1
|
Gomez DE, Dunkel B, Renaud DL, Arroyo LG, Schoster A, Kopper JJ, Byrne D, Toribio RE. Survival rates and factors associated with survival and laminitis of horses with acute diarrhoea admitted to referral institutions. Equine Vet J 2024; 56:970-981. [PMID: 38083907 DOI: 10.1111/evj.14032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/02/2023] [Indexed: 08/09/2024]
Abstract
BACKGROUND Clinicopathological findings and their association with the outcome and development of laminitis in horses with acute diarrhoea has not been investigated in a multicentre study across different geographic regions. OBJECTIVES Describe and compare clinicopathologic findings of diarrhoeic horses between different geographic regions, survival rates and factors associated with non-survival and laminitis. STUDY DESIGN Multicentre retrospective case series. METHODS Information from horses with acute diarrhoea presenting to participating institutions between 2016 and 2020 was collected, and clinicopathological data were compared between surviving and non-surviving horses and horses that did and did not develop laminitis. Survival rates and seasonal and geographic differences were also investigated. RESULTS One thousand four hundred thirty-eight horses from 26 participating institutions from 4 continents were included; 76% survived to discharge with no differences identified between geographic regions. The survival proportion of horses with SIRS and creatinine concentrations > 159 μmol/L was 55% (154/279) compared with 81% (358/437) for those with SIRS and creatinine concentrations < 159 μmol/L (p < 0.001). The survival proportion of horses with SIRS that had an L-lactate concentration > 2.8 mmol/L was 59% (175/298) compared with 81% (240/296) in horses with SIRS and L-lactate concentration < 2.8 mmol/L (p < 0.001). The proportion of horses that developed laminitis was lower in Europe (4%, 19/479) compared with North America (8%, 52/619), Australia (8%, 12/138) and Latin America (11%, 16/146) (p < 0.05). More horses developed laminitis in the summer (46%, 39/85) compared with winter (18%, 15/85), spring (18%, 15/85) and fall (19%, 16/85) (p < 0.01). Horses with laminitis had greater odds of non-survival than those without laminitis (OR: 3.73, 95% CI: 2.47-5.65). MAIN LIMITATIONS Not all variables were available for all horses due to the retrospective nature. CONCLUSIONS Clinicopathological findings in horses with acute diarrhoea and their association with survival are similar across geographic regions. However, developing laminitis secondary to diarrhoea is less common in Europe. In addition, factors associated with non-survival were indicative of disease severity and subsequent cardiovascular compromise.
Collapse
Affiliation(s)
- Diego E Gomez
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Bettina Dunkel
- Department of Clinical Science and Services, The Royal Veterinary College, Hertfordshire, UK
| | - David L Renaud
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Luis G Arroyo
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Angelika Schoster
- Vetsuisse Faculty, Equine Department University of Zurich, Zurich, Switzerland
- Ludwig-Maximilians-University Munich, Equine Clinic, Oberschleissheim, Germany
| | - Jamie J Kopper
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, Iowa, USA
| | - David Byrne
- College of Veterinary Medicine, Murdoch University, Perth, Western Australia, Australia
| | - Ramiro E Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
2
|
van Galen G, Divers TJ, Savage V, Schott HC, Siwinska N. ECEIM consensus statement on equine kidney disease. J Vet Intern Med 2024; 38:2008-2025. [PMID: 38801172 PMCID: PMC11256176 DOI: 10.1111/jvim.17101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
The aim of this consensus statement is to summarize and appraise scientific evidence and combine this with the clinical experience of a panel of experts to optimize recommendations on how to recognize and manage kidney disease in horses.
