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Abstract
Nephrotoxic and hemodynamically mediated disorders are the most common causes of acute renal failure (ARF) in horses and foals. Leptospira spp. is the most common infectious cause of ARF. Initial treatments for ARF include elimination of nephrotoxic drugs, correction of predisposing disorders, and fluid therapy to promote diuresis. Horses and foals with polyuric ARF often have a good prognosis, while those with oliguric or anuric ARF have a guarded to poor prognosis. When fluid therapy is unsuccessful in improving urine production, various drugs treatments have been used in an attempt to increase urine production, but none are consistently effective in converting oliguria to polyuria.
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Affiliation(s)
- Thomas J Divers
- College of Veterinary Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853-6401, USA.
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Gough RL, McGovern KF. Serum symmetric dimethylarginine concentration in healthy neonatal Thoroughbred foals. Equine Vet J 2021; 54:958-964. [PMID: 34606121 DOI: 10.1111/evj.13520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/21/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Symmetric dimethylarginine (SDMA) is widely used in other species as a marker of renal dysfunction and is considered a more sensitive indicator of glomerular filtration rate than creatinine. Reference ranges are established in healthy adult horses (≤14 μg/dL) and concentrations are increased in horses with acute kidney injury (median 32 μg/dL; range 15-92). OBJECTIVES To establish the normal range of SDMA concentrations in neonatal Thoroughbreds. STUDY DESIGN Cross-sectional. METHODS Blood samples were collected from Thoroughbred foals <36 h old deemed healthy by physical examination. Exclusion criteria included foals from mares undergoing treatment for placentitis and foals that developed clinical disease or died/euthanised <2 weeks from birth. Biochemistry and serum SDMA concentrations were obtained. RESULTS Subjects included 120 foals. Median age was 13.5 h (range 1.0-34.0). Median and 95% confidence interval for SDMA concentration was 69.0 µg/dL (63.0, 75.0; range 35.0-376.0). A cut-off value of 168 µg/dL would include 95% of individuals and is therefore suggested. Serum SDMA concentration was correlated with age (R = -.3, P = .003), creatinine concentration (R = .6, P ≤ .001) and urea concentration (R = .3, P = .002). MAIN LIMITATIONS Limitations include a small sample size, no consideration of subclinical disease and a short follow-up period. CONCLUSIONS In equine neonates, SDMA concentration is higher than in adult horses, older foals and adults with acute kidney injury. Therefore, currently SDMA cannot be used as a marker of renal dysfunction in this age group. Further work is required to assess whether SDMA concentration is increased in neonates with renal disease and, if so, what cut-off should be used.
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Frączkowska K, Trzebuniak Z, Żak A, Siwińska N. Measurement of Selected Renal Biochemical Parameters in Healthy Adult Donkeys Considering the Influence of Gender, Age and Blood Freezing. Animals (Basel) 2021; 11:1748. [PMID: 34208098 PMCID: PMC8230895 DOI: 10.3390/ani11061748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 12/24/2022] Open
Abstract
The reference values of the serum and urine biochemical parameters have not been well-studied in donkeys. This study aimed to assess the normal values of the selected renal biomarkers, such as: serum creatinine, blood urea nitrogen (BUN), albumin, total protein (TP), electrolytes and symmetric dimethylarginine (SDMA), urine protein concentration (UPC), urine protein/creatinine ratio (UPCR), the urine gamma-glutamyl transferase (GGTP)-to-creatinine ratio, serum creatinine-to-urine creatinine ratio (sCr/uCr), serum BUN-to-serum creatinine ratio (sBUN/sCr) and UPC-to-TP ratio, as well as the fractional electrolyte excretion of sodium (FENa) and potassium (FEK) in donkeys. The effects of age, gender and deep freezing of the serum material were investigated. Sixty-five healthy adult donkeys were involved in this study. The results showed higher BUN and TP values and lower albumin, UPCR, FENa and FEK levels in donkeys when compared to the reference values in horses. A significant gender relationship for creatinine and BUN was found. Age influenced the values of albumin, TP, potassium and chlorine. Potassium, sodium and SDMA did not show significant concentration changes after freezing. The study results demonstrated that horse reference range values for some parameters cannot be applied to donkey samples. Only a few of the serum parameters were not affected by freezing, and this should be taken into account when storing biological materials.
