0.7). The PCC for the clinical cases ranged from 0.76 to 3.37 ml min-1 kg-1. The correlation between RCC and PCC was significant (r = 0.91). Thus SC120, t1/2 and PCC may be useful methods of assessing renal function in dogs with renal impairment insufficient to cause azotaemia.

The Prevalence of Leptospiral Antibodies in Free Roaming Cats in Worcester County, Massachusetts

BACKGROUND Serosurveys of cats for exposure to or infection with leptospires have been published from other geographic areas, but none for cats in the United States in the past 4 decades. HYPOTHESIS/OBJECTIVES The purpose of this pilot study was to determine the prevalence of leptospiral antibodies in a population of free roaming cats in Worcester County, (central) Massachusetts. ANIMALS Sixty-three free roaming cats presenting to a trap-neuter-return (TNR) program. METHODS Prospective study. Serum was collected from 63 free roaming cats presented to a university associated TNR. Microagglutination titers to Leptospira interrogans serovars Autumnalis, Hardjo, Bratislava, Icterohaemorrhagiae, Canicola, Pomona, and L kirshneri Grippotyphosa were determined. RESULTS A total of 3 of 63 cats (4.8%) had a titer of 1 : 100 or greater to one or more serovars, with Autumnalis being the most common. None of the cats were seropositive to Hardjo, Grippotyphosa, or Canicola. CONCLUSIONS AND CLINICAL IMPORTANCE These results are consistent with previously published seroprevalence rates in feral cats. Additional studies are required to determine the role of leptosporosis in clinical disease in the domestic cat.

Fluid therapy for acute and chronic renal failure.

Animals with renal failure have a number of fairly predictable metabolic abnormalities. They are commonly presented to the veterinarian in a state of negative water balance, although prior fluid therapy in an oliguric patient may result in overhydration. Animals with oliguric ARF have sodium retention; those with polyuric ARF have increased urinary sodium loss. Chronic renal failure does not necessarily affect the ability of the renal tubule to conserve or excrete sodium, although the response to changes in sodium load is much slower than in the normal animal. Potassium retention occurs in oliguric ARF and potassium wasting in polyuric ARF; potassium balance is approximately normal in animals with CRF. Both ARF and CRF cause metabolic acidosis, although the acid-base status in a given animal will be affected by respiratory compensation, as well as other problems such as vomiting. Calcium levels are usually normal to slightly decreased in renal failure, whereas phosphorus levels are generally increased. The basic principles of fluid therapy should be used when constructing a plan for such therapy in an animal with renal failure. Intravenous administration of fluids is almost always necessary. The choice of the type of fluid, solutes, and electrolytes to be administered is based on the predicted abnormalities associated with renal failure as well as the laboratory abnormalities in the animal. Careful monitoring of the patient and periodic assessment of various laboratory parameters are necessary in order to make appropriate adjustments in fluid therapy.

Current techniques in peritoneal dialysis

OBJECTIVE To provide a current overview of the technique of peritoneal dialysis in dogs and cats. CLINICAL IMPLICATION Peritoneal dialysis is the process by which water and solutes move between blood in the peritoneal capillaries and fluid (dialysate) instilled into the peritoneal cavity, across the semipermeable membrane of the peritoneum. The primary indication for peritoneal dialysis (PD) in animals is for treatment of renal failure to correct water, solute, and acid-base abnormalities and to remove uremic toxins. SUMMARY Peritoneal dialysis is a modality of renal replacement therapy commonly used in human medicine for the treatment of chronic kidney disease and end-stage kidney failure. Peritoneal dialysis utilizes the peritoneum as a membrane across which fluids and uremic solutes are exchanged. Dialysate is instilled into the peritoneal cavity and, through the process of diffusion and osmosis, water, toxins, electrolytes, and other small molecules are allowed to equilibrate.Objective To provide a current overview of the technique of peritoneal dialysis in dogs and cats. Clinical Implication Peritoneal dialysis is the process by which water and solutes move between blood in the peritoneal capillaries and fluid (dialysate) instilled into the peritoneal cavity, across the semipermeable membrane of the peritoneum. The primary indication for peritoneal dialysis (PD) in animals is for treatment of renal failure to correct water, solute, and acid-base abnormalities and to remove uremic toxins. Summary Peritoneal dialysis is a modality of renal replacement therapy commonly used in human medicine for the treatment of chronic kidney disease and end-stage kidney failure. Peritoneal dialysis utilizes the peritoneum as a membrane across which fluids and uremic solutes are exchanged. Dialysate is instilled into the peritoneal cavity and, through the process of diffusion and osmosis, water, toxins, electrolytes, and other small molecules are allowed to equilibrate.

