Evaluation of Canine Pancreas-Specific Lipase Activity, Lipase Activity, and Trypsin-Like Immunoreactivity in an Experimental Model of Acute Kidney Injury in Dogs

Evaluation of Disease Spectrum in Hospitalized Cats with Hyperlipasemia: Pancreatitis Alone Is Rare, Hyperlipasemia without Suspected Pancreatitis Is Common

Histological evidence of pancreatitis is commonly found in necropsy studies in cats. A clinical diagnosis of pancreatitis is challenging due to nonspecific clinical signs, a lack of diagnostic lipase cutoffs, and frequent presence of multiple diseases. It is still unknown how often pancreatitis alone is found in sick cats and how often clinicopathological evidence of pancreatitis in sick cats does not lead to a clinical diagnosis of pancreatitis. Our aims were to evaluate the extent of comorbidities in cats with suspected pancreatitis, evaluate how often sick cats with hyperlipasemia are diagnosed only with non-pancreatic diseases, and compare their clinical findings. Medical records of 563 client-owned hospitalized cats with available lipase activity measurement (LIPC Roche) > 30 U/L (RI, 6-26) were searched and medical diagnoses recorded and grouped by organ system. Clinicopathological findings were compared between cats with pancreatitis alone (PA), pancreatitis with concurrent disease (PD), and no suspected pancreatitis (NP). We found that PA was present in 33 (6%) cats, 159 cats (28%) were in the PD group, and 371 cats (66%) had no suspected pancreatitis (NP). Clinical, laboratory, and ultrasonographic findings did not differ between PA and PD cats. Lipase activities did not differ between the three groups. The most common disease categories in PD and NP cats were gastrointestinal, hepatobiliary, renal/urinary, and endocrine, and renal/urinary, gastrointestinal, cardiac, and musculoskeletal, respectively. We conclude that cats are rarely hospitalized because of suspected pancreatitis alone, and PA cats did not differ clinically from PD cats. Hyperlipasemia in sick cats without a diagnosis of pancreatitis may be due to a reactive pancreatopathy or preexisting chronic pancreatitis.

A comparative analysis of canine pancreatic lipase tests for diagnosing pancreatitis in dogs

IMPORTANCE

Early diagnosis of canine pancreatitis is challenging due to non-specific clinical signs. Currently, abdominal ultrasonography and measurement of canine pancreatic lipase (cPL) have been employed for the diagnosis of pancreatitis.

OBJECTIVE

Many qualitative and quantitative commercial cPL tests have been developed and used in veterinary clinics. This study aimed to compare three different methodologies SNAP cPL, Spec cPL, and Vcheck cPL tests to assess the concordance of these assays.

METHODS

Fifty serum samples were collected from 36 dogs with or without pancreatitis and subjected to SNAP cPL, Spec cPL, and Vcheck cPL tests. Agreement and correlation coefficients were calculated between the test results, and correlations were determined during the management of the patients.

RESULTS

The results of the three cPL assays were strongly correlated in 47/50 serum samples (94%). Cohen's kappa analysis between the Spec cPL and Vcheck cPL showed near perfect agreement (κ = 0.960, p < 0.001), SNAP cPL and Vcheck cPL (κ = 0.920, p < 0.001), and Spec cPL and SNAP cPL (κ = 0.880, p < 0.001). The correlation coefficients (r) between data from Spec cPL and Vcheck cPL tests was calculated by Spearman's correlation test (r = 0.958, p < 0.001). Furthermore, the patterns of change in serum cPL concentrations determined using Spec cPL and Vcheck cPL were significantly consistent during the monitoring period in 11 patients.

CONCLUSIONS AND RELEVANCE

Our data illustrated that Spec cPL and Vcheck cPL tests are compatible for clinical use in the diagnosis and monitoring of canine pancreatitis.

Clinical enzymology of the dog and cat

Clinical enzymology studies the enzyme activity in serum or other body fluids for the diagnosis, prognosis or monitoring of a variety of diseases. Clinical enzymology has greatly benefited from advances in technology and is now an integral part of laboratory analysis. However, to maximise the clinical benefits of serum enzyme measurement, clinicians and clinical pathologists must have a good understanding of the pathophysiology behind serum enzyme alterations. They must also be aware of the preanalytical and analytical factors that can affect the accuracy of serum enzyme activity measurement. This review article first covers the basic concepts of clinical enzymology and the general mechanisms related to serum enzyme alterations. Then, the review discusses the potential effects of various preanalytical and analytical factors on enzyme activity measurement. Lastly, it explores the pathophysiology and clinical use of various serum enzymes in canine and feline medicine. The present review article aims to be a comprehensive one-stop source for clinical pathologists and small animal practitioners.