Collapse
Affiliation(s)
- Gaby van Galen
- Goulburn Valley Equine HospitalCongupnaVictoriaAustralia
- Sydney School of Veterinary ScienceUniversity of SydneySydneyNew South WalesAustralia
| | - Thomas J. Divers
- College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | | | - Harold C. Schott
- College of Veterinary MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Natalia Siwinska
- Faculty of Veterinary MedicineWroclaw University of Environmental and Life SciencesWroclawPoland
| |
Collapse
|
3
|
Lovett A, Vokes J, Loghides N, Johnstone L, Sykes B. Survival of formalin intoxication in a 13-year-old Thoroughbred gelding. Equine Vet J 2024; 56:494-502. [PMID: 37587652 DOI: 10.1111/evj.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Formalin intoxication via the gastrointestinal route has not been previously reported in the horse. Whereas ingestion of formalin in humans, although rare, is well documented. Majority of human cases are either accidental, suicidal or homicidal and often lead to fatality, with a reported lethal formaldehyde dose equating to 0.12 - 0.16 g/kg bwt. OBJECTIVES To describe a single case report of the clinical management of an adult horse referred to a veterinary teaching hospital following accidental administration of 10% formalin via nasogastric tube. METHODS A 13-year-old Thoroughbred gelding originally presented to the referring veterinarian for colic where 1.8 L of 10% formalin was accidentally administered instead of mineral oil via nasogastric intubation, a potentially lethal dose of formaldehyde (0.12 g/kg bwt). Approximately 20-hours following 10% formalin administration the horse was admitted to the referral hospital with moderate tachycardia, occasional ectopic beats, tacky and hyperaemic mucous membranes, delayed capillary refill time, reduced borborygmi, and pronounced digital pulses. Diagnostic investigations included laboratory blood analysis, urinalysis, electrocardiogram, abdominal ultrasound, palpation per rectum and gastroscopy. RESULTS Patient assessment found evidence of toxicity to the gastrointestinal tract, hypovolaemia and risk for laminitis. Intensive care included fluid and electrolyte therapy, anti-inflammatories and analgesia, continuous digital cryotherapy, gastro-protectants and other methods of gastrointestinal support. The horse was discharged from hospital on day 14 with no long-term complications and the client-veterinarian relationship was preserved. DISCUSSION In human cases of ingestion, gastrointestinal injury is typically accompanied by severe metabolic acidosis and multiple organ dysfunction syndrome due to toxicity of other body systems that can contribute to non-survival. Formaldehyde toxicity in the present case predominantly affected the gastrointestinal tract, most likely a direct result of the route of administration. Aside from gastrointestinal injury, primary toxicity of other body systems was not confirmed. To prevent this medical error recurring, the referring veterinary clinic revised their labelling and storage of 10% formalin. CONCLUSION This is the first report of systemic formalin intoxication in the horse. Following a high dose of 10% formalin (0.12 g/kg bwt formaldehyde) enterally, the horse survived having received intensive supportive care based on human guidelines for ingested formalin.
Collapse
Affiliation(s)
- Amy Lovett
- Equine Veterinary Clinic, School of Veterinary Sciences, Massey University, Palmerston North, New Zealand
| | - Jessica Vokes
- Equine Veterinary Clinic, School of Veterinary Sciences, Massey University, Palmerston North, New Zealand
| | - Natasha Loghides
