Assessment of acute kidney injury in canine parvovirus infection: Comparison of kidney injury biomarkers with routine renal functional parameters

Assessment of cell cycle arrest biomarkers and neutrophil gelatinase-associated lipocalin to distinguish acute kidney injury from other diseases in dogs

BACKGROUND

Cell cycle arrest biomarkers (tissue inhibitor of metalloproteinase-2 [uTIMP-2] and insulin-like growth factor binding protein 7 [uIGFBP7]), and neutrophil gelatinase-associated lipocalin (NGAL) variables are valuable biomarkers for early diagnosis of acute kidney injury (AKI) in people.

OBJECTIVES

To evaluate uTIMP-2, uIGFBP7, fractional excretion of NGAL (FeNGAL), and urinary to serum NGAL ratio (u/sNGAL) in healthy dogs, dogs with AKI, dogs with chronic kidney disease (CKD), and critically ill (CI) dogs.

ANIMALS

Forty-two client-owned dogs (healthy, n = 10; AKI, n = 11; CKD, n = 11; CI, n = 10).

METHODS

Prospective, observational study. After assessment of routine renal biomarkers, stress (uTIMP-2, uIGFBP7) and damage (NGAL) biomarkers were measured, using ELISA kits, and normalized to urinary creatinine (uCr).

RESULTS

Normalized uTIMP-2 and [uTIMP-2] × [uIGFBP7]/uCr were significantly higher in the AKI group (median 151.9 [range, 2.2-534.2] and 62.9 [1.1-266.8] pg/mL respectively), compared to healthy dogs (0.3 [0.2-74.7]; P < .001 and 0.16 [0.1-58.1] pg/mL; P < .001), dogs with CKD (0.7 [0.3-742.5]; P = .04 and 0.37 [0.2-180.1] pg/mL; P = .03) and CI dogs (1.9 [0.2-37.0]; P = .03 and 0.8 [0.1-16.1] pg/mL; P = .02). Fractional excretion of NGAL was significantly higher in dogs with AKI (54.17 [7.93-155.32] %), than in healthy (0.03 [0.01-0.21] %; P < .001) and CI dogs (3.05 [0.05-28.86] %; P = .02).

CONCLUSIONS AND CLINICAL IMPORTANCE

Normalized uTIMP-2, [uTIMP-2] × [uIGFBP7]/uCr, and FeNGAL can be valuable renal biomarkers for early diagnosis of AKI in dogs.

Early Detection of Chronic Kidney Disease Using Plasma Neutrophil Gelatinase-Associated Lipocalin and Kidney Injury Molecule-1 in Small-Breed Dogs: A Retrospective Pilot Study

Multiple diagnostic modalities are urgently needed to identify early-stage kidney diseases. Various molecules have been investigated; however, most studies have focused on identifying specific biomarkers in urine. Considering that assessing the symmetrical dimethylarginine (SDMA) plasma concentration is more suitable as an early diagnostic test for chronic kidney disease (CKD) in routine veterinary practice, we aimed to investigate the clinical usefulness of plasma neutrophil gelatinase-associated lipocalin (pNGAL) and plasma kidney injury molecule-1 (pKIM-1) concentrations for CKD detection in small-breed dogs. Through a retrospective analysis, we found that numerous clinicopathological data showed a log-normal distribution, even when they satisfied normality tests. Moreover, the log-transformed pNGAL and pKIM-1 concentrations successfully identified CKD International Renal Interest Society (IRIS) stages 1-4 and the risk group with underlying CKD risk factors. Correlation analysis and group comparison of other factors confirmed the possibility of using these two biomarkers for detecting the CKD risk group and IRIS stage 1. Receiver operating characteristic curve analysis revealed that the diagnostic accuracy for discriminating the risk group was superior in the order of pKIM-1, pNGAL, SDMA, and serum creatinine levels. In conclusion, these results suggest that pKIM-1 and pNGAL are possible early or quantifiable markers of insignificant CKD or can be at least used as an adjunct with traditional indicators.

Rhabdomyolysis and myoglobinuria following single induction dose of propofol in a dog

OBJECTIVE

To report a case of rhabdomyolysis and myoglobinuria following single induction dose of propofol in a dog.