Fuzapladib in a randomized controlled multicenter masked study in dogs with presumptive acute onset pancreatitis

BACKGROUND

Currently, no specific treatment is available for acute onset pancreatitis (AP), and management relies on symptomatic and supportive standard of care (SOC). Fuzapladib is a novel leukocyte function-associated antigen type-1 (LFA-1) activation inhibitor, blocking activation and subsequent adhesion and migration of neutrophils, potentially decreasing the risk of pancreatitis progression and systemic inflammation.

OBJECTIVE

Evaluate the safety and clinical response of dogs with AP after 3 days of administration of fuzapladib.

ANIMALS

Sixty-one client-owned dogs with presumptive AP.

METHODS

Randomized, masked, and placebo controlled multicenter study. Sixty-one dogs with AP were included for safety assessment, whereas 35 evaluable cases (fuzapladib, n = 16; placebo, n = 19) were included for clinical evaluation. Clinical improvement was assessed based on the change in the modified clinical activity index (MCAI) score on Day 3 compared to Day 0. Secondary variables included canine acute pancreatitis clinical severity index (CAPCSI) scores and serum concentrations of canine pancreatic lipase immunoreactivity, cytokines, and C-reactive protein.

RESULTS

Fuzapladib was well tolerated by all treated dogs. Mean change in MCAI scores was significantly higher in the fuzapladib-treated (-7.75) than the placebo group (-5.68; P = .02, 95% confidence interval [CI] for the difference, -4.33, -0.35), suggesting clinical improvement in fuzapladib-treated dogs. No significant difference was found in any of the secondary variables between groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Administration of fuzapladib to dogs was safe, and a favorable response was detected in 2 clinical activity scores. Effects of fuzapladib on survival and duration of hospitalization were not studied.

Utility of 1,2-o-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin)-ester-lipase for monitoring dogs with chronic pancreatitis

BACKGROUND

The utility of 1,2-o-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin)-ester-(DGGR)-lipase activity (DLA) in monitoring clinical progression of chronic pancreatitis (CP) in dogs is unknown.

OBJECTIVE

To examine the association of DLA with clinical signs of CP, as assessed by a CP clinical severity score (CPCSS).

ANIMALS

Twenty-four dogs.

METHODS

This is a retrospective study. Chronic pancreatitis was diagnosed based on clinical signs and DLA > 250 U/L and monitored using CPCSS and DLA.

RESULTS

The study included 134 visits (median, 10 visits/dog; range, 2-11). Mild-moderate (CPCSS, 0-3) and severe (CPCSS, ≥4) disease were documented in 94 (70%) and 40 (30%) visits, respectively. In emergency visits (n = 44; 33%) CPCSS (median, 5; range, 0-15) and DLA (median, 534 U/L; range, 63-7133) were higher (P < .001 and P = .003, respectively) than in scheduled ones (n = 90; 67%; median, 1; range, 0-6 and median, 384 U/L; range, 49-3747, respectively). DGGR-lipase activity was associated (P = .009) with the CPCSS, with a lower activity documented in mild-moderate CPCSS (median 391 U/L; range, 49-3747), compared to severe score (median, 558 U/L; range, 63-7133). DGGR-lipase activity was significantly, but weakly, correlated with CPSS (r = 0.233, P = .007). DGGR-lipase activity inefficiently discriminated mild-moderate vs severe CP (area under the receiver operator characteristics curve, 0.64; 95% confidence interval, 0.53-0.75; P = .012), with DLA cutoff of 428 U/L corresponding to sensitivity of 65% and specificity of 63%.

CONCLUSIONS AND CLINICAL IMPORTANCE

Increased DLA is associated with emergency revisits in dogs with CP, possibly reflecting acute flare-ups. DGGR-lipase activity was associated with the CPCSS over the follow-ups but could not differentiate disease severity.