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Affiliation(s)
- Kaja Frączkowska
- Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, 50-375 Wroclaw, Poland; (K.F.); (Z.T.)
| | - Zuzanna Trzebuniak
- Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, 50-375 Wroclaw, Poland; (K.F.); (Z.T.)
| | - Agnieszka Żak
- Department of Immunology, Pathophysiology and Veterinary Preventive Medicine, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, 50-375 Wroclaw, Poland;
| | - Natalia Siwińska
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, 50-366 Wroclaw, Poland
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Siwinska N, Zak A, Paslawska U. Detecting acute kidney injury in horses by measuring the concentration of symmetric dimethylarginine in serum. Acta Vet Scand 2021; 63:3. [PMID: 33446216 PMCID: PMC7809759 DOI: 10.1186/s13028-021-00568-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) in horses may develop as a complication of a primary disease or following the administration of nephrotoxic drugs, and may pose a diagnostic challenge. Hence, the main objective of this study was to evaluate the concentrations and diagnostic significance of serum symmetric dimethylarginine (SDMA) and conventional renal dysfunction biomarkers in healthy horses, horses at risk of developing AKI, and horses with clinically evident AKI. A second aim was to assess how gastrointestinal disease and exposure to potentially nephrotoxic drugs affected SDMA levels. Thirty healthy horses, 30 horses with gastrointestinal disease and/or receiving phenylbutazone or gentamicin (risk group) and 11 horses with AKI were included in the study. Serum SDMA levels were measured using commercially available enzyme immunoassay tests. RESULTS SDMA levels in healthy horses, horses at risk of AKI and horses with AKI were 12 µg/dL (11-14), 12 µg/dL (11-13) and 20 µg/dL (20-37), respectively (all results presented as a median (quartile 1-quartile 3)). There was a significant difference in SDMA concentration between the healthy horses and those with AKI, whereas the SDMA levels in healthy horses and those at risk of AKI were comparable. A SDMA cut-off value of 19 µg/dL was established. Horses from the risk group had higher urine protein concentration and urine protein to creatinine ratio compared with healthy horses. Furthermore, horses with colic from the risk group presented with elevated urine γ-glutamyl transpeptidase to creatinine ratio. CONCLUSION The SDMA cut-off value established in healthy horses was higher than previously reported. The SDMA level correlated with the azotaemia levels. Horses from the AKI risk group had normal SDMA levels but single urine parameters was abnormal indicating their higher sensitivity in assessing subclinical kidney dysfunction.
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Affiliation(s)
- Natalia Siwinska
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, C.K. Norwida 25, 50-375 Wroclaw, Poland
| | - Agnieszka Zak
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, C.K. Norwida 25, 50-375 Wroclaw, Poland
- Department of Immunology, Pathophysiology and Veterinary Preventive Medicine, University of Environmental and Life Sciences, C.K. Norwida 25, 50-375 Wroclaw, Poland
| | - Urszula Paslawska
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, C.K. Norwida 25, 50-375 Wroclaw, Poland
- Veterinary Institute, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, Torun ul. Gagarina 7, 87-100 Torun, Poland
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Schott HC, Esser MM. The Sick Adult Horse: Renal Clinical Pathologic Testing and Urinalysis. Vet Clin North Am Equine Pract 2020; 36:121-134. [PMID: 32037140 DOI: 10.1016/j.cveq.2019.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Clinicopathologic evaluation of renal function and renal disease in sick adult horses remains grounded in detection of azotemia, assessment of serum and urine electrolyte concentrations, and evaluation of urinalysis findings, including specific gravity, reagent strip analysis, and sediment examination. Because increases in serum or plasma urea nitrogen and creatinine concentrations are insensitive indicators of a decreased glomerular filtration rate, there is considerable interest in identifying novel biomarkers of renal function or injury in blood and urine, with serum symmetric dimethylarginine concentration being the most recent addition to the commercial market.