CASE SUMMARY

A 5-year-old intact male Shih-Tzu dog was presented for pigmenturia occurring a few hours following anesthesia for comprehensive oral health assessment and treatment. After premedication with IV diazepam (0.5 mg/kg), anesthesia was induced with IV propofol (4 mg/kg) and maintained with isoflurane vaporized in oxygen. A few hours following recovery from anesthesia, the dog developed rhabdomyolysis and myoglobinuria associated with increased serum alanine aminotransferase and C-reactive protein concentrations, as well as mild hypokalemia and euglycemic glycosuria. Approximately 48 hours after IV fluid therapy, the dog was clinically normal, and myoglobinuria progressively resolved.

NEW OR UNIQUE INFORMATION PROVIDED

This is the first case description of rhabdomyolysis and myoglobinuria following a single dose of injectable propofol.

Assessment of Hematological and Serum Biochemistry Parameters in Dogs with Acute Diarrhea Due to Different Etiologies

Acute diarrhea (AD) has a complex etiology and may lead to life-threatening conditions. Hematological and serum biochemistry analyses can be useful for a differential diagnosis and for determining the severity of diarrhoea. Dogs with AD (n=72) were divided into Isospora (n=18), Toxocara (n=18), Parvoviral Enteritis (n=18), and Dietary Diarrhea (n=18) subgroups following clinical and laboratory examinations. The study aimed to evaluate the diagnostic value of certain hematological and serum biochemistry parameters. Clinical examinations, rapid diagnostic tests, complete blood count (CBC), and biochemical analyses were performed. White blood cell count (WBC), granulocyte, and mean hemoglobin concentration (MCH) levels were lower in the Parvoviral Enteritis Group compared with the other groups (p<0.01). Isospora, Parvoviral Enteritis, and Toxocara groups had lower glucose and total protein, and higher creatinine levels than those of the Control and Dietary Diarrhea groups (p<0.0001). The albumin level of the Dietary Diarrhea Group was higher compared with the other groups (p<0.0001). Parvoviral Enteritis and Isospora groups had higher ALP levels than those of the other groups (p<0.0001). Blood urea nitrogen (BUN), alanine aminotransferase (ALT), C-reactive protein (CRP), and cholesterol levels were determined to be highest in the Parvoviral Enteritis Group (p<0.0001). The total bilirubin level was higher in Parvoviral Enteritis and Toxocara groups compared with the Control, Isospora, and Dietary Diarrhea groups (p<0.0001). As a result, it was concluded that in cases of AD due to parvoviral enteritis and Toxocara canis, serum biochemistry abnormalities may be more severe, can provide more clinical information than CBC, and can be useful in forming a differential diagnosis list, especially in triage.

Canine parvovirus-2: An Emerging Threat to Young Pets

Canine parvovirus-2 (CPV-2) is a highly contagious and key enteropathogen affecting the canine population around the globe by causing canine parvoviral enteritis (CPVE) and vomition. CPVE is one of the the leading causes of morbidity and mortality in puppies and young dogs. Over the years, five distinct antigenic variants of CPV-2, namely CPV-2a, CPV-2b, new CPV-2a, new CPV-2b, and CPV-2c, have emerged throughout the world. CPV-2 infects a diverse range of wild animals, and the newer variants of CPV-2 have expanded their host range to include felines. Despite the availability of highly specific diagnostics and efficacious vaccines, CPV-2 outbreaks have been reported globally due to the emergence of newer antigenic variants, expansion of the viral host range, and vaccination failures. The present chapter describes the latest information pertaining to virus properties and replication, disease manifestations in animals, and an additional recent updates on diagnostic, prevention and control strategies of CPV-2.

Serum cobalamin concentrations in dogs infected with canine parvoviral enteritis

OBJECTIVE

To compare the serum cobalamin concentrations in canine parvovirus (CPV)-infected dogs with those of healthy control dogs.

Animals

45 dogs with CPV enteritis and 17 healthy age-matched control dogs.

Procedures

Infection was confirmed by visualization of CPV-2 through fecal electron microscopy. All dogs received supportive care. Serum samples taken at admission were used to determine cobalamin, C-reactive protein, and albumin concentrations.

Results

Serum cobalamin concentrations were significantly lower in the CPV-infected group (median [interquartile range], 173 pmol/L [< 111 to 722 pmol/L]) than in healthy control dogs (379 pmol/L [193 to > 738 pmol/L). There was no association between cobalamin concentration and C-reactive protein or albumin concentration.