Assessment of changes in blood pancreatic lipase activities using FDC-v-LIP in dogs that underwent various surgical procedures

OBJECTIVE

To describe the perioperative changes in blood pancreatic lipase activity and explore the contributing clinical factors associated with these changes.

DESIGN

Prospective observational study.

SETTING

University teaching hospital.

ANIMALS

One hundred and four dogs underwent various surgical procedures under general anesthesia.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Blood pancreatic lipase activities, which were measured using FUJI DRI-CHEM v-Lip-P (FDC-v-Lip), significantly increased postoperatively compared to preoperative measurements (premedian 58.5 U/L [range, 23-157] vs. postmedian 80 U/L [range, 22-1000], P < 0.0001). The patient with a postoperative increase in FDC-v-Lip over the normal range (35 dogs [33.6%]) had significantly higher preoperative FDC-v-Lip values.

CONCLUSIONS

In this study, dogs had significantly increased pancreas-specific lipase activities after surgical procedures under general anesthesia. Direct contributors to the increase and its relevance to clinical and histological pancreatitis should be determined in the future.

Risk Factors and Clinical Presentation in Dogs with Increased Serum Pancreatic Lipase Concentrations—A Descriptive Analysis

Simple Summary

Over the past several years, there has been an increasing importance placed on clinical presentation as part of a diagnosis of pancreatitis, and yet there is comparatively little data investigating the full array of clinical signs that may be seen in dogs with pancreatitis. Our study showed that dogs with increased pancreatic lipase immunoreactivity concentrations could display a wide range of clinical signs, which may be related to pancreatitis or a concurrent disease. Non-specific clinical signs, such as anorexia, were prevalent. Additionally, overt abdominal pain was infrequently reported, and veterinarians should be cautious in ruling out pancreatitis due to a lack of abdominal pain alone. Additionally, limited data is available on potential risk factors for pancreatitis in dogs; this information could be important in the development of disease prevention strategies. In our study, the most common concurrent disease was hepatobiliary abnormalities. Additional studies are needed to determine whether this is a causative or associative relationship. Drug use reflected common prescribing practices, and anti-epileptic drug use was low despite prior studies documenting clear associations between phenobarbital and potassium bromide and drug-associated pancreatitis. Adult maintenance diets, in addition to human foods and dog treats, were commonly fed prior to the development of an increased pancreatic lipase concentration.

Abstract

Limited data exist regarding the full array of clinical signs seen in dogs with pancreatitis and potential risk factors for the disease. Laboratory submissions from the Gastrointestinal Laboratory at Texas A&M University were retrospectively reviewed for dogs with an increased serum pancreatic lipase immunoreactivity (cPLI) concentration (≥400 µg/L), and an internet-based survey was distributed to the attending veterinarian and/or technician on each case. The survey contained questions related to (i) clinical signs, (ii) prior gastrointestinal upset, (iii) comorbidities, (iv) pre-existing medical therapies, and (v) dietary history. One hundred and seventy (170) survey responses were recorded. The top three clinical signs reported were inappetence (62%), diarrhea (53%), and vomiting (49%). Abdominal pain was noted in only 32% of dogs, likely associated with poor pain detection. Additionally, the majority of dogs (71%) had prior episodes of gastrointestinal upset within the past 12 months, lending support for the commonality of recurrent acute pancreatitis, or acute on chronic disease. Hepatobiliary abnormalities (24%) were the most common concurrent disease, and endocrine disorders were seen in a low proportion of respondents (5–8%). Adult maintenance diets (65%), dog treats (40%), and human foods (29%) were commonly consumed by dogs prior to the discovery of increased cPLI concentration.

Effects of medical history and clinical factors on serum lipase activity and ultrasonographic evidence of pancreatitis: Analysis of 234 dogs

Background

Lipase measurements and ultrasonographic (US) evidence of pancreatitis correlate poorly.

Objectives

Identify explanations for discrepant lipase and pancreatic US results.

Animals

Two hundred and thirty‐four dogs with gastrointestinal signs.

Methods

A retrospective study was conducted, in which lipase activity and US were performed within 30 hours. Medical history, clinical examination results, lipase activity, and US results were recorded.

