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Assisted feeding through an oesophagostomy tube in patients with chronic kidney disease and uraemic syndrome: impact on body condition score, renal function and survival
Full text linkLa dietoterapia rappresenta il primo strumento terapeutico nel paziente in
presenza di danno renale acuto e malattia renale cronica. Tuttavia la maggior
parte di tali pazienti non è in grado di alimentarsi volontariamente e nel
quantitativo adeguato ai propri fabbisogni. Obiettivo del presente studio è
di valutare BCS, parametri di funzionalità renale e sopravvivenza in pazienti
in crisi uremica sottoposti o meno ad alimentazione assistita.
Lo studio è stato condotto su quattordici cani con pregressa CKD e in fase
di riacutizzazione o scompenso. Sette pazienti sono stati gestiti mediante
impiego di feeding tube (FT), 7 mediante terapia medica tradizionale (GC).
Per ciascuno dei due gruppi, BCS, creatinina, urea, e fosforo sierici e sopravvivenza,
sono stati valutati a T0 e ad uno (T1) e due mesi (T2). I dati sono
stati elaborati statisticamente.
Il GC presentava una differenza significativa di BCS (p=0,04), creatinina
(p=0,001), urea (p=0,005) e fosforo (p=0,04) a diversi controlli. Il FT presentava
una differenza significativa di BCS (p=0,03), valori sierici di creatinina
(p=0,006), urea (p=0,0001) e fosforo (p=0,02) ai diversi controlli. Il FT mostrava
una sopravvivenza alla crisi uremica maggiore (p=0,01) del GC.
Le evidenze del presente studio riportano un significativo miglioramento di
BCS, parametri di funzionalità renale e sopravvivenza nei pazienti gestiti con
feeding rispetto agli altri. Il feeding tube sembra rappresentare un ausilio terapeutico
estremamente utile nella gestione medica del paziente in crisi uremica.Introduction – A renal diet is a fundamental part of the medical management
of patients with acute and chronic kidney disease. Unfortunately, most patients
are not able to eat a sufficient amount of a renal diet to achieve an adequate
calorie intake. The aim of this study was to evaluate the Body Condition Score
(BCS), renal function and survival rate in a group of uraemic patients managed
with a feeding tube and compare the findings with those in a comparable group
managed without a feeding tube.
Materials and Methods – Fourteen dogs with acute-on-chronic kidney disease
formed the study population. Seven dogs were managed with the use of a feeding
tube (FT group) and seven were managed without a feeding tube (control
group). BCS, serum creatinine, urea and phosphate concentrations and survival
rate were evaluated in both groups at time 0 (T0), after 1 month (T1) and after
2 months (T2). Data were analysed statistically.
Results – There were significant differences in BCS (p=0.04), creatinine
(p=0.001), urea (p=0,005) phosphate (p=0.04) at the different time points in the
control group. The FT group also had significant difference in BCS (p=0.03), creatinine
(p=0.006), urea (p=0.0001) and phosphate (p=0.02) at the different time
points. The survival rate was higher in the FT group than in the control group
(p=0.01).
Discussion – The results of the present study show significant improvements
in BCS, renal function and survival in patients managed with a feeding tube, compared
to those in which a feeding tube was not used. A feeding tube seems to
be a very useful therapeutic instrument for the management of patients with
uraemic syndrome
SUCCESSFUL MANAGEMENT OF ACUTE BABESIOSIS IN A DOG
Full text linkCanine babesiosis is a tick-borne disease caused by Babesia spp. Dogs with uncomplicated babesiosis typically show pale mucous membranes, fever, anorexia, depression, water-hammer pulse, and splenomegaly. The complicated form can include acute renal failure, cerebral babesiosis, coagulopathy, icterus and hep- atopathy, immune-mediated hemolytic anemia (IMHA), acute respiratory distress syndrome (ARDS), hemo- concentration. This case report describes the presentation, diagnosis, and management of acute systemic inflammatory response syndrome (SIRS) in a dog affected by Babesia canis. A Border Collie, intact male, 8-years-old, was presented in emergency setting showing weakness, anorexia and ’pigmenturia’ started 2 days before. The dog was used as cattle dog in Piedmont region and recently moved to Tuscany. Dog showed fever (38.