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Affiliation(s)
- Harold C Schott
- Department of Large Animal Clinical Sciences, Veterinary Medical Center, College of Veterinary Medicine, Michigan State University, Room D-202, 736 Wilson Road, East Lansing, MI 48824, USA.
| | - Melissa M Esser
- Department of Large Animal Clinical Sciences, Veterinary Medical Center, College of Veterinary Medicine, Michigan State University, Room D-202, 736 Wilson Road, East Lansing, MI 48824, USA
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Affiliation(s)
- Jessica A. Hokamp
- Department of Veterinary Pathobiology; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
| | - Mary B. Nabity
- Department of Veterinary Pathobiology; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
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Bauquier JR, Boston RC, Sweeney RW, Wilkins PA, Nolen-Walston RD. Plasma Peak and Trough Gentamicin Concentrations in Hospitalized Horses Receiving Intravenously Administered Gentamicin. J Vet Intern Med 2015; 29:1660-6. [PMID: 26426540 PMCID: PMC4895685 DOI: 10.1111/jvim.13626] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 06/17/2015] [Accepted: 08/26/2015] [Indexed: 12/03/2022] Open
Abstract
Background Gentamicin is an aminoglycoside antimicrobial commonly used in horses at 6.6 mg/kg IV once daily. Therapeutic drug monitoring (TDM) can confirm desired peak concentration is reached for common bacterial isolates, and detect toxicosis associated with high trough values. Objectives Determine the relationship between gentamicin dose and plasma concentration in hospitalized horses, and identify a starting dose range to achieve peaks > 32 μg/mL. Animals Sixty‐five horses (2002–2010) receiving once‐daily gentamicin with TDM performed (N = 99 sets). Methods Retrospective study. Data from hospitalized horses including weight, dose, plasma peak, and trough gentamicin concentration, creatinine concentrations and presence of focal or systemic disease were collected from medical records. Peak concentrations measured 25–35 minutes after administration were included (N = 77). Data were divided into low (<7.7 mg/kg), medium (7.7–9.7 mg/kg) and high (>9.7 mg/kg) dose groups, and were grouped by the horse having focal or systemic disease. Results Peak concentrations resulting from doses ≥7.7 mg/kg were 5.74 μg/mL (SE 2.1 μg/mL) greater than peaks from doses <7.7 mg/kg (P = .007). Peak concentrations was 3.6 times more likely to be >32 μg/mL if dose was ≥7.7 mg/kg (P = .04). There were no significant effects of dose on trough or creatinine concentration. At a given dose, horses with focal disease had higher peaks than those with systemic disease (P = .039). Conclusions and Clinical Importance These data suggest gentamicin dosage should be individually determined in horses using TDM, but support an initial once‐daily dose of 7.7–9.7 mg/kg IV to achieve peaks >32 μg/mL and trough concentrations <2 μg/mL. Further studies evaluating the safety of doses >6.6 mg/kg are required.
