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Veterinary World Jun 2023Humans and dogs with azotemia can develop coagulation disorders. Therefore, this study aimed to evaluate the coagulation profiles and thromboelastographic parameters in...
BACKGROUND AND AIM
Humans and dogs with azotemia can develop coagulation disorders. Therefore, this study aimed to evaluate the coagulation profiles and thromboelastographic parameters in dogs with acute kidney injury (AKI) and chronic kidney disease (CKD).
MATERIALS AND METHODS
In this prospective study, 31 client-owned dogs with renal azotemia (creatinine >220 μmol/L) were enrolled. Clinical signs of hemostatic disorders, complete blood count, coagulation profile, D-dimers, thromboelastography, and 28-day survival data were obtained and analyzed using the t-test, Mann-Whitney U test, and Chi-square test. Statistical significance was set at p < 0.05.
RESULTS
Seventeen dogs with AKI, 10 with CKD, and four with acute-on-chronic kidney injury (AoC) were enrolled. Ten dogs (AKI, 8/17; CKD, 2/10) had thrombocytopenia. Prothrombin time was prolonged in four dogs with AKI and longer in dogs with AKI than in dogs with CKD (p = 0.004). The activated partial thromboplastin time was prolonged in 23 dogs (AKI, 14/17; CKD, 7/10; AoC, 3/4) and was longer in azotemic dogs than in healthy control dogs (p = 0.003). Thromboelastographic tracings were hypocoagulable in three dogs with AKI and hypercoagulable in 16 dogs (AKI 4/17, CKD 9/10, AoC 3/4). The thromboelastographic values for maximum amplitude (p < 0.001) and global clot strength (p < 0.001) were lower in dogs with AKI than in those with CKD.
CONCLUSION
Hypercoagulable thromboelastographic tracings were observed in dogs with CKD, whereas coagulation times were prolonged in dogs with AKI. However these findings should be validated by further studies.
PubMed: 37577193
DOI: 10.14202/vetworld.2023.1214-1221 -
Kidney360 Apr 2022
Topics: Creatinine; Humans; Kidney Tubular Necrosis, Acute; Microscopy
PubMed: 35721608
DOI: 10.34067/KID.0001212022 -
Clinical and Molecular Hepatology Jan 2022Acute kidney injury (AKI) is common in advanced cirrhosis. Prerenal azotemia, hepatorenal syndrome, and acute tubular necrosis are the main causes of AKI in patients... (Review)
Review
Acute kidney injury (AKI) is common in advanced cirrhosis. Prerenal azotemia, hepatorenal syndrome, and acute tubular necrosis are the main causes of AKI in patients with cirrhosis. Evaluation of renal function and differentiation between functional and structural kidney injury are important issues in the management of cirrhosis. However, AKI in cirrhosis exists as a complex clinical spectrum rather than concrete clinical entity. Based on current evidence, changes in serum creatinine (Cr) levels remain the most appropriate standard for defining AKI in cirrhosis. However, serum Cr has a limited role in assessing renal function in this population. This review examines previous studies that investigated the ability of recent biomarkers for AKI in cirrhosis from the perspective of earlier and accurate diagnosis, classification of AKI phenotype, and prediction of clinical outcomes. Serum cystatin C and urine neutrophil gelatinase-associated lipocalin have been extensively studied in cirrhosis, and have facilitated improved diagnosis and prognosis prediction in patients with AKI. In addition, urine N-acetyl-β-D-glucosaminidase, interleukin 18, and kidney injury molecule 1 are other promising biomarkers for advanced cirrhosis. However, the clinical significance of these markers remains unclear because there are no cut-off values defining the normal range and differentiating phenotypes of AKI. In addition, AKI has been defined in terms of serum Cr, and renal biopsy-the gold standard-has not been carried out in most studies. Further discovery of innovate biomarkers and incorporation of various markers could improve the diagnosis and prognosis prediction of AKI, and will translate into meaningful improvements in patient outcomes.