Results

Lipase and US results were weakly correlated (r_s = .25, P < .001). At both evaluated time cut‐offs, median lipase activities were significantly higher with shorter durations of clinical signs before presentation (≤2 days, 334 U/L; >2 days, 118 U/L; P = .03; ≤7 days, 334 U/L; >7 days, 99 U/L; P = .004), but US was not significantly more frequently positive. For both cut‐offs (>216/≤216 U/L, >355/≤355 U/L; reference range, 24‐108 U/L), median disease duration was significantly shorter (3 vs 4 days) with higher lipases. Previous pancreatitis episodes were significantly associated with an US diagnosis of pancreatitis (P = .04), but median lipase activities were not significantly higher (386 U/L vs 153 U/L; P = .06) in these dogs. Pancreatic US was significantly more often positive when the request contained “suspicion of pancreatitis” (P < .001) or “increased lipase” (P = .01). Only changes in pancreatic morphology, echogenicity, and peripancreatic mesentery were significantly associated with a positive US diagnosis, and also had significantly higher lipase activities.

Conclusions and Clinical Importance

Duration of clinical signs before presentation differently affects laboratory and US evidence of pancreatitis. Previous pancreatitis episodes and information given to radiologists influence US results. These findings can be helpful for future studies on pancreatitis in dogs.

Accuracy of 1,2-o-Dilauryl-rac-glycero-3-glutaric Acid-(6'-methylresorufin) Ester (DGGR)-Lipase to Predict Canine Pancreas-Specific Lipase (cPL) and Diagnostic Accuracy of Both Tests for Canine Acute Pancreatitis

Different lipase assays have variable reported diagnostic accuracies for acute pancreatitis (AP) in dogs. The aims of this retrospective study were to evaluate optimal cutoffs for 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) ester (DGGR)-lipase to predict diagnostic cutoffs of canine pancreas-specific lipase (cPL; IDEXX). DGGR-lipase activity and cPL from the same blood draw in 301 dogs with a variety of diseases were compared using Spearman’s rank correlation, Cohen’s kappa agreement, and receiver operating characteristic (ROC) curves. Activity of DGGR-lipase (10−15,616 U/L) and cPL concentrations (8.1−≥2000 µg/L) were highly correlated (rs = 0.91). Areas under the ROC curves (AUCs) to predict cPL >200 and ≥400 µg/L with DGGR-lipase were 0.97 and 0.99, with optimal cutoffs of 143 U/L (sensitivity (Se) 91.7%; specificity (Sp) 95.3%) and 205 U/L (Se 97.5%; Sp 96.4%), and Cohen’s kappa agreements of 0.87 and 0.92, respectively. AUCs for a clinical diagnosis of AP, assigned to 87/301 dogs, with DGGR-lipase (0.75) and cPL (0.76) did not differ significantly (p = 0.48); optimal cutoffs were 161 U/L for DGGR (Se 67%; Sp 81%) and 235 µg/L for cPL (Se 68%; Sp 84%). To conclude, DGGR-lipase is a highly accurate predictor of cPL with a comparable performance when used to diagnose AP in dogs.

Advances in the diagnosis of acute pancreatitis in dogs

In the last 20 years, the diagnosis of pancreatitis has become more frequent as a result of improved diagnostic modalities such as abdominal ultrasound examination, advanced imaging, and immunoassays for the measurement of pancreatic lipase. Our aim is to provide a state‐of‐the‐art overview of the clinical diagnosis of acute pancreatitis (AP) in dogs with a particular focus on pancreatic lipase assay validation and clinical performance, in addition to advanced imaging modalities. We also discuss the potential indications for cytology and histopathology in dogs with suspected AP.

Serum feline pancreatic lipase immunoreactivity and trypsin-like immunoreactivity concentrations in cats with experimentally induced chronic kidney disease

Background

Serum feline pancreatic lipase immunoreactivity (fPLI) and trypsin‐like immunoreactivity (fTLI) concentrations are commonly used in cats for the evaluation of pancreatic disease. The effect of kidney disease on these tests in cats are unknown.

Objective

To investigate the effect of experimentally induced chronic kidney disease (CKD) on serum fPLI and fTLI concentrations.

Animals

Surplus serum samples from 20 cats with CKD experimentally induced for an unrelated project and a group of healthy control cats.

Methods

Serum fTLI and fPLI concentrations were compared between groups.

