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The Journal of Veterinary Medical... Mar 2016Immunoglobulin (Ig) A nephropathy is a rare form of canine glomerular disease. This report describes a case of canine IgA nephropathy showing characteristics typical of...
Immunoglobulin (Ig) A nephropathy is a rare form of canine glomerular disease. This report describes a case of canine IgA nephropathy showing characteristics typical of human IgA nephropathy. An 8-year-old, spayed female Miniature Dachshund showed persistent severe proteinuria without azotemia. She was receiving long-term glucocorticoid therapy due to chronic gastritis and an intra-abdominal suture granuloma. A renal biopsy demonstrated mesangial proliferative glomerulonephritis with predominantly mesangial IgA deposition and electron-dense deposits in the paramesangium. These findings closely resembled those of human IgA nephropathy. Glucocorticoid treatment was discontinued, and the angiotensin-converting enzyme inhibitor enalapril was administrated as an antiproteinuric agent. The proteinuria subsequently went into remission, and the patient has maintained good condition without recurrence.
Topics: Animals; Dog Diseases; Dogs; Female; Glomerulonephritis, IGA; Proteinuria
PubMed: 26596464
DOI: 10.1292/jvms.15-0161 -
Journal of Veterinary Internal Medicine 2023Hyperthyroid cats often have urine specific gravity (USG) values <1.035. It remains unclear how USG changes after treatment, if USG can be used to predict azotemia after...
BACKGROUND
Hyperthyroid cats often have urine specific gravity (USG) values <1.035. It remains unclear how USG changes after treatment, if USG can be used to predict azotemia after treatment, or how iatrogenic hypothyroidism influences USG values.
OBJECTIVES
To determine the proportion of hyperthyroid cats with USG <1.035 vs ≥1.035; if USG changes after treatment; and whether USG <1.035 correlated with unmasking of azotemia or hypothyroidism.
ANIMALS
Six hundred fifty-five hyperthyroid cats treated with radioiodine; 190 clinically normal cats.
METHODS
Prospective, before-and-after study. Hyperthyroid cats had serum thyroxine, thyroid-stimulating hormone, and creatinine concentrations, and USG measured before and 6 months after successful treatment with radioiodine.
RESULTS
Of untreated hyperthyroid cats, USG was ≥1.035 in 346 (52.8%) and <1.035 in 309 (47.2%). After treatment, 279/346 (80.6%) maintained USG ≥1.035, whereas 67/346 (19.4%) became <1.035; 272/309 (88%) maintained USG <1.035, whereas 37/309 (12%) became ≥1.035. Only 22/346 (6.4%) with USG ≥1.035 developed azotemia after treatment, compared with 136/309 (44%) with <1.035 (P < .001). Of cats remaining nonazotemic, 38% had USG <1.035, compared with 20% of normal cats (P < .001). The 137 cats with iatrogenic hypothyroidism had lower USG after treatment than did 508 euthyroid cats (1.024 vs 1.035), but USGs did not change after levothyroxine supplementation. USG <1.035 had high sensitivity (86.1%) but moderate specificity (65.2%) in predicting azotemia after treatment.
CONCLUSIONS AND CLINICAL IMPORTANCE
Hyperthyroidism appears not to affect USG in cats. However, cats with evidence of sub-optimal concentrating ability before radioiodine treatment (USG < 1.035) are more likely to develop azotemia and unmask previously occult chronic kidney disease. Iatrogenic hypothyroidism itself did not appear to affect USG values.
Topics: Cats; Animals; Iodine Radioisotopes; Azotemia; Prospective Studies; Hypothyroidism; Hyperthyroidism; Kidney Concentrating Ability; Iatrogenic Disease; Cat Diseases
PubMed: 37668163
DOI: 10.1111/jvim.16849 -
Journal of Feline Medicine and Surgery Oct 2022Radioactive iodine (I) is the preferred treatment for feline hyperthyroidism but neither the optimal I dose nor consistent predictors of post-treatment azotaemia have...
OBJECTIVES
Radioactive iodine (I) is the preferred treatment for feline hyperthyroidism but neither the optimal I dose nor consistent predictors of post-treatment azotaemia have been determined. The aims of the study were to evaluate the relationships between: (1) I dose and survival; and (2) pretreatment and post-treatment serum creatinine concentration.
METHODS
Medical records of hyperthyroid cats treated with I at a single referral hospital were reviewed. Information regarding signalment, body weight, pretreatment and post-treatment serum total thyroxine concentration (TT4), serum creatinine concentration, I dose and survival were determined. Multivariable Cox proportional hazards analysis was used to identify variables associated with survival. Multivariable linear regression analysis was used to identify variables associated with post-treatment serum creatinine concentration.