- Equine Veterinary Clinic, School of Veterinary Sciences, Massey University, Palmerston North, New Zealand
| | - Laura Johnstone
- Equine Veterinary Clinic, School of Veterinary Sciences, Massey University, Palmerston North, New Zealand
| | - Benjamin Sykes
- Equine Veterinary Clinic, School of Veterinary Sciences, Massey University, Palmerston North, New Zealand
| |
Collapse
|
4
|
van Spijk JN, Lo HC, Merle R, Richter IG, Diemar A, Stoeckle SD, Gehlen H. Serum and Urinary Matrix Metalloproteinase-9 Concentrations in Dehydrated Horses. Animals (Basel) 2023; 13:3776. [PMID: 38136813 PMCID: PMC10741069 DOI: 10.3390/ani13243776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
Matrix metalloproteinase-9 is increased in renal tissue in human kidney disease, but its role as a biomarker for kidney disease has not been fully evaluated yet. The aim of this study was to evaluate serum MMP-9 (sMMP-9) and urinary MMP-9 (uMMP-9) concentrations in dehydrated horses. Dehydrated horses were prospectively included. Blood and urinary samples were taken at admission, and after 12, 24, and 48 h (t0, t12, t24, t48), an anti-equine MMP-9 sandwich ELISA was used. Four healthy horses served as the controls. Serum creatinine, urea, symmetric dimethylarginine (SDMA), urine-specific gravity, urinary protein concentration, fractional sodium excretion, and urinary gamma-glutamyl transferase/creatinine ratio (uGGT/Cr) were measured. Statistical analysis included a repeated measures ANOVA and mixed linear regression model. Overall, 40 dehydrated horses were included (mild dehydration 13/40, moderate 16/40, severe 11/40). Acute kidney injury was found in 1/40 horses; 7/40 horses showed elevated serum creatinine, 11/40 horses elevated serum SDMA, and 5/28 elevated uGGT/Cr at presentation. In dehydrated horses, sMMP-9 concentrations were significantly higher on t0 (median: 589 ng/mL, range: 172-3597 ng/mL) compared to t12 (340 ng/mL, 132-1213 ng/mL), t24 (308 ng/mL, 162-1048 ng/mL), and t48 (258 ng/mL, 130-744 ng/mL). In healthy horses, sMMP-9 (239 ng/mL, 142-508 ng/mL) showed no differences over time or compared to patients. uMMP-9 and uMMP-9/creatinine did not differ over time or to the controls. No differences were found between dehydration groups. Urinary casts (p = 0.001; estimate = 135) and uGGT/Cr (p = 0.03; estimate = 6.5) correlated with sMMP-9. Serum urea was associated with uMMP-9/Cr (p = 0.01, estimate 0.9). In conclusion, sMMP-9 was elevated at arrival in dehydrated patients compared to later measurements. Correlations to uGGT/Cr and urinary casts need further evaluation.
Collapse
Affiliation(s)
- Julia N. van Spijk
- Equine Clinic, Free University of Berlin, 14163 Berlin, Germany; (J.N.v.S.); (H.-C.L.); (H.G.)
- Vetsuisse Faculty, Equine Department, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Hsiao-Chien Lo
- Equine Clinic, Free University of Berlin, 14163 Berlin, Germany; (J.N.v.S.); (H.-C.L.); (H.G.)
| | - Roswitha Merle
- Institute for Veterinary Epidemiology and Biostatistics, Free University of Berlin, 14163 Berlin, Germany;
| | - Ina-Gabriele Richter
- Research Centre of Medical Technology and Biotechnology, Department of Cell Biology, 99947 Bad Langensalza, Germany; (I.-G.R.); (A.D.)
| | - Anne Diemar
- Research Centre of Medical Technology and Biotechnology, Department of Cell Biology, 99947 Bad Langensalza, Germany; (I.-G.R.); (A.D.)
| | - Sabita D. Stoeckle
- Equine Clinic, Free University of Berlin, 14163 Berlin, Germany; (J.N.v.S.); (H.-C.L.); (H.G.)
- Equine Clinic, University of Leipzig, An den Tierkliniken 11a, 04103 Leipzig, Germany
| | - Heidrun Gehlen
- Equine Clinic, Free University of Berlin, 14163 Berlin, Germany; (J.N.v.S.); (H.-C.L.); (H.G.)