Results

Mean (±SD) serum fTLI concentrations in 20 cats with CKD (117.8 ± 63.6 μg/L) were significantly higher than those in healthy cats (n = 32; 46.9 ± 17.5 μg/L; P < .0001). Serum fTLI concentrations in cats with CKD were above the upper limit of the reference interval in 13 of 20 cats (65%). Serum fPLI concentrations were not significantly different between cats with induced CKD (n = 18; 8.6 μg/L; range, 5.4‐9.9 μg/L) and healthy cats (n = 41; 7.4 μg/L; range, 5.0‐15.2 μg/L; P = .12). All cats with experimentally induced CKD had serum fPLI concentrations within the reference interval.

Conclusions and Clinical Importance

Decreased renal function has a clinically relevant impact on serum fTLI concentrations and potentially could interfere with a diagnosis of exocrine pancreatic insufficiency (EPI). Serum fPLI concentration was not affected by experimentally induced CKD and thus serum fPLI may be used for the diagnosis of pancreatitis in cats with kidney disease. Additional studies are needed to verify these results in cats with naturally occurring CKD.

Signalment and Clinical Data of Cats with Exocrine Pancreatic Insufficiency Diagnosed Using Feline Trypsin-like Immunoreactivity in Routine Diagnostics

Serum feline trypsin-like immunoreactivity (fTLI) is commonly used to diagnose feline exocrine pancreatic insufficiency (EPI). This study aimed to describe signalment and clinical data of cats with EPI. Determination of TLI was performed using an in-house ELISA; the reference interval was defined using a Reference Limit Estimator. Groups were formed from 4813 cats (2019-2020), based on their fTLI concentration: 1 (<8 µg/L; decreased; n = 275), 2 (8-88 µg/L; reference interval; n = 4256), and 3 (>88 µg/L; increased; n = 282). Males and Domestic Shorthairs were most common in all groups. Group 3 had the highest (13 years), and group 1 had the lowest (9 years), median age. Clinical information was available for 200 cats (decreased fTLI: n = 87, lower reference interval (8-12 µg/L): n = 113). Treatment response was observed in 83% (decreased fTLI) and 66% (lower reference interval). EPI cats displayed weight loss (69%), diarrhoea (68%), vomiting (41%), anorexia (39%), poor hair coat (35%), lethargy (33%), and/or polyphagia (21%). The lower the serum fTLI concentration, the more often good treatment response was reported (p = 0.022) but there were no statistically significant clinical signs. In conclusion, fTLI is a helpful parameter to diagnose EPI but predicting treatment response based on signalment or clinical signs is not possible.

Effect of prednisolone therapy on serum levels of 1,2-O-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin) ester lipase in dogs

BACKGROUND

Activity of 1,2-O-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin) ester (DGGR) lipase in serum shows good agreement with pancreatic lipase (cPL) in dogs. Although prednisolone therapy does not seem to affect serum cPL concentration, its influence on DGGR lipase is unclear.

OBJECTIVES

The aim of the study was to evaluate the effect of prednisolone therapy on DGGR lipase serum activity in dogs.

ANIMALS

Thirty-four dogs were used, of which 17 dogs received prednisolone (study group) and 17 healthy dogs did not receive treatment.

METHODS

A prospective cohort study measured DGGR lipase activity in both groups at 3 time points: T0, T1, and T2, corresponding to days 0, 7-10, and 21-30, respectively. Dogs from study group presented a medical reason that justified the use of prednisolone for at least 3 weeks. Initial prednisolone dose was .5-2.0 mg/kg/day PO with a reduction at T1 to a final dose that was maintained until T2. DGGR lipase activity >160 U/L was defined as clinically relevant.

RESULTS

In the study group, DGGR lipase activity increased significantly from T0 to T1 (P = .02) and decreased significantly from T1 to T2 (P = .02). Median DGGR activity at each time point (T0, T1, and T2) was 24.74 (14.45-31.48), 36.82 (23.8-80.16), and 29.52 (15.91-48.48) U/L, respectively. In the control group, no significant changes were observed over time (P = .93). The DGGR lipase activity and prednisolone doses were not correlated for both T0-T1 (r_s = .371, P = .14) and T1-T2 (r_s = 0.390, P = .12).

CONCLUSION AND CLINICAL IMPORTANCE

DGGR lipase activity was affected by prednisolone administered orally in dogs. However, this variation was not clinically important as values remained below the relevant upper limit.