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Affiliation(s)
- J R Bauquier
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - R C Boston
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - R W Sweeney
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - P A Wilkins
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - R D Nolen-Walston
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
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Burton AJ, Giguère S, Arnold RD. Pharmacokinetics, pulmonary disposition and tolerability of liposomal gentamicin and free gentamicin in foals. Equine Vet J 2014; 47:467-72. [DOI: 10.1111/evj.12309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/12/2014] [Indexed: 01/26/2023]
Affiliation(s)
- A. J. Burton
- Department of Large Animal Medicine; College of Veterinary Medicine; University of Georgia; Athens USA
| | - S. Giguère
- Department of Large Animal Medicine; College of Veterinary Medicine; University of Georgia; Athens USA
| | - R. D. Arnold
- Department of Drug Discovery and Development; Harrison School of Pharmacy; Auburn University; Alabama USA
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Hovanessian N, Davis J, McKenzie H, Hodgson J, Hodgson D, Crisman M. Pharmacokinetics and safety of firocoxib after oral administration of repeated consecutive doses to neonatal foals. J Vet Pharmacol Ther 2013; 37:243-51. [DOI: 10.1111/jvp.12082] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- N. Hovanessian
- Virginia-Maryland Regional College of Veterinary Medicine; Blacksburg VA USA
| | - J.L. Davis
- North Carolina State University College of Veterinary Medicine; Raleigh NC USA
| | - H.C. McKenzie
- Virginia-Maryland Regional College of Veterinary Medicine; Blacksburg VA USA
| | - J.L. Hodgson
- Virginia-Maryland Regional College of Veterinary Medicine; Blacksburg VA USA
| | - D.R. Hodgson
- Virginia-Maryland Regional College of Veterinary Medicine; Blacksburg VA USA
| | - M.V. Crisman
- Virginia-Maryland Regional College of Veterinary Medicine; Blacksburg VA USA
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Barton MH, Parviainen A, Norton N. Polymyxin B protects horses against induced endotoxaemia in vivo. Equine Vet J 2010; 36:397-401. [PMID: 15253079 DOI: 10.2746/0425164044868350] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY A safe, affordable and effective treatment for endotoxaemia in horses is needed in order to reduce the incidence of this potentially fatal condition. OBJECTIVE To evaluate the effect of polymyxin B (PMB) on signs of experimentally-induced endotoxaemia. HYPOTHESIS PMB ameliorates the adverse effects of endotoxaemia without causing nephrotoxicity. METHODS Four groups of 6 healthy mature horses each received 20 ng endotoxin/kg bwt i.v. over 30 mins. Additionally, each group received one of the following i.v.; 5000 u PMB/kg bwt 30 mins before endotoxin infusion; 5000 u PMB/kg bwt 30 mins after endotoxin infusion; 1000 u PMB/kg bwt 30 mins prior to endotoxin infusion; or saline. Clinical response data and samples were collected to determine neutrophil count, serum tumour necrosis factor (TNF) activity, plasma thromboxane B2 concentration and urine gamma glutamyltranspeptidase (GGT) to creatinine ratio. RESULTS Treatment with PMB before or after administration of endotoxin significantly reduced fever, tachycardia and serum TNF, compared to horses receiving saline. The differences in response to endotoxin were greatest between horses that received saline vs. those that received 5000 u PMB/kg bwt prior to endotoxin. Urine GGT:creatinine did not change significantly. CONCLUSIONS AND POTENTIAL RELEVANCE This study indicates that PMB may be a safe and effective treatment of endotoxaemia, even when administered after onset. Although nephrotoxicity was not demonstrated with this model, caution should be exercised when using PMB in azotaemic patients.
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Affiliation(s)
- M H Barton
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia 30602, USA
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Dacre KJP, Pirie S, Prince DP. Choke, pleuropneumonia and suspected gentamicin vestibulotoxicity in a horse. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2003.tb00208.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Urinary Activities of Proximal Tubule Enzymes in Neonates Treated with GentamicinIn order to determine the nephrotoxicity of gentamicin, an aminoglycoside antibiotic, activity of the enzymes dominantly localized in proximal tubules, i.e. alanine aminopeptidase (AAP), γ-glutamyl transferase (GGT) and N-acetylβ-D-glucosaminidase (NAG) was examined. Determinations were performed in 12-h urine samples of 30 neonates i.v. receiving gentamicin against Gram negative infections in daily doses of 5.0 mg/kg body mass for 10 consecutive days. The activities of the same enzymes were measured in 12-h urine samples of 30 examinées of the control group. The groups consisted of neonates of both sexes. The pretreatment period lasted for 5 days. On day 8 of gentamicin application, statistically significant differences in the activity of AAP and GGT expressed in U/mmol creatinine between the gentamicin-receiving and control group (p<0.01) were found. No significant differences in NAG activity of the gentamicin-treated group in comparison with the control were recorded during the 10-day gentamicin therapy. It can be concluded that 10-day treatment of neonates with usually prescribed gentamicin doses results in mild nephrotoxic changes close to the end of the therapy accompanied by increased activity of both urinary AAP and GGT, known as very sensitive indicators of nephrotoxicity. During the same treatment period no changes in NAG activity were observed, meaning that the antibiotic causes no severe injuries to proximal tubule cells at the level of cellular organelles.