Topics: Acute Kidney Injury; Biomarkers; Creatinine; Female; Humans; Kidney; Liver Cirrhosis; Male
PubMed: 34333958
DOI: 10.3350/cmh.2021.0148 -
Journal of Veterinary Internal Medicine Sep 2022Hyponatremia is common in horses with bacterial pleuropneumonia, but no further characterization of this abnormality has been reported.
BACKGROUND
Hyponatremia is common in horses with bacterial pleuropneumonia, but no further characterization of this abnormality has been reported.
OBJECTIVES
Describe admission plasma sodium concentration ([Na]) in horses with septic pneumopathy and evaluate any association of plasma [Na] with markers of systemic inflammation.
ANIMALS
Medical records of horses >1 month of age that between 2008 and 2021 had a transtracheal aspirate (TTA) performed, abnormal TTA cytology, positive TTA culture, pulmonary disease on ultrasonography, radiography or both, and plasma [Na] assessed by direct ion-selective-electrode (dISE). Horses with concurrent diarrhea or azotemia were excluded.
METHODS
Clinical and clinicopathological variables of interest between hypo- and normonatremic horses were compared. Spearman correlation and Fisher exact tests were used to identify significant associations (P < .05).
RESULTS
Twenty of 35 horses had hyponatremia (median, 132 mmol/L; 25-75th interquartile range [IQR], 129.7-133.1 mmol/L; reference range, 134.2-138.4 mmol/L). A higher proportion of horses with systemic inflammatory response syndrome (SIRS) had hyponatremia (P = .01). Hyponatremic patients had higher mean plasma fibrinogen concentration (461 ± 160.5 mg/dL; P = .01) and higher rectal temperature (38.8 ± 0.7°C; P = .02) than normonatremic horses. Negative correlations were found between plasma [Na] and fibrinogen (P = .001; ρ = -0.57) concentrations and between plasma [Na] and rectal temperature (P = .001; ρ = -0.51). Presence or absence of pleural effusion did not influence severity of hyponatremia. Mean duration of hospitalization was longer (P = .04) in hyponatremic horses (9.8 ± 6.6 days).
CONCLUSIONS AND CLINICAL IMPORTANCE
Hyponatremia at admission is associated with the presence of inflammation, SIRS, and with longer duration of hospitalization.
Topics: Animals; Fibrinogen; Horse Diseases; Horses; Hyponatremia; Inflammation; Lung Diseases; Sodium; Systemic Inflammatory Response Syndrome
PubMed: 36054644
DOI: 10.1111/jvim.16522 -
Journal of Feline Medicine and Surgery Jun 2023The objective of the study was to compare renal functional biomarkers in cats and in caudal stomatitis (CS) and in age-matched control cats.
OBJECTIVES
The objective of the study was to compare renal functional biomarkers in cats and in caudal stomatitis (CS) and in age-matched control cats.
METHODS
A cross-sectional, case-control study was conducted on 44 client-owned cats with CS that were prospectively enrolled and evaluated for a Comprehensive Oral Health Assessment and Treatment at one of four institutions. Renal function was assessed with measurement of serum creatinine, urea nitrogen, serum symmetric dimethylarginine, urinalysis, urine protein:creatinine ratio and urine protein electrophoresis. Affected gingiva was biopsied to confirm the diagnosis of stomatitis. Renal biochemical analyses from the experimental group were compared with those of 44 age-matched controls without CS enrolled prospectively or retrospectively after presenting to the primary institution for routine healthcare. Control cats were included if they were clinically stable, their chronic illnesses were well managed and minimal dental disease was present on examination. Renal biomarkers were compared between groups using a -test or the Mann-Whitney U-test. Frequency of azotemia, proteinuria and the clinical diagnosis of renal disease were compared using Fisher's exact test.
RESULTS
Relative to the control group, cats in the CS group had significantly lower serum creatinine ( <0.001) and albumin concentrations ( <0.001), urine specific gravity ( = 0.024) and hematocrit ( = 0.003), and higher serum phosphorus ( <0.001), potassium ( <0.001) and globulin concentrations ( <0.001), white blood cell count ( <0.001) and urine protein:creatinine ratio ( = 0.009). There were no significant differences in serum symmetric dimethylarginine or urea nitrogen concentrations. No clinically significant findings were noted on urine protein electrophoresis. There were no significant differences in the frequency of azotemia, proteinuria or renal disease categories between the two groups.