| |
Collapse
|
5
|
Giraldo AF, Carballo R, Serrenho RC, Tran V, Valverde A, Renaud DL, Gomez DE. Association of the type of metabolic acidosis and non-survival of horses with colitis. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2023; 64:1044-1050. [PMID: 37915775 PMCID: PMC10581353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background Metabolic acidosis (MA) is the most common acid-base disorder reported in horses with colitis but its association with survival is yet to be determined. Objective Investigate the types of MA in horses with colitis to determine effects of various anions on fatality rates. Animals and procedures We studied 158 horses with colitis. Horses were classified into 4 groups depending on the anion contributing to MA: i) no MA, ii) lactic acidosis (LA), iii) unmeasured strong ion (USI) acidosis, and iv) hyperchloremic acidosis (HA). Results Sixty percent (95/158) of horses had no MA, 22% (34/158) had LA, 12% (19/158) had HA, and 6% (10/158) had USI acidosis. The fatality rate of horses without MA was 20% (20/95), whereas the rates for those with LA, USI, and HA were 53% (18/34), 30% (3/10), and 16% (3/19), respectively. Horses with LA were more likely to die or be euthanized than horses without MA (OR: 4.2, 95% CI: 1.83 to 9.72, P < 0.001) and HA (OR: 5.9, 95% CI: 1.47 to 24.4, P < 0.01). Conclusion and clinical relevance Lactic acidosis was the most common type of MA in horses with colitis, and it was associated with non-survival.
Collapse
Affiliation(s)
- Andres F Giraldo
- Departments of Clinical Studies (Giraldo, Carballo, Tran, Valverde, Gomez) and Population Medicine (Serrenho, Renaud), Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1
| | - Rafael Carballo
- Departments of Clinical Studies (Giraldo, Carballo, Tran, Valverde, Gomez) and Population Medicine (Serrenho, Renaud), Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1
| | - Rita Couto Serrenho
- Departments of Clinical Studies (Giraldo, Carballo, Tran, Valverde, Gomez) and Population Medicine (Serrenho, Renaud), Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1
| | - Vylan Tran
- Departments of Clinical Studies (Giraldo, Carballo, Tran, Valverde, Gomez) and Population Medicine (Serrenho, Renaud), Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1
| | - Alex Valverde
- Departments of Clinical Studies (Giraldo, Carballo, Tran, Valverde, Gomez) and Population Medicine (Serrenho, Renaud), Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1
| | - David L Renaud
- Departments of Clinical Studies (Giraldo, Carballo, Tran, Valverde, Gomez) and Population Medicine (Serrenho, Renaud), Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1
| | - Diego E Gomez
- Departments of Clinical Studies (Giraldo, Carballo, Tran, Valverde, Gomez) and Population Medicine (Serrenho, Renaud), Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1
| |
Collapse
|
6
|
Satué K, Fazio E, Medica P, Miguel L, Gardón JC. Biochemical and Hematological Indexes of Liver Dysfunction in Horses. J Equine Vet Sci 2023; 126:104294. [PMID: 36958409 DOI: 10.1016/j.jevs.2023.104294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
In the present review, the authors, based on the multiple functions performed by the liver, analyze the multiple biochemical and hematological changes as an expression of altered liver function in the horse. The liver performs important metabolic functions related to the synthesis, degradation, and excretion of various substances. Modification of these functions can be evaluated and diagnosed by determining serum concentrations of several serum analytes, including enzymes and other endogenous substances. Hepatocellular enzymes, such as sorbitol dehydrogenase-SDH and glutamate dehydrogenase-GLDH, are released following hepatocellular necrosis. Hepatobiliary enzymes, such as γ-glutamyl transferase-GGT, increase in response to necrosis, cholestasis, and other alterations in bile conducts. Serum concentrations of mainly endogenous and exogenous substances that the liver should synthesize or eliminate, such as proteins (albumin and globulins), bile acids, urea, glucose, total and direct bilirubin, and coagulation factors, and fibrinogen should be included in the liver function test profile. The interpretation of laboratory tests of liver function will allow the diagnosis of functional loss of the organ. Some of the analytes considered provide information on the prognosis of liver disease. This review will provide an accurate and objective interpretation of the common biochemical and hematological tests in use in the diagnosis of equine hepatic disease patients, aiding still further the veterinary activity on the applied equine clinical cases.