RETROSPECTIVE OBSERVATION OF 64 DOGS WITH RENAL FAILURE MANAGED BY HEMODIALYSIS
No full textAcute Kidney Injury (AKI) is a severe disease associated with a sudden onset of renal
parenchymal injury most typically characterized by generalized failure. AKI may to be
severe and culminated with the requirement for renal replacement therapy (RRT) or
death. The aim of this study was to evaluate potential prognostic factors (clinical and
laboratory parameters), intra/inter dialysis complications and mortality rate in a cohort
of dogs with AKI and AKI/CKD managed by hemodialysis (HD) at Department of
Veterinary Science of University of Pisa between 2012 and 2015. We included 64 dogs
with anamnestic, clinical, imaging and laboratory findings of AKI or acute on chronic
kidney disease (AKI/CKD) managed by hemodialysis. All Dogs were also divided into two
groups: survivors and non-survivors. Survivors were defined as patients remaining not
dependent by dialysis for at least 30 days after discharge from the hospital. Data were
statistically analyzed with GraphPad Prism® for Mac. In our cohort 43/64 were males
and 21/64 were females. Mean age and body weight were 5.5 ± SD 3.3 years and 26.7
kg±1SD 1.6 kg respectively. At presentation 26/64 dogs were anuric (<0.5 ml/kg/h),
15/64 were oliguric (1ml/kg/h). 29/64 dogs
were in AKI stage 5 (SrCr>10mg/dl), 29/64 were in AKI 4 (SrCr 5-10 mg/dL), 2/64 were
in AKI 3 (SrCr 2.6-5mg/dL), 1/64 were in AKI 2 (SrCr 1.6-2.5) and 3/64 were in AKI 1
(SrCr<1.6mg/dL). Most of etiology of AKI in this dogs were: Leptospira infection (14/64),
Leishmania infection (5/64), toxicity (8/64), ethylene glycol (3/64), pancreatitis (4/64),
heart stroke (2/64), snake bite (2/64), uretheral obstruction (2/64), pyometra (3/64),
unknown (17/64) and other causes (4/64). Non-survivors dogs were 37/6, while
survivors were 27/64. T-Test unpaired showed significant difference at presentation in
serum creatinine (p=0.047), phosphorus (p=0.0468), and ionic calcium (p=0.042)
between survivors and non-survivors. No significant difference was found in serum urea,
albumin, C-reactive protein (CRP) and potassium between survivors and non-survivors.
In our cohort the overall survival rate was 42.2% and it showed similar to previously data reported. Serum creatinine, phosphorous and ionized calcium seemed to have a
significant prognostic relevance, while serum urea, CRP and potassium did not seem to
affect prognosis significantly
ARMAX Forecast Model for Estimating the Annual radon Activity Concentration in Confined Environment by Short Measurements Performed by Active Detectors
Full text linkThis work aims to implement a forecast model that, combined with the use of active instrumentation for a rather limited time, and with the knowledge of a set of data referring to the environmental parameters of the place to be monitored, can estimate the concentration of indoor radon activity for longer time periods. This model has been built through the MATLAB program, exploiting the theories of time series and, in particular, ARMAX models, to reproduce the variation in the concentration of radon activity. The model validation has been carried out by comparing real vs. simulated values. In addition, analytic treatment of input data, such as temperature, pressure, and relative humidity, can reduce the influence of sudden transients allowing for better stability of the model. The final goal is to estimate the annual radon activity concentration on the basis of spot measurements carried out by active instrumentation, such to avoid the need to measure for an entire calendar year by the use of passive detectors. The first experimental results obtained in conjunction with active radon measurement demonstrates the applicability of the method not only for forecasting future average concentrations, but also for optimizing remedial actions
PANCREATITIS AND ACUTE KIDNEY INJURY (AKI): RETROSPECTIVE OBSERVATION OF 41 DOGS WITH AKI MANAGED BY HEMODIALYSIS
No full textAcute Kidney Injury (AKI) is a severe disease associated with a sudden onset of renal parenchymal injury
most typically characterized by generalized failure. AKI may to be severe and culminated with the
requirement for renal replacement therapy (RRT) or death. Acute pancreatitis is a potentially reversible
condition, but severe disease that can cause systemic and local complications and recognized more commonly
as an etiology as well as a complication of AKI. Aim With this retrospective study we investigate the
role of pancreatitis in dogs with AKI managed by hemodialysis (HD), and we evaluate how this morbidity
influences patients’ outcome. Material and methods This study includes 41 dogs, managed by intermittent
hemodialysis (IHD), with anamnestic, clinical, imaging and laboratory findings of AKI or AKI/CKD. All
Dogs were divided into two groups: 1) patients affected by AKI and Pancreatitis (n=13) and 2) dogs affected
by only AKI (n=28). Diagnosis of pancreatitis was established by physical examination, diagnostic
imaging findings and measurement of pancreatic lipase concentration in serum dog (cPLI
R ). We excluded
patients with positivity of cPLI
R but negative abdominal ultrasound. We consider laboratory findings of
all dogs at moment of presentation. Data were statistically analyzed using GraphPad Prism
R for Mac.