CONCLUSIONS AND RELEVANCE
The present study does not demonstrate a significant difference in the frequency of kidney disease between cats with and without CS. Longitudinal evaluation is warranted to investigate the relationship between renal disease and CS.
Topics: Cats; Animals; Azotemia; Creatinine; Retrospective Studies; Case-Control Studies; Cross-Sectional Studies; Kidney; Proteinuria; Acute Kidney Injury; Biomarkers; Urea; Cat Diseases
PubMed: 37350300
DOI: 10.1177/1098612X231179883 -
Scientific Reports Dec 2023To explore whether ferroptosis is involved in focal segmental glomerulosclerosis (FSGS) and its mechanism. The FSGS rat model was constructed by single nephrectomy...
To explore whether ferroptosis is involved in focal segmental glomerulosclerosis (FSGS) and its mechanism. The FSGS rat model was constructed by single nephrectomy combined with fractional tail vein injection of doxorubicin. 24-hour urine protein, serum biochemistry, HE, PAS and Masson pathological staining were measured to assess renal injury. Glomerular and morphological changes of ferroptosis were observed by transmission electron microscopy. Iron content in renal tissue was assessed by Prussian blue staining and iron detection. GSH/GSSG kit was used to detect the content and proportion of reduced/oxidized glutathione. Lipid peroxidation related proteins including MDA expression was assessed by colorimetry. The iron metabolism biomarkers such as hepcidin, ferroportin and TFR, ferroptosis biomarkers such as GPX4, ACSL4, and ferritinophagy biomarkers such as LC3II/LC3I, NCOA4, and FTH1 were detected by Western blot. Significant urinary protein, hyperlipidemia, azotemia, increased serum creatinine and hypoproteinemia were observed in FSGS rats. Histology and electron microscopy showed segmental sclerosis of glomeruli, compensatory enlargement of some glomeruli, occlusion of capillary lumen, balloon adhesion, increased mesangial matrix, atrophy of some tubules, and renal interstitial fibrosis in renal tissue of FSGS rats. The morphology of glomerular foot processes disappeared; the foot processes were extensively fused and some foot processes detached. Mitochondria became smaller, membrane density increased, and mitochondrial cristae decreased or disappeared. In addition, iron deposition was observed in renal tissue of FSGS rats. Compared with the control group, the levels of GSH, GSH/GSSG, GPX4, and ferroportin were reduced and the expression of GSSG, MDA, ACSL4, hepcidin, and TFR was increased in the renal tissue of FSGS rats; meanwhile, the expression of LC3II/LC3I and NCOA4 was increased and the expression of FTH1 was decreased. Ferroptosis is involved in the pathological progression of FSGS, which is probably associated with activation of ferritinophagy. This represents a potential therapeutic target for FSGS.
Topics: Rats; Animals; Glomerulosclerosis, Focal Segmental; Hepcidins; Ferroptosis; Glutathione Disulfide; Biomarkers; Iron
PubMed: 38097813
DOI: 10.1038/s41598-023-49697-8 -
Frontiers in Immunology 2022Patients after kidney transplantation need to take long-term immunosuppressive and other drugs. Some of these drug side effects are easily confused with the symptoms of...
BACKGROUND
Patients after kidney transplantation need to take long-term immunosuppressive and other drugs. Some of these drug side effects are easily confused with the symptoms of Fanconi syndrome, resulting in misdiagnosis and missed diagnosis, and causing serious consequences to patients. Therefore, improving awareness, early diagnosis and treatment of Fanconi syndrome after kidney transplantation is critical.