Clinical Relevance

While hypocobalaminemia was common in CPV-infected dogs, the clinical relevance of this finding remains to be determined. Studies assessing markers of cellular cobalamin deficiency in dogs with CPV infection appear warranted.

Natural infection of parvovirus in wild fishing cats (Prionailurus viverrinus) reveals extant viral localization in kidneys

Carnivore protoparvovirus-1 (CPPV-1), a viral species containing feline panleukopenia virus (FPV) and canine parvovirus (CPV) variants, are widely spread among domestic and wild carnivores causing systemic fatal diseases. Wild fishing cats (Prionailurus viverrinus), a globally vulnerable species, have been found dead. Postmortem examination of the carcasses revealed lesions in intestine, spleen and kidney. CPPV-1 antigen identification in these tissues, using polymerase chain reaction (PCR) and immunohistochemistry (IHC), supported the infection by the virus. PCR- and IHC-positivity in kidney tissues revealed atypical localization of the virus while in situ hybridization (ISH) and transmission electron microscopy (TEM) with the pop-off technique confirmed the first description of viral localization in kidneys. Complete genome characterization and deduced amino acid analysis of the obtained CPPV-1 from the fishing cats revealed FPV as a causative agent. The detected FPV sequences showed amino acid mutations at I566M and M569R in the capsid protein. Phylogenetic and evolutionary analyses of complete coding genome sequences revealed that the fishing cat CPPV-1 genomes are genetically clustered to the FPV genomes isolated from domestic cats in Thailand. Since the 1970s, these genomes have also been shown to share a genetic evolution with Chinese FPV strains. This study is the first evidence of CPPV-1 infection in fishing cats and it is the first to show its localization in the kidneys. These findings support the multi-host range of this parvovirus and suggest fatal CPPV-1 infections may result in other vulnerable wild carnivores.

Update on Canine Parvoviral Enteritis

Canine parvoviral enteritis is one of the most common causes of morbidity and mortality in dogs worldwide. Tests can detect viral antigen in feces, and characteristic decreases in total leukocyte, neutrophil, and lymphocyte counts can increase the index of suspicion in affected cases and can be used to prognosticate morbidity and mortality. The standard of care for infected animals includes IV crystalloid and sometimes colloid fluids, antiemetics, broad-spectrum antibiotics, and early enteral nutrition. Vaccination induces protective immunity in most dogs. Vaccination, along with limiting exposure in young puppies, is the most effective means of preventing parvoviral enteritis in dogs.

Changes in renal parameters and their association with subclinical vector-borne infections in Bernese Mountain dogs

Background

An increased risk for glomerulonephritis and a higher prevalence of antibodies to Borrelia (B.) burgdorferi sensu lato have been reported in Bernese mountain dogs (BMDs). The aim of the study was to determine the prevalence of laboratory abnormalities suggestive of kidney disease in clinically healthy BMDs compared to a control population and to investigate if there is a correlation with the occurrence of antibodies to B. burgdorferi sensu lato, Ehrlichia canis, and Anaplasma (A.) spp. and with the occurrence of Dirofilaria (D.) immitis antigen.

A total of 197 BMDs and 57 control dogs were included in the study. Laboratory evidence of kidney disease was defined as renal azotemia and/or proteinuria with a urine protein creatinine ration of more than 0.5 in an inactive urine sediment. A SNAP®4Dx® ELISA (IDEXX, Laboratories, Inc., Westbrook, ME, USA) was used to detect antibodies to B. burgdorferi sensu lato, E. canis and Anaplasma spp. and antigen of D. immitis.

Results

Laboratory evidence of kidney disease was significantly more common in BMDs than in control dogs (17.8% versus 1.8%) (p = 0.005). The proportion of BMDs with anti-B. burgdorferi sensu latu antibodies and anti-A. phagocytophilum antibodies was significantly higher in BMDs (p <  0.001). However, an association between these findings could not be identified.

Conclusion

BMDs are more often affected by kidney disease and have a higher prevalence of antibodies to bacterial pathogens transmitted by Ixodes ticks than control dogs. However, a causal relationship between these two variables could not be established due to a lack of association between these two findings.