Result Dogs with pancreatitis were 31,7% (13/41) of all subject; patients with pancreatitis that died were
84,6% (11/13) while only 25% (7/28) of the dogs without pancreatitis and managed with HD had worse
outcome. T-Test unpaired showed not significant difference in the concentrations of creatinine (p=0.668),
phosphorus (p=0.511), albumin (p=0.496), cholesterol (p=0.197), and ionic calcium (p=0.751) between two
groups at presentation. The quantitive proteinuria (UP/UC) was evaluated with t-test unpaired between two
groups and wasn’t statistically significant (p=0.293). Chi Square test instead showed a significant difference
(p=0.016) between number of dogs who survived or died in relation to the presence of pancreatitis. The
test was also evaluated in relation with the presence of disseminated intravascular coagulation (DIC) and
wasn’t statistically significant. Conclusion Dogs with AKI and affected by pancreatitis had a worse outcome
than patients without pancreatitis, but at presentation there weren’t any significant difference between two
groups in hematologic parameters. Pancreatitis is reported in veterinary medicine as common complication
in renal failure and in human medicine is documented that risk of acute pancreatitis in patients on long-term
hemodialysis is significantly high. We haven’t also showed any correlation with presence of pancreatitis and
CID
Ultrasonographic alterations in dogs at different stage of CKD
No full textAlthough 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<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<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 (>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
KIDNEY INJURY IN DOGS WITH ACUTE PANCREATITIS
No full textAcute pancreatitis (AP) is a common disease in dogs characterized by a wide spectrum of
clinical signs, as anorexia, vomiting, diarrhoea and abdominal pain. AP can lead to
kidney injury via hypovolemia, cytokine-induced ischemia, inflammation and oxidative
stress. The aim of the study was to evaluate the prevalence of kidney injury in dogs with
AP. The study enrolled 65 dogs with positivity to SNAP cPL® test and clinical and
laboratory signs suggestive of AP. Dogs with non-pancreatic acute abdominal disease
were excluded. WBC, neutrophil count, serum C-reactive protein (CRP), serum creatinine
(SrCr) and urea and urinalysis were evaluated at time of diagnosis. The magnitude of AP
was assessed using the clinical severity index (CSI) as described by Mansfield (2008). The
patients were divided into two groups: survivors and non-survivors. Non-survivors
included dogs, which died within seven days from admission. Data were statistically
analysed using GraphPad Prism® for Mac. The study population was composed by intact
(n=30) and spayed females (n=13), and intact (n=34) and neutered males (n=2). Patients
showed median age of 8.8 (0.4–14.6) years, BCS of 5/9 (2/9-7/9) and body weight of 16
(2.5-64) kg. Overall seven-day survival was 67.7% 44/65 dogs . CSI≥5 was associated
with poor outcome (p=0.047) and elevated CRP (p=0.014). Dogs with CRP three-fold
higher than upper reference range, showed a significantly poorer outcome (p=0.0003).