METHODS
This retrospective study analyzed 1728 cases of allogeneic kidney transplant patients admitted to the Second Xiangya Hospital of Central South University from July 2016 to January 2021. Two patients with Fanconi syndrome secondary to drugs, adefovir dipivoxil (ADV) and tacrolimus, were screened. We summarized the diagnostic process, clinical data, and prognosis.
RESULTS
The onset of Fanconi syndrome secondary to ADV after renal transplantation was insidious, and the condition developed after long-term medication (>10 years). It mainly manifested as bone pain, osteomalacia, and scoliosis in the late stage and was accompanied by obvious proximal renal tubular damage (severe hypophosphatemia, hypokalemia, hypocalcemia, hypouricemia, glycosuria, protein urine, acidosis, etc.) and renal function damage (increased creatinine and azotemia). The pathological findings included mitochondrial swelling and deformity in renal tubular epithelial cells. The above symptoms and signs were relieved after drug withdrawal, but the scoliosis was difficult to rectify. Fanconi syndrome secondary to tacrolimus has a single manifestation, increased creatinine, which can be easily confused with tacrolimus nephrotoxicity. However, it is often ineffective to reduce the dose of tacrolomus, and proximal renal failure can be found in the later stage of disease development. There was no abnormality in the bone metabolism index and imageological examination findings. The creatinine level decreased rapidly, the proximal renal tubule function returned to normal, and no severe electrolyte imbalance or urinary component loss occurred when the immunosuppression was changed from tacrolimus to cyclosporine A.
CONCLUSIONS
For the first time, drug-induced Fanconi syndrome after kidney transplantation was reported. These results confirmed that the long-term use of ADV or tacrolimus after kidney transplantation may have serious consequences, some of which are irreversible. Greater understanding of Fanconi syndrome after kidney transplantation is necessary in order to avoid incorrect and missed diagnosis.
Topics: Allografts; Antiviral Agents; Creatinine; Fanconi Anemia; Fanconi Syndrome; Humans; Kidney Transplantation; Kidney Tubules, Proximal; Renal Insufficiency; Retrospective Studies; Scoliosis; Tacrolimus
PubMed: 36059468
DOI: 10.3389/fimmu.2022.979983 -
Journal of Clinical Medicine Jul 2023The aims of this study were to analyze prevalence and severity of vascular risk factors in older patients referred to our clinic due to onset of Very Late-Onset...
BACKGROUND
The aims of this study were to analyze prevalence and severity of vascular risk factors in older patients referred to our clinic due to onset of Very Late-Onset Schizophrenia-Like Psychosis (VLOSLP) and to create a specific phenotype based on pathophysiological insight rather than age of onset.
METHODS
In a longitudinal study, 103 (M = 39, F = 64; mean age of 80.32 ± 7.65 years) patients were evaluated with cognitive, neuropsychiatric, and functional assessment scales. Blood concentration of hemoglobin (Hb), mean corpuscular volume (MCV), platelets, total protein test (TPT), creatinine, azotemia, glycemia, total cholesterol (TC), triglycerides (TG), uric acid (UA), sodium (Na), potassium (K), chlorine (Cl), calcium (Ca), folate, vitamin B12 (Vit-B12), and homocysteine were measured. Presence/absence of tobacco use, alcohol consumption, psychoactive substance use, hypertension, hyperlipidemia, diabetes mellitus, and history of vascular disease were collected.
RESULTS
Females were more apathetic than males (NPI-Apathy: = 0.040). Males had a significantly higher level of Hb ( = 0.019) and UA ( = 0.001), and a lower level of platelets ( = 0.004) and Ca ( = 0.003), and used more tobacco ( = 0.046) and alcohol ( = 0.024) than females. Comparing patients < 80 and ≥80 years, we found differences in frequency of vascular risk factors among men ( = 0.027). In total, 102 patients were treated for psychosis (59.16% of them were using atypical antipsychotics).
CONCLUSIONS
The results of this study could be useful for a progressive demonstration of the causal relationship between cardiac and cerebral vascular events and VLOSLP.