Hyperlipasemia in critically ill dogs with and without acute pancreatitis: Prevalence, underlying diseases, predictors, and outcome

Background

Hyperlipasemia is frequent in critically ill people without evidence of acute pancreatitis (AP), and has been associated with increased morbidity and mortality.

Objective

To evaluate the prevalence of hyperlipasemia at admission and development of hyperlipasemia during hospitalization in critically ill dogs, explore factors associated with hyperlipasemia, and evaluate association with outcome.

Animals

Critically ill, client owned dogs (n = 1360), presented on emergency and admitted to the intensive care unit, that had 1,2‐o‐dilauryl‐rac‐glycero‐3‐glutaric acid‐(6′‐methylresorufin) ester (DGGR) lipase activity measured within 24 hours of admission.

Methods

Retrospective cross‐sectional study of clinical and laboratory records.

Results

The DGGR lipase activity was increased >3× the upper reference limit at admission in 216/1360 (16%) dogs, of which 70/216 (32%) had a clinical diagnosis of AP. Other primary conditions associated with hyperlipasemia were renal, endocrine, and immune‐mediated diseases, and upper airway obstruction. Predictors of hyperlipasemia at admission were prior glucocorticoid administration, vomiting and abdominal pain, increased age, plasma bilirubin and creatinine concentrations, and decreased hematocrit. Of dogs with repeat measurements, 78/345 (23%) had significantly increased lipase during hospitalization, of which 13/78 (17%) had a clinical diagnosis of AP. Other primary conditions associated with in‐hospital hyperlipasemia were renal and immune‐mediated disorders. Predictors of developing hyperlipasemia during hospitalization were hemodialysis events, increased plasma bilirubin and creatinine concentrations, and decreased hematocrit. Hyperlipasemia both at admission and during hospitalization was associated with longer hospitalization and higher mortality.

Conclusions and Clinical Importance

Significant DGGR‐hyperlipasemia is frequent in critically ill dogs and associated with a variety of nonpancreatic conditions and negative outcome.

Evaluation of 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester lipase concentrations in cats with kidney disease and with normal SNAP fPL

Measuring 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester (DGGR) lipase activity is a cost-effective test for diagnosing pancreatitis compared to the feline pancreas-specific lipase (Spec fPL) test. However, little is known about the influence of renal insufficiency on DGGR lipase in cats. This study evaluated the influence of renal function on serum DGGR lipase in the cat. Serum samples from 49 cats with normal pancreas-specific lipase immunoreactivity were analyzed for DGGR lipase activity and serum creatinine. Median serum DGGR lipase activity for cats with kidney disease (KD+) was 22 IU/L (range: 9 to 29 IU/L), whereas for cats without kidney disease (KD-) and healthy cats, the medians were 16 IU/L (range: 6 to 32 IUI/L), and 15 IU/L (range: 9 to 23 IU/L), respectively. The KD+ group had significantly higher DGGR lipase concentrations compared to the healthy group (P = 0.030), but most results were within the reference range. There was a weak positive correlation between creatinine and DGGR lipase values (R 2 = 19.6%; P = 0.0014) and no significant correlation between symmetric dimethylarginine (SDMA) and DGGR lipase. Key clinical message: Although cats with kidney disease had significantly higher serum DGGR lipase concentrations than the healthy controls, the difference was small and does not appear to be clinically relevant.

Canine cutaneous and renal glomerular vasculopathy in the Republic of Ireland: a description of three cases

Background

Cutaneous and renal glomerular vasculopathy (CRGV) is a condition of unknown aetiology involving microvascular thrombosis. It has recently been described in over 160 dogs in the United Kingdom and usually has a grave prognosis. To date, this condition has not been described in dogs residing in the Republic of Ireland.

Case presentation

Three dogs presented to University College Dublin Veterinary Hospital (UCDVH) for investigation of rapidly progressive skin lesions. All dogs were diagnosed with CRGV on post-mortem examination. All three dogs had azotaemia on presentation or rapidly developed azotaemia, and all were euthanased because of progression of clinical signs and likelihood of CRGV. One dog was affected by seizure-like episodes and had thrombotic microangiopathy evident within the cerebrum.

Conclusions

CRGV occurs in dogs residing in the Republic of Ireland and is a differential for cases presenting with skin lesions and azotaemia. The histopathological lesions of CRGV can also affect the brain leading to neurological signs such as seizures. Owners and veterinarians should be aware that this condition can occur in dogs in Ireland.