SrCr>1.5 mg/dL and urea>55 mg/dL above the reference range were significantly
associated with increased risk of death (p<0.0001 and p<0.0009 respectively). In this
study ove all mo tality ate was 32.3% and 37% in dogs wit CSI≥4. Howeve in t is
cohort of dogs median CSI was 4 and 66% of dogs were in CSI≥4 g oup. o t is eason
median CSI was used to divide dogs into two g oups and dogs wit CSI≥5 n=32 ave
been associated with increased risk of death (13/32, 40%). Previous study reported an
overall mortality rate of 23% for all dogs and 53% for dogs wit CSI sco e≥4. evious
studies have failed to find a correlation between CRP and outcome or CSI. In our cohort
of patients C s owed a low sensibility and it was associated wit CSI≥5. Patients with 3xCRP showed a significantly higher risk of death; comorbility or multi organic
dysfunction syndrome could be more frequent in these patients. In canine AP elevated
SrCr has been reported as prognostic marker. Previous study found that dogs with renal
damage sco e 2 anu ia o a otemia≥1.5-fold increase in serum urea and SrCr) had a
higher mortality rate than dogs with renal damage score 0 or 1. However, renal damage
score was a part of a multiple organ CSI, making the role of azotemia unclear. In a more
recent study, 55% of dogs with AP showed elevated SrCr, but it was not prognostic. In
this cohort of dogs, elevation in serum urea or SrCr have been associated with poor
outcome
ARTERIAL BLOOD GAS IN AZOTEMIC DOGS
No full textArterialbloodgasinazotemicdogshasnotbeenreported.AtpresentonlyfewstudieshavebeenreportedinVeterinaryMedicineaboutrespiratoryabnormalitiesinrenalfailure(1,2).Respiratorytractdiseaseindogswithkidneyfailurerangesfromalterationsinbreathingpatterntoprogressivedyspneaandacuterespiratorydistresssyndromewithamajorimpairmentingasexchangeandeventualcyanosis.Lunginvolvementinazotemicpatientsrepresentsaseverecomplicationcausingincreasedcasefatalitydependingontheseverityofrespiratorydistress.Arterialbloodgassampleistheonlytestthataccuratelymeasurethepartialpressureofoxygen(PaO2)andoxygensaturationwithaearlyrecognitionofoxygenimpairmentalsobycalculationofP[A−a]O2gradientandPaO2/FiO2ratio.Objective:Toevaluatearterialbloodgasparameters(Ph,PaO2,PaCO2,SO2PaO2/FiO2ratio,Alveolar-arterialP[A−a]O2gradientandbicarbonate)inazotemicdogsatadmissioninICU. Methods:Datawerecollectedretrospectively.Thirtydogswithsevereacuteazotemia(creatinine>5mg/dL)wereselected.Arterialbloodsamples(approx0.4mL)wereobtainedfromthedorsalpedalarteryforeachpatientatpresentationusing60IUbalancedheparinself-fillingsampler(safePICOSelf-fill®.RadiometerMedicalApS-Denmark-fig2)andrunimmediatelyinabloodgasanalyzer(ABL700seires,Radiometer-Copenhagen-fig1).Allmeasurementswereobtainedonroomairatsealevel(FiO221%).Alveolar-arterialoxygentensiongradient,andP/Fwereauthomaticallycalculatedbybloodgasanalyzer.Dogsweresubsequentlydividedintwogroupsaccordingtooutcome:survivors(S)andnotsurvivors(NS).NormaldistributionwasassessedusingtheShapiro-Wilktest.MannWhitneytestwasusedtocomparePh,PaCO2,PaO2,P[A−a]O2gradient,PaO2/FiO2andbicarbonateinsurvivorsversusnonsurvivors. Results:13/30dogssurvived(43.3%),17/30dogsdidnotsurvive(56.7%).(S)grouphadmeanvaluesofpH7.3(min7.1-max7.4),PaO297.0mmHg(min55.5-max112.0),PaCO229.4mmHg(min18.9-max36.5),PaO2/FiO2ratioof461.5mmHg(min264–max531.0),P[A−a]O2gradient25.8mmHg(min12.7-max61.2),SO299.3%(min86.5-max101.8)andHCO3-16.9mmol/l(min8.5-max22.4).(NS)grouphadameanvaluesofpH7.3(min7.1-max7.6),PaO285.5mmHg(min49.4-max116.0),PaCO231.3mmHg(min17,9-max40,1),PaO2/FiO2393.1mmHg(min235.0-max552.0),SO294.8%(min75.7-max101.7),P[A−a]O237.0mmHg(min15.2-max68.8),HCO3-16.1mmol/l(min5.5-max27.8).
TheMann-Whitneytestrevealedasignificativeincrease(P10.00mmHg)atadmissionwhilethemeanvalueofPaCO2(<37±3mmHg)andHCO3-(<21±2mmol/L)wasreducedinalldogs(Table1,Fig.3-4-5). Conclusion:Arterialbloodgasparametersindogswithrenalfailurehasnotbeenreportedbefore.StastisticallysignificancewasfoundforPaO2,PaO2/FiO2andSO2betweensurvivorsversusnon-survivor.AnincreasedvalueofmeanAlveolar-arterialoxygengradientinazotemicdogsrespectreferencevalueswasalsofound.Thiscouldresultfromimpaireddiffusionor,morecommonly,byventilation-perfusioninequalityofthe"shunting"variety.PaCO2andHCO3-wasreducedinalldogsenrolledrespectreferencevalues.Theutilityofarterialbloodgasshouldbeconsideredinordertoevaluatearterialgasexchangeinthesepatients.Theseresultssuggesttoevaluatearterialbloodgasalsoduringhospitalizationtobetterverifyanypossiblecorrelationwithoutcome
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