PubMed: 37510946
DOI: 10.3390/jcm12144831 -
Journal of Veterinary Internal Medicine Sep 2021Radioiodine ( I) is the treatment of choice for hyperthyroidism in cats, but current I-dosing protocols can induce iatrogenic hypothyroidism and expose azotemia.
BACKGROUND
Radioiodine ( I) is the treatment of choice for hyperthyroidism in cats, but current I-dosing protocols can induce iatrogenic hypothyroidism and expose azotemia.
OBJECTIVES
To develop a cat-specific algorithm to calculate the lowest I dose to resolve hyperthyroidism, while minimizing risk of iatrogenic hypothyroidism and subsequent azotemia.
ANIMALS
One thousand and four hundred hyperthyroid cats treated with I.
METHODS
Prospective case series (before-and-after study). All cats had serum concentrations of thyroxine (T ), triiodothyronine (T ), and thyroid-stimulating hormone (TSH) measured (off methimazole ≥1 week). Using thyroid scintigraphy, each cat's thyroid volume and percent uptake of Tc-pertechnatate (TcTU) were determined. An initial I dose was calculated by averaging dose scores for T /T concentrations, thyroid volume, and TcTU; 80% of that composite dose was administered. Twenty-four hours later, percent I uptake was measured, and additional I administered, as needed, to deliver an adequate radiation dose to the thyroid tumor(s). Serum concentrations of T , TSH, and creatinine were determined 6 to 12 months later.
RESULTS
The median calculated I dose was 1.9 mCi (range, 1.0-10.6 mCi); 1380 cats required additional I administration on day 2. Of the cats, 1047 (74.8%) became euthyroid, 57 (4.1%) became overtly hypothyroid, 240 (17.1%) became subclinically hypothyroid, and 56 (4%) remained hyperthyroid. More overtly (71.9%) and subclinically (39.6%) hypothyroid cats developed azotemia than euthyroid cats (14.2%; P < .0001).
CONCLUSIONS AND CLINICAL IMPORTANCE
Our algorithm for calculating individual I doses resulted in cure rates similar to historical treatment rates, despite much lower I doses. This algorithm appears to lower prevalence of both I-induced overt hypothyroidism and azotemia.
Topics: Algorithms; Animals; Cat Diseases; Cats; Hyperthyroidism; Hypothyroidism; Iodine Radioisotopes; Thyroxine
PubMed: 34351027
DOI: 10.1111/jvim.16228 -
Advances in Chronic Kidney Disease Sep 2020Acute kidney injury (AKI) is common among hospitalized patients with Coronavirus Infectious Disease 2019 (COVID-19), with the occurrence of AKI ranging from 0.5% to 80%.... (Review)
Review
Acute kidney injury (AKI) is common among hospitalized patients with Coronavirus Infectious Disease 2019 (COVID-19), with the occurrence of AKI ranging from 0.5% to 80%. The variability in the occurrence of AKI has been attributed to the difference in geographic locations, race/ethnicity, and severity of illness. AKI among hospitalized patients is associated with increased length of stay and in-hospital deaths. Even patients with AKI who survive to hospital discharge are at risk of developing chronic kidney disease or end-stage kidney disease. An improved knowledge of the pathophysiology of AKI in COVID-19 is crucial to mitigate and manage AKI and to improve the survival of patients who developed AKI during COVID-19. The goal of this article is to provide our current understanding of the etiology and the pathophysiology of AKI in the setting of COVID-19.
Topics: Acute Kidney Injury; Anti-Bacterial Agents; Antiviral Agents; Apolipoprotein L1; Ascorbic Acid; Azotemia; COVID-19; Cytokines; Disease Progression; Glomerulonephritis; Glomerulonephritis, Membranous; Hospital Mortality; Humans; Kidney Tubules, Proximal; Length of Stay; Myoglobin; Nephritis, Interstitial; Nephrosis, Lipoid; Renal Insufficiency, Chronic; Rhabdomyolysis; SARS-CoV-2; Severity of Illness Index; Thrombotic Microangiopathies; Vitamins; COVID-19 Drug Treatment
PubMed: 33308501
DOI: 10.1053/j.ackd.2020.09.003