Collapse
Affiliation(s)
- Katiuska Satué
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, CEU-Cardenal Herrera University, Valencia, Spain.
| | - Esterina Fazio
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Messina, Italy
| | - Pietro Medica
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Messina, Italy
| | - Laura Miguel
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, CEU-Cardenal Herrera University, Valencia, Spain
| | - Juan Carlos Gardón
- Department of Animal Medicine and Surgery, Faculty of Veterinary and Experimental Sciences, Catholic University of Valencia-San Vicente Mártir, Valencia, Spain
| |
Collapse
|
7
|
Galen GV, Olsen E, Siwinska N. Biomarkers of Kidney Disease in Horses: A Review of the Current Literature. Animals (Basel) 2022; 12:ani12192678. [PMID: 36230418 PMCID: PMC9559299 DOI: 10.3390/ani12192678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 11/15/2022] Open
Abstract
Creatinine only allows detection of kidney disease when 60 to 75% of the glomerular function is lost and is therefore not an ideal marker of disease. Additional biomarkers could be beneficial to assess kidney function and disease. The objectives are to describe new equine kidney biomarkers. This systematic review assesses the available literature, including the validation process and reference values, following which the authors suggest recommendations for clinical use. SDMA may have some potential as equine kidney biomarker, but there is currently a lack of evidence that SDMA offers any advantage compared to creatinine in detecting Acute Kidney Injury (AKI). Cystatin C and podocin show potential as biomarkers for kidney disease (including detecting AKI earlier than creatinine) and should be studied further. NGAL has potential as a biomarker of kidney disease (including detecting AKI earlier than creatinine), and potential as an inflammatory marker. Literature on MMP-9 does not allow for conclusive statements about its potential as a biomarker for kidney disease. The future may show that NAG has potential. For all biomarkers, at this stage, available scientific information is limited or too scarce to support clinical use, and only SDMA can be measured for clinical purposes. In conclusion, there are multiple new biomarkers with the potential to diagnose kidney problems. However, there are only a few studies available and more data is needed before these biomarkers can be applied and recommended in our daily practice.
Collapse
Affiliation(s)
- Gaby van Galen
- Sydney School of Veterinary Science, University of Sydney, Sydney, NSW 2006, Australia
- Goulburn Valley Equine Hospital, Congupna, VIC 3633, Australia
| | - Emil Olsen
- Veterinary Teaching Hospital (Universitetsdjursjukhuset, UDS), Swedish Veterinary Agricultural University (SLU), 750 07 Uppsala, Sweden
| | - Natalia Siwinska
- Department of Internal Medicine, Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, University of Environmental and Life Sciences Wroclaw, 50-375 Wroclaw, Poland
| |
Collapse
|
8
|
Satué K, Fazio E, Muñoz A, Medica P. Successful Pregnancy Outcome in Mares: The Potential Role of Body Conditional Score, Age and Biochemical Parameter's Adjustments. J Equine Vet Sci 2022; 115:104023. [PMID: 35643379 DOI: 10.1016/j.jevs.2022.104023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
Abstract
The objective of this research was to evaluate the changes in body condition score (BCS), age and the main biochemical parameters in pregnant Spanish Purebred mares. A total of 45 pregnant Spanish broodmares has been studied, classified in three different groups: group A (n = 15), aging 14-18 years old and BCS lower than 4 of 10, group B (n = 15), with ages of 4 to 8 years and a BCS of 5-6/10, and group C (n = 15), aging between 6 and 11 years and a BCS of 8 of 10. Three pregnancy periods were considered: the 1st period, from the 1st to the 3rd, the 2nd from the 4th to the 6th, and the last period, from the 7th month of pregnancy to delivery. Blood samples were taken every month along the pregnancy. The following plasma biochemical parameters were measured: triglycerides, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, total, direct and indirect bilirubin, aspartate aminotransferase, lactate dehydrogenase, γ-glutamyl transferase, alkaline phosphatase, total plasma proteins, albumin, glucose, urea and creatinine. Pregnancy in the Spanish broodmare induced hyperlipidemia with hypertriglyceridemia and increased plasma concentrations of total, direct and indirect bilirubin (P < .05). Older pregnant mares showed biochemical changes probably consistent with decreased organ functionality (P < .05). Obesity did not influence lipidic metabolism during pregnancy (P > .05).