Haemostatic changes associated with fluid resuscitation in canine parvoviral enteritis

The haemostatic status of dogs with canine parvovirus (CPV) enteritis, within 24 h of admission after initial fluid administration, has been described previously, but the haemostatic status at admission and after standard fluid resuscitation, as well as after initial fluid redistribution, has not been investigated previously. The objective of this study was to characterise the haemostatic status at admission and describe the effect of crystalloid fluid resuscitation on haemostatic variables in dogs with CPV enteritis. Twenty-seven client-owned, hospitalised dogs with confirmed natural CPV infection and 15 healthy age-matched controls were included in a prospective, observational clinical study. The volume of resuscitation fluid, haematocrit (HCT), platelet count, thromboelastography (TEG) variables, antithrombin (AT) activity, fibrinogen- and C-reactive protein (CRP) concentrations were measured in all dogs at admission, after fluid resuscitation and, in 10 dogs, after receiving an additional 3 hours of maintenance-rate crystalloid fluids. For the CPV group at admission, the median TEG reaction time (R) and maximum amplitude (MA) or clot strength, as well as the median HCT, fibrinogen and CRP concentrations, were significantly increased compared to the controls. After fluid resuscitation, median R was significantly shorter, MA significantly increased and HCT and AT activity significantly decreased compared to admission values. The haemostatic variables remained unchanged after 3 h of maintenance-rate crystalloid therapy. The increased clot strength present in dogs with CPV enteritis at admission was exacerbated after fluid resuscitation and persisted for hours after large-volume crystalloid fluid administration.

Renal ischemia/reperfusion injury: An insight on in vitro and in vivo models

Optimal tissue oxygenation is essential for its normal function. Suboptimal oxygenation or ischemia contributes to increased mortalities during various pathological conditions such as stroke, acute kidney injury (AKI), cardiac failure. Despite the rapid progression of renal tissue injury, the mechanism underlying renal ischemia/reperfusion injury (IRI) remains highly unclear. Experimental in vitro and in vivo models epitomizing the fundamental process is critical to the research of the pathogenesis of IRI and the development of plausible therapeutics. In this review, we describe the in vitro and in vivo models of IRI, ranges from proximal tubular cell lines to surgery-based animal models like clamping of both renal pedicles (bilateral IRI), clamping of one renal pedicle (unilateral IRI), clamping of one/or both renal arteries/or vein, or unilateral IRI with contralateral nephrectomy (uIRIx). Also, advanced technologies like three-dimensional kidney organoids, kidney-on-a-chip are explained. This review provides thoughtful information for establishing reliable and pertinent models for studying IRI-associated acute renal pathologies.

Urine neutrophil gelatinase-associated lipocalin to diagnose and characterize acute kidney injury in dogs

BACKGROUND

Urine neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker of acute kidney injury (AKI) in dogs.

OBJECTIVES

To evaluate the utility of urinary NGAL for characterizing AKI according to volume responsiveness, presence of inflammation and sepsis, and prognosis.

ANIMALS

Dogs with AKI (n = 76) and healthy controls (n = 10).

METHODS

Prospective study. Clinical and clinicopathologic data including absolute urine NGAL concentration (uNGAL) and NGAL normalized to urine creatinine concentration (uNGALC) were measured upon admission. Dogs were graded according to International Renal Interest Society (IRIS) AKI guidelines and compared based on AKI features: volume-responsive (VR-) AKI vs. intrinsic (I-) AKI based on IRIS criteria; VR-AKI and I-AKI based on urine chemistry; inflammatory versus noninflammatory; septic versus nonseptic; and survivors versus nonsurvivors. Nonparametric statistics were calculated, and significance set at P < .05.

RESULTS

Urinary NGAL was significantly higher in dogs with AKI compared to controls, regardless of AKI grade. Urinary NGAL did not differ between dogs with VR-AKI and I-AKI based on IRIS criteria, whereas higher uNGALC was recorded in dogs with I-AKI based on urine chemistry. Urinary NGAL was significantly higher in dogs with inflammatory AKI, whereas no difference with respect to sepsis or outcome was identified.

CONCLUSIONS AND CLINICAL IMPORTANCE

Urinary NGAL is a sensitive marker for AKI in dogs, but its specificity is affected by systemic inflammation. Increased urinary NGAL in both I-AKI and VR-AKI also suggests the presence of tubular damage in transient AKI. Combining urine chemistry data with IRIS criteria could facilitate AKI characterization in dogs.