RESULTS
One hundred and ninety-eight (79 male, 119 female) cats were treated for hyperthyroidism with I (median dose 138 MBq; interquartile range 92-168). Median survival time was 1153 days (range 16-1871). Post-treatment serum creatinine ( <0.001) and age ( = 0.049) were significantly associated with survival. Every 10 µmol/l increase in post-treatment serum creatinine concentration and every year increase in age was associated with a 1.07-fold (confidence interval [CI] 1.04-1.11) and 1.17-fold (CI 1.00-1.37) increase in the daily hazard of death, respectively. Pretreatment serum creatinine concentration was directly, and post-treatment serum TT4 concentration was inversely, associated with post-treatment serum creatinine concentration. Every 1 μmol/l increase in pretreatment serum creatinine concentration was associated with an increase in post-treatment serum creatinine concentration of 0.7 μmol/l (SE 0.17; <0.001). Conversely, every 1 nmol/l decrease in post-treatment serum TT4 concentration was associated with a 1.2 μmol/l (SE 0.61; <0.001) increase in post-treatment serum creatinine concentration.
CONCLUSIONS AND RELEVANCE
Post-treatment serum TT4 concentration was associated with post-treatment azotaemia, which was associated with survival. Although I dose was not directly associated with survival, dosing strategies that minimise post-treatment hypothyroidism and azotaemia could improve patient survival.
Topics: Animals; Azotemia; Cat Diseases; Cats; Creatinine; Female; Hyperthyroidism; Iodine Radioisotopes; Male; Thyroid Neoplasms; Thyroxine
PubMed: 34730466
DOI: 10.1177/1098612X211056837 -
Case Report: Acute Kidney Injury Due to Chronic Milk-Alkali Syndrome in a Patient With Colon Cancer.Frontiers in Medicine 2022Common causes of hypercalcemia include primary hyperparathyroidism and paraneoplastic syndrome of malignancy. Because of this, physicians can easily miss extrinsic...
BACKGROUND
Common causes of hypercalcemia include primary hyperparathyroidism and paraneoplastic syndrome of malignancy. Because of this, physicians can easily miss extrinsic causes of hypercalcemia such as milk-alkali syndrome in patients with cancer. We successfully treated a case of acute kidney injury due to severe hypercalcemia caused by milk-alkali syndrome due to long-term milk drinking in a patient with colon cancer.
CASE DESCRIPTION
A 62-year-old man was referred to nephrology for hypercalcemia and azotemia that was found during preoperative evaluation for colon cancer surgery. The patient had experienced several months of dizziness and anorexia. We started hemodialysis because hypercalcemia and azotemia were not improved despite large amounts of hydration and diuretics. We suspected paraneoplastic syndrome because of concomitant colon cancer and low intact parathyroid hormone (PTH). Renal microcalcifications were observed on ultrasonography. Metastatic calcifications of the lung and stomach were present, but no malignant metastasis appeared on bone scans. There was no evidence of metastatic malignant lesions on chest or abdominal enhanced computed tomography. PTH-related peptide was not detected. Thus, other causes of hypercalcemia beyond malignancy were considered. On history-taking, the patient reported consuming 1,000 to 1,200 mL of milk daily for the prior 3 months. Hypercalcemia was due to chronic milk-alkali syndrome. We advised withdrawal of milk and nutritional pills. Hemodialysis was stopped after 2 weeks since azotemia and hypercalcemia were resolving. Acute kidney injury was improved, and mild hypercalcemia remained when he underwent hemicolectomy after 1 month. Thereafter, serum calcium and creatinine remained normal at discharge and follow-up for 1 year in the outpatient clinic. However, lung calcifications still remained on bone scan after 1 year.
CONCLUSIONS
Chronic milk-alkali syndrome is a rare condition resulting from excessive calcium and alkali intake through various routes, like milk, nutritional supplements, and medicines for osteoporosis. Therefore, early management for hypercalcemia should include precise history taking including diet, previous diagnoses, and current medications.
PubMed: 35187010
DOI: 10.3389/fmed.2022.834107 -
Iranian Journal of Kidney Diseases Jul 2013The aim of this study was to determine the prevalence of albuminuria and its correlates and investigate disease management for patients with type 2 diabetes mellitus in...
INTRODUCTION
The aim of this study was to determine the prevalence of albuminuria and its correlates and investigate disease management for patients with type 2 diabetes mellitus in Ahvaz.
MATERIALS AND METHODS
This was a cross-sectional study on the 350 patients with type 2 diabetes mellitus attending the Diabetes Clinic at Golestan Hospital, from October 2010 to September 2011. Demographic characteristics were recorded and height, weight, and blood pressure were measured. Blood urea nitrogen and serum levels of creatinine, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, and glycosylated hemoglobin A were measured in fasting blood samples. Spot urine and 24-hour urine collection were tested for albumin and kidney ultrasonography was done.