Estimation of glomerular filtration rate in dogs by plasma clearance of gadolinium diethylenetriamine pentaacetic acid as measured by use of an ELISA.

OBJECTIVE-To evaluate use of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) to estimate glomerular filtration rate (GFR) by plasma clearance and use of an ELISA as the method of Gd-DTPA quantification. ANIMALS-16 dogs of various sexes and breeds (12 dogs were clinically normal, and 4 dogs were polyuric and polydipsic with no other clinical or biochemical abnormalities). PROCEDURES-GFR was estimated by measuring the plasma clearance of Gd-DTPA and iohexol by use of an ELISA and high-performance liquid chromatography (HPLC), respectively. The GFR was determined by use of a 1-compartment model for both methods. The GFRs obtained by Gd-DTPA plasma clearance were compared with those obtained by iohexol plasma clearance by use of correlation analysis, paired t tests, and limits of agreement analysis. A paired t test was used to evaluate differences between the 2 plasma clearance methods. RESULTS-A strong linear correlation (r(2) = 0.90) was found between GFRs derived from the plasma clearance of Gd-DTPA and those derived from the plasma clearance of iohexol. By use of limits of agreement analysis, almost all (13/14) dogs had Gd-DTPA GFRs that were within 12% of iohexol GFRs. The remaining dog had a Gd-DTPA GFR that was 45% higher than the iohexol GFR. There was no significant difference between Gd-DTPA GFRs and those obtained with iohexol. CONCLUSIONS AND CLINICAL RELEVANCE-This study revealed that plasma clearance of Gd-DTPA measured by use of an ELISA is an effective method to estimate GFR in dogs because it compared favorably with results for the iohexol-HPLC method.

Hemolytic anemia after ingestion of the natural hair dye Lawsonia inermis (henna) in a dog.

Objectives To describe the clinical presentation and case management of a dog that developed hemolytic anemia and evidence of renal tubular dysfunction after ingestion of a natural hair dye containing Lawsonia inermis (henna). To review cases of henna toxicity reported in the human literature. Case Summary An 8-year-old female spayed Border Collie was presented 5 days after ingestion of a box of natural hair dye. The dog was showing signs of lethargy, vomiting, diarrhea, and weakness. A serum biochemistry profile, complete blood count, and urinalysis demonstrated evidence of renal tubular dysfunction and a regenerative anemia without spherocytosis. The dog was treated with a transfusion of packed RBCs and IV fluids, resulting in significant clinical improvement. Repeat diagnostics showed resolution of the anemia and no lasting evidence of tubular dysfunction. New or Unique Information Provided To the authors’ knowledge, this is the first reported case in the veterinary literature of toxicity following ingestion of Lawsonia inermis (henna). Henna ingestion was associated with the development of hemolytic anemia and acute kidney injury.

Gastroduodenal Ulceration in Small Animals: Part 2. Proton Pump Inhibitors and Histamine-2 Receptor Antagonists

In the first part of this review, we discussed the pathophysiology and epidemiology of gastric acid secretion and the epidemiology of gastroduodenal ulceration in dogs and cats. In this section, we discuss the pharmacology and evidence-based clinical use of histamine-2 receptor antagonists and proton pump inhibitors.

Gastroduodenal Ulceration in Small Animals: Part 1. Pathophysiology and Epidemiology

Gastroduodenal ulceration in small animals is a complex and important comorbidity that occurs when the physiological homeostasis of the gastrointestinal tract is disrupted secondary to administration of medications or the presence of local or systemic diseases. The aim of this article is to provide a comprehensive review of the veterinary literature regarding the pathophysiology, epidemiology, and risk factors associated with gastroduodenal ulceration in small animals. Pertinent concepts from the human literature will be integrated into the discussion. This article serves as an introduction to the second part of this series, which will review current evidence regarding the use of H2-receptor antagonists and proton pump inhibitors in small animals.