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Savage CJ. Urinary clinical pathologic findings and glomerular filtration rate in the horse. Vet Clin North Am Equine Pract 2008; 24:387-404, vii. [PMID: 18652961 DOI: 10.1016/j.cveq.2008.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Urinary specific gravity (USG) measurements are underused by equine ambulatory veterinarians. Urinary dipstick and USG findings can assist in the diagnosis and prognosis of many disease processes in the horse. Simple methods for measurement of the glomerular filtration rate and urinary biochemical markers can improve equine urinary diagnostic abilities in critical care patients. Fractional excretion of electrolytes and minerals assists in fluid care and in management of nutrition of horses.
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Affiliation(s)
- Catherine J Savage
- Equine Clinical Services, Equine Centre, University of Melbourne, 250 Princes Highway, Werribee, Victoria 3030, Australia.
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Scarpa P, Di Fabio V, Ramirez C, Baggiani L, Ferro E. Proteinuria, GGT index and fractional clearance of electrolytes in exercising athletic horses. Vet Res Commun 2007; 31 Suppl 1:339-42. [PMID: 17682909 DOI: 10.1007/s11259-0061-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P Scarpa
- Department of Veterinary Clinical Sciences - Section of Internal Medicine and Veterinary Laboratory Medicine - Faculty of Veterinary Medicine, University of Milan, Milan, Italy.
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Driessen B, Zarucco L, Steffey EP, McCullough C, Del Piero F, Melton L, Puschner B, Stover SM. Serum fluoride concentrations, biochemical and histopathological changes associated with prolonged sevoflurane anaesthesia in horses. JOURNAL OF VETERINARY MEDICINE. A, PHYSIOLOGY, PATHOLOGY, CLINICAL MEDICINE 2002; 49:337-47. [PMID: 12440788 DOI: 10.1046/j.1439-0442.2002.00462.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The volatile anaesthetic sevoflurane is degraded to fluoride (F-) and a vinyl ether (Compound A), which have the potential to harm kidney and liver. Whether renal and hepatic injuries can occur in horses is unknown. Cardiopulmonary, biochemical and histopathological changes were studied in six healthy thoroughbred horses undergoing 18 h of low-flow sevoflurane anaesthesia. Serum F- concentrations were measured and clinical laboratory tests performed to assess hepatic and renal function before and during anaesthesia. Necropsy specimens of kidney and liver were harvested for microscopic examination and compared to pre-experimental needle biopsies. Cardiopulmonary parameters were maintained at clinically acceptable levels throughout anaesthesia. Immediately after initiation of sevoflurane inhalation, serum F- levels began to rise, reaching an ongoing 38-45 micromol 1(-1) plateau at 8 h of anaesthesia. Serum biochemical analysis revealed only mild increases in glucose and creatinine kinase and a decrease in total calcium. Beyond 10 h of anaesthesia mild, time-related changes in urine included increased volume, glucosuria and enzymuria. Histological examination revealed mild microscopic changes in the kidney involving mainly the distal tubule, but no remarkable alterations in liver tissue. These results indicate that horses can be maintained in a systemically healthy state during unusually prolonged sevoflurane anaesthesia with minimal risk of hepatocellular damage from this anaesthetic. Furthermore, changes in renal function and morphology observed after sevoflurane inhalation are judged minimal and appear to be clinically irrelevant; they may be the result of anaesthetic duration, physiological stressors, sevoflurane (or its degradation products) or other unkown factors associated with these animals and study conditions.
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Affiliation(s)
- B Driessen
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, 95616, USA.
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