RESULTS
A total of 72 of 350 patients (20.6%) had microalbuminuria and 18 (5.1%) had macroalbuminuria. Elevated serum creatinine was seen in 6.9% and azotemia in 6.0%. In multivariable analysis, blood urea nitrogen level, glycosylated hemoglobin A, and duration of diabetes mellitus were associated with urinary albumin excretion (P = .04). A small proportion of the participants achieved optimal treatment goals for modifiable risk factors.
CONCLUSIONS
Abnormal urinary albumin excretion is seen in one-quarter of type 2 diabetic patients and a small but important number of them have azotemia. Albuminuria was found to be associated with long-term duration of diabetes mellitus, poor glucose control (revealed by high glycosylated hemoglobin A levels), and high blood urea nitrogen. Poor glycemic control may have a significant role in the progression of diabetic nephropathy in these patients.
Topics: Adult; Aged; Albuminuria; Azotemia; Biomarkers; Blood Urea Nitrogen; Chi-Square Distribution; Creatinine; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Disease Progression; Female; Glycated Hemoglobin; Humans; Iran; Linear Models; Logistic Models; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Prevalence; Prognosis; Risk Factors; Time Factors
PubMed: 23880803
DOI: No ID Found -
California Medicine Sep 1967Chronic intermittent hemodialysis may relieve some medical problems of terminal uremia (for example, azotemia, acidosis, hypertension, neuro-muscular disorders,... (Review)
Review
Chronic intermittent hemodialysis may relieve some medical problems of terminal uremia (for example, azotemia, acidosis, hypertension, neuro-muscular disorders, bleeding, pericarditis) to such a degree that many patients are able to resume their normal activity. There remain, however, problems which are not readily changed by hemodialysis (anemia, peripheral neuropathy, pruritus, sexual impotence, renal osteodystrophy). These, together with medical problems possibly caused by hemodialysis (for example, osmotic disequilibrium, errors in dialysate composition, hepatitis, hemosiderosis, isoimmunization from blood transfusions, shunt problems and psychological problems of dependency upon the artificial kidney) represent a limitation of the present type of hemodialysis therapy.
Topics: Cardiovascular Diseases; Hematologic Diseases; Hepatitis; Humans; Kidney Failure, Chronic; Personality Disorders; Renal Dialysis
PubMed: 4864655
DOI: No ID Found -
Journal of Veterinary Internal Medicine May 2018Feline morbillivirus (FeMV) is associated with the presence of tubulo-interstitial nephritis (TIN) in cats, however the seroprevalence of FeMV in the UK and the...
BACKGROUND
Feline morbillivirus (FeMV) is associated with the presence of tubulo-interstitial nephritis (TIN) in cats, however the seroprevalence of FeMV in the UK and the association between the presence of FeMV and renal azotemia is unknown HYPOTHESIS/OBJECTIVES: To identify whether paramyxoviruses are present in urine samples of geriatric cats and to develop an assay to assess FeMV seroprevalence. To investigate the relationship between both urinary paramyxovirus (including FeMV) excretion and FeMV seroprevalence and azotemic chronic kidney disease (CKD).
ANIMALS
Seventy-nine cats (40 for FeMV detection; 72 for seroprevalence).
METHODS
Retrospective cross-sectional, case control study. Viral RNA was extracted from urine for RT-PCR. PCR products were sequenced for virus identification and comparison. The FeMV N protein gene was cloned and partially purified for use as an antigen to screen cat sera for anti-FeMV antibodies by Western Blot.
RESULTS
Feline morbillivirus RNA from five distinct morbilliviruses were identified. Detection was not significantly different between azotemic CKD (1/16) and nonazotemic groups (4/24; P = .36). Three distinct, non-FeMV paramyxoviruses were present in the nonazotemic group but their absence from the azotemic group was not statistically significant (P = .15). 6/14 (43%) azotemic cats and 40/55 (73%) nonazotemic cats were seropositive (P = .06).
CONCLUSIONS AND CLINICAL IMPORTANCE
Feline morbillivirus was detected in cats in the UK for the First time. However, there was no association between virus prevalence or seropositivity and azotemic CKD. These data do not support the hypothesis that FeMV infection is associated with the development of azotemic CKD in cats in the UK.
Topics: Animals; Azotemia; Case-Control Studies; Cat Diseases; Cats; Cross-Sectional Studies; Female; Male; Morbillivirus; Morbillivirus Infections; Paramyxoviridae; Paramyxoviridae Infections; Renal Insufficiency, Chronic; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; Seroepidemiologic Studies; United Kingdom
PubMed: 29572949
DOI: 10.1111/jvim.15097 -
JFMS Open Reports 2023A 3-year-old male neutered Sphynx cat was referred for history of chronically increased liver enzymes and lower urinary tract signs that were first reported when the cat...