Collapse
Affiliation(s)
- Katiuska Satué
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, CEU-Cardenal Herrera University, Valencia, Spain.
| | - Esterina Fazio
- Department of Veterinary Sciences, Veterinary Physiology Unit, Messina University, Messina, Italy
| | - Ana Muñoz
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, University of Córdoba, Córdoba, Spain
| | - Pietro Medica
- Department of Veterinary Sciences, Veterinary Physiology Unit, Messina University, Messina, Italy
| |
Collapse
|
9
|
Olsen E, van Galen G. Chronic Renal Failure-Causes, Clinical Findings, Treatments and Prognosis. Vet Clin North Am Equine Pract 2022; 38:25-46. [DOI: 10.1016/j.cveq.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
10
|
Relevant Equine Renal Anatomy, Physiology, and Mechanisms of Acute Kidney Injury: A Review. Vet Clin North Am Equine Pract 2022; 38:1-12. [PMID: 35282956 DOI: 10.1016/j.cveq.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Regulation of renal blood flow is by both extrinsic and intrinsic systems. Intrinsic regulation occurs via the afferent and efferent arterioles and tubuloglomerular feedback mechanisms with activation of the juxtaglomerular apparatus. Mechanisms of acute kidney injury are frequently associated with changes in renal blood flow. Acute tubular necrosis and apoptosis are common in horses following ischemic or toxic insults and in sepsis-associated acute kidney injury. Sepsis-associated renal injury often has a complex mechanism of disease involving both functional and obstructive changes in intrarenal circulation. Acute interstitial nephritis may occur following Leptospira sp infection or can be secondary to tubular necrosis.
Collapse
|
11
|
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.
Collapse
Affiliation(s)
- Thomas J Divers
- College of Veterinary Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853-6401, USA.
| |
Collapse
|
12
|
Lo HC, Winter JC, Merle R, Gehlen H. Symmetric dimethylarginine and renal function analysis in horses with dehydration. Equine Vet J 2021; 54:670-678. [PMID: 34110650 DOI: 10.1111/evj.13484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute dehydration caused by a variety of diseases in horses can lead to acute kidney injury. However, current renal biomarkers usually indicate renal damage late in the course of the disease. A novel biomarker would be helpful to diagnose renal disease earlier. OBJECTIVES (1) To estimate the correlation of serum symmetric dimethylarginine (SDMA) concentrations with the degree of dehydration, traditional renal biomarkers and renal function analysis, and (2) to determine the value of SDMA as a prognostic and early biomarker of renal injury in horses. STUDY DESIGN Prospective cohort. METHODS Serum SDMA, creatinine and urea concentrations and renal function analysis were measured in 41 horses with dehydration at 4 time points until 48 h after admission. Horses were grouped according to their dehydration level into mildly, moderately and severely dehydrated groups. RESULTS Serum SDMA concentrations at admission correlated with creatinine concentrations (r = .412, P < .001). Differences in SDMA concentrations at admission were detected among dehydration levels but not between survivors and nonsurvivors. Significant correlations of SDMA concentrations with other markers of renal function analysis and short-term outcome were not observed. MAIN LIMITATIONS Besides the small sample size and low statistical power, missing urine samples at specific time points were also 1 of the main limitations. Only 1 of the horses developed acute kidney injury, which made the evaluation of the predictive value of SDMA difficult. CONCLUSIONS SDMA concentrations correlated significantly with creatinine concentrations in dehydrated horses. Further research is needed to reveal the application of SDMA in horse.