Acute pancreatitis and acute kidney injury in dogs

Acute pancreatitis and acute kidney injury are well-documented comorbidities in human medicine. Dogs that develop acute kidney injury during hospitalization have significantly higher mortality rates than those that do not. The aim of this study was to evaluate the prevalence of acute kidney injury in dogs with acute pancreatitis and the prognostic value of various clinicopathological parameters. Cases of acute pancreatitis presented between January 2012 and June 2016 were identified. The diagnosis of acute pancreatitis was based on two or more of the following clinical signs: abdominal pain, diarrhea, vomiting or anorexia/hyporexia, no other abdominal extra-pancreatic diseases at abdominal ultrasound, and abnormal SNAP cPL test. Diagnosis of acute kidney injury was based on the guidelines of the International Renal Interest Society. Dogs were classified into survivors and non-survivors. Serum creatinine, urea, amylase, total calcium, total cholesterol, C-reactive protein, WBC and band neutrophils were evaluated at admission. Clinical severity index was calculated at admission. Clinical and clinicopathological data were compared between survivors and non-survivors. Sixty-five dogs with acute pancreatitis were assessed. Clinical severity index≥6.5 were associated with poor outcome (P=0.0011). Serum urea and creatinine concentrations at admission were significantly lower in survivors than non-survivors (P<0.0001 and P=0.0002, respectively). Acute kidney injury was diagnosed in 17/65 dogs (26.2%) and was associated with poor outcome (P<0.0001). Oligo-anuria was associated with poor outcome (P=0.0294). Increased clinical severity index and azotemia in dogs with acute pancreatitis were associated with an increased risk of mortality. Acute kidney injury may be a comorbidity of canine acute pancreatitis. The presence of oligo-anuria is associated with poor outcome.

A retrospective study of 157 hospitalized cats with pancreatitis in a tertiary care center: Clinical, imaging and laboratory findings, potential prognostic markers and outcome

BACKGROUND

Pancreatitis in cats (FP) has been increasingly diagnosed in recent years, but clinical studies of large numbers of affected cats are scarce.

OBJECTIVES

To describe a large cohort of cats with FP requiring hospitalization.

ANIMALS

One hundred and fifty-seven client-owned cats.

METHODS

Retrospective study, including cats diagnosed with pancreatitis based on sonographic evidence, positive SNAP feline pancreatic lipase immunoreactivity test results, increased 1,2-o-dilauryl-rac-glycerol-glutaric Acid-(6'-methylresorufin ester)-lipase activity, histopathology, or some combination of these.

RESULTS

One-hundred and twenty-two cats (77.7%) survived to discharge. Median time from onset of clinical signs to presentation was longer (P = .003) in nonsurvivors. Causes of FP included recent general anesthesia, trauma, hemodynamic compromise, and organophosphate intoxication, but most cases (86.6%) were idiopathic. Ultrasonographic findings consistent with pancreatitis were documented in 134 cats, including pancreatomegaly (81.3%), decreased (31.3%), or increased (14.9%) pancreatic echogenicity, extra-hepatic biliary tract dilatation (24%), and increased peri-pancreatic echogenicity (13%). Lethargy (P = .003), pleural effusion (P = .003), hypoglycemia (P = .007), ionized hypocalcemia (P = .016), azotemia (P = .014), parenteral nutrition administration (P = .013), and persistent anorexia during hospitalization (P = .001) were more frequent in nonsurvivors, whereas antibiotics were more frequently administered to survivors (P = .023). Nevertheless, when Bonferroni's correction for multiple comparisons was applied, none of the variables was statistically significant.

CONCLUSIONS AND CLINICAL IMPORTANCE

Previously unreported, clinically relevant, potential prognostic factors, including hypoglycemia, azotemia, parenteral nutrition, and withholding antibacterial treatment were identified in this exploratory study. These preliminary results should be examined further in confirmatory studies.