CASE SUMMARY
A 3-year-old male neutered Sphynx cat was referred for history of chronically increased liver enzymes and lower urinary tract signs that were first reported when the cat was 5 months old. Urine metabolic profile revealed increased amino aciduria and glucosuria despite normoglycemia, suggesting Fanconi syndrome. Urine sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed a banding pattern suggestive of primary tubular damage. Serial blood work showed non-regenerative normocytic normochromic anemia, persistently elevated liver enzymes, worsening azotemia and progressive hyperchloremic metabolic acidosis. Ultrasound revealed irregular kidneys and bilaterally hyperechoic cortices and medullae with a loss of normal corticomedullary distinction. Laparoscopic kidney biopsy revealed a moderate-to-severe chronic interstitial fibrosis with chronic lymphoplasmacytic inflammation, tubular degeneration and atrophy, mild glomerulosclerosis and mild large vascular amyloidosis. Tubular epithelial cell karyomegaly was multifocally evident throughout the kidney. The liver had moderate diffuse zone 1 hepatocellular atrophy, periportal fibrosis, biliary hyperplasia, mild perisinusoidal amyloidosis and hepatocyte karyomegaly in zones 2 and 3. The patient continued to decline and developed polyuria, polydipsia, lethargy and hyporexia irrespective of rigorous management, which failed to curtail the progressive anemia and azotemia. The patient was euthanized 8 months from the onset of clinical signs.
RELEVANCE AND NOVEL INFORMATION
Fanconi syndrome in cats is a rare condition, with most reports occurring secondary to chlorambucil treatment. This is the first known case of Fanconi syndrome occurring with concurrent hepatorenal epithelial karyomegaly in a young Sphynx cat.
PubMed: 37810577
DOI: 10.1177/20551169231190611 -
Animals : An Open Access Journal From... Mar 2022Previous studies of azotaemia in canine babesiosis revealed pre-renal and renal azotaemia in infected dogs, and an association between an increased de Ritis quotient...
Previous studies of azotaemia in canine babesiosis revealed pre-renal and renal azotaemia in infected dogs, and an association between an increased de Ritis quotient (aspartate aminotransferase to alanine aminotransferase activity; AST/ALT ratio) and azotaemia in affected animals. Serum activities of AST and ALT, and AST/ALT ratio were compared between azotaemic and non-azotaemic dogs infected with , and between affected dogs with pre-renal and renal azotaemia. Statistical analyses revealed higher AST activity and an increased AST/ALT ratio in azotaemic dogs, and an increase of these two parameters in infected dogs with renal azotaemia in comparison to dogs with pre-renal azotaemia. Moreover, AST activity and AST/ALT ratio were correlated with renal indices such as renal failure index, sodium fractional excretion, and urinary creatinine to serum creatinine ratio. The study also revealed a lack of correlation between AST and ALT activities in azotaemic dogs, although a correlation was observed when including all dogs in this study (azotaemic and non-azotaemic dogs treated as one group). The results of this study indicate that increased serum AST activity in azotaemic dogs infected with may have a renal origin, and the AST/ALT ratio could be considered as a simple and convenient renal index that is useful in the recognition of renal azotaemia in canine babesiosis.
PubMed: 35268195
DOI: 10.3390/ani12050626 -
Cleveland Clinic Journal of Medicine 1992Between 1980 and 1988, 12 patients at the Cleveland Clinic had biopsy-proven acute tubulointerstitial nephritis. Etiologies of the disease included drugs, systemic...
Between 1980 and 1988, 12 patients at the Cleveland Clinic had biopsy-proven acute tubulointerstitial nephritis. Etiologies of the disease included drugs, systemic illness, and idiopathic causes. Clinical features were nonspecific, and the diagnosis of acute tubulointerstitial nephritis was seldom entertained in these patients prior to biopsy. Seven patients had unrelated underlying renal disease. Treatment included discontinuation of the offending agent and/or a trial of steroids. All patients had final creatinine levels lower than at diagnosis. Because the condition is potentially reversible, this disease should be considered in all patients with new azotemia who do not exhibit prerenal factors, features typical of acute tubular necrosis, red blood cell casts heralding a glomerular process, or evidence of obstructive uropathy.
Topics: Acute Disease; Adolescent; Adult; Aged; Female; Humans; Kidney Diseases; Male; Middle Aged; Nephritis, Interstitial; Retrospective Studies; Sulfonamides
PubMed: 1551211
DOI: 10.3949/ccjm.59.1.27