Effects of immunosuppressive prednisolone therapy on pancreatic tissue and concentration of canine pancreatic lipase immunoreactivity in healthy dogs

The objective of this study was to examine the effects of immunosuppressive prednisolone therapy on pancreatic tissue and the concentration of serum canine pancreatic lipase immunoreactivity (cPLI) in healthy dogs. Six healthy beagle dogs were subcutaneously administered an immunosuppressive dose of prednisolone [4 mg/kg body weight (BW)] once daily for either 2 or 3 weeks. Serum cPLI concentration was measured before and after treatment. Ultrasonographic examination of the pancreas and laparoscopic biopsy and histopathological examination of the right pancreatic lobe and the liver were also conducted before and after treatment. The expression of pancreatic lipase messenger ribonucleic acid (mRNA) in the pancreas and liver was examined by polymerase chain reaction (PCR). Although the serum cPLI concentration was significantly higher on day 14 and on the day of the second laparoscopy than before treatment, it was classified as normal (≤ 200 μg/L) in 5 dogs and as abnormal (≥ 400 μg/L) in only 1 dog. None of the 6 dogs showed clinical signs of pancreatitis during the study period. After treatment, ultrasonographic examination of the pancreas showed no changes except for a hypoechoic pancreas in 1 dog. Histopathological examination of the right pancreatic lobe in all dogs showed no evidence of pancreatitis after treatment. Pancreatic lipase mRNA expression was detected in the pancreas, but not in the liver, before and after treatment. The administration of 4 mg/kg BW per day of prednisolone for 2 or 3 weeks increased the serum cPLI concentration without clinical signs of pancreatitis, although an abnormal cPLI concentration (≥ 400 μg/L) was observed in only 1 dog. No ultrasonographic or histological evidence of pancreatitis was observed in any of the dogs.

Assessment of Canine Pancreas-Specific Lipase and Outcomes in Dogs with Hemodialysis-Dependent Acute Kidney Injury

Background

Renal replacement therapies can be life‐saving for dogs with severe acute kidney injury (AKI), however, comorbidities including pancreatitis might affect outcome.

Hypothesis/Objectives

To investigate the prevalence of pancreas‐specific lipase (Spec cPL) measurements consistent with pancreatitis (≥400 μg/L) in dogs undergoing intermittent hemodialysis (IHD) for treatment of AKI and to determine whether there were associations between 30‐days outcomes and Spec cPL measurements.

Animals

Fifty‐three client‐owned dogs presented to teaching hospitals between November 2008 and September 2016 that underwent IHD.

Methods

Retrospective medical record review from dogs that received IHD for management of AKI and also had a Spec cPL measurement. Association between survival, dialysis‐dependency, and Spec cPL measurements was assessed.

Results

Forty of 53 (76%) dogs were alive at 30‐days and 33/53(62%) had a Spec cPL result ≥400 μg/L. Spec cPL was not significantly different either between surviving (635.5 μg/L, range 29–1,001) and nonsurviving dogs (860 μg/L, range 56–1,001; P = 0.75) or between dialysis‐dependent (1,001 μg/L, range 177–1,001) and nondialysis‐dependent dogs (520 μg/L, range 29–1,001; P = 0.08). Spec cPL ≥400 μg/L was not significantly associated either with survival (P = 0.74) or dialysis‐dependency (P = 0.33).

Conclusions and Clinical Importance

Results revealed a high prevalence of Spec cPL ≥400 μg/L in dogs with AKI treated with IHD. No significant associations between Spec cPL and survival or dialysis‐dependency in dogs with AKI at 30 days were identified in the current study, however, the latter could be due to lack of power in this study.

SNAP Tests for Pancreatitis in Dogs and Cats: SNAP Canine Pancreatic Lipase and SNAP Feline Pancreatic Lipase

A clinical diagnosis of pancreatitis in dogs and cats can be challenging. Several diagnostic modalities have been evaluated over the years for the diagnosis of canine and feline pancreatitis, but most of these modalities have been shown to be of limited clinical use because of poor performance, limited availability, or because they are invasive, or all of these. Assays for the measurement of pancreatic lipase (PL) immunoreactivity [Specific canine PL (Spec cPL) in dogs and Specific feline PL (Spec fPL) in cats] were first developed approximately 15 years ago, and studies have shown that they are currently the serum tests of choice for the evaluation of canine and feline patients, respectively, suspected of having pancreatitis. This is a direct consequence of their high specificity of detecting only PL and their sensitivity for pancreatitis when compared with other serum tests. SNAP cPL and SNAP fPL are in-clinic tests that have been developed based on the Spec cPL and Spec fPL assays. As with any other test, false-positive and false-negative results do occur with PL immunoreactivity assays, and it is important to know the limitations of these assays.