Collapse
Affiliation(s)
- Hsiao-Chien Lo
- Equine Clinic: Surgery and Radiology, Free University of Berlin, Berlin, Germany
| | - Judith C Winter
- Equine Clinic: Surgery and Radiology, Free University of Berlin, Berlin, Germany
| | - Roswitha Merle
- Institute for Veterinary Epidemiology and Biostatistics, Free University of Berlin, Berlin, Germany
| | - Heidrun Gehlen
- Equine Clinic: Surgery and Radiology, Free University of Berlin, Berlin, Germany
| |
Collapse
|
13
|
Siwinska N, Zak A, Slowikowska M, Paslawska U. Renal Resistive Index as A Potential Indicator of Acute Kidney Injury in Horses. J Equine Vet Sci 2021; 103:103662. [PMID: 34281637 DOI: 10.1016/j.jevs.2021.103662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022]
Abstract
Reliable and simple tests are constantly being sought to enable the quick detection of acute kidney injury in humans and animals. Diagnosis of subclinical AKI in horses, mainly in field practice, is difficult. An ultrasound scan is a routine test performed when kidney disease is suspected. The aim of the study was to establish the value of the renal resistive index (RRI) in intrarenal arteries in horses with clinical AKI and compare it to that of healthy horses. The second goal was to determine whether potentially nephrotoxic agents can influence RRI. The kidney ultrasonography examination was performed in 30 healthy horses, 11 horses with AKI and 30 horses at risk for AKI (10 colic horses, 10 horses receiving gentamicin and 10 horses receiving NSAIDs). RRI values were measured using pulsed-wave Doppler. Differences in RRI between groups were observed only in the right kidney. Horses with AKI had significantly higher RRI values compared to healthy horses. In the risk group, there was no effect of potentially nephrotoxic agents on the RRI value. RRI value in horses seem to be lower than in other species. The increase in this parameter in horses with AKI affected only one kidney and these values did not reach values obtained in other species. The clinical application of this method in non-cooperating animals remains questionable, and therefore RRI Doppler ultrasonography of blood flow in the intrarenal arteries may have poor clinical utility as a diagnostic tool in the diagnosis of AKI in horses.
Collapse
Affiliation(s)
- Natalia Siwinska
- Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
| | - Agnieszka Zak
- Department of Immunology, Pathophysiology and Veterinary Preventive Medicine, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Malwina Slowikowska
- Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Urszula Paslawska
- Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland; Veterinary Institute, Faculty of Biological and Veterinary Sciences Nicolaus Copernicus University Toruń ul. Toruń, Poland
| |
Collapse
|
14
|
Evaluation of Serum and Urine Neutrophil Gelatinase-associated Lipocalin and Cystatin C as Biomarkers of Acute Kidney Injury in Horses. J Vet Res 2021; 65:245-252. [PMID: 34250311 PMCID: PMC8256477 DOI: 10.2478/jvetres-2021-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/22/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Diagnosis of acute kidney injury (AKI) in horses is difficult at the subclinical stage, due to nonspecific clinical signs. The aim of this study was to evaluate the concentrations of selected serum and urinary biomarkers in healthy horses, horses at risk of AKI, and those with clinical AKI. Material and Methods Thirty healthy horses, 30 horses at risk of AKI and 11 horses with clinical AKI and azotaemia were included in the study. Serum and urinary neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C were measured using commercially available enzyme immunoassay tests. Results The median and (in parentheses) first and third quartile concentrations of selected biomarkers in healthy horses, horses at risk of AKI and horses with AKI were respectively as follows: serum cystatin C – 0.25 (0.19–0.37), 0.23 (0.15–0.37) and 0.61 (0.37–1.13) mg/L; serum NGAL – 50.5 (38.8–58.8), 51.1 (40.4–66.9) and 98.1 (59.4–128.2) ng/mL; urinary NGAL – 20.7 (17.9–24.5), 32.3 (32.7–55.8) and 36.6 (26.8–89.9) ng/mL; and urinary cystatin C – 0.1 (0.07–0.13), 0.13 (0.1–0.2) and 0.34 (0.22–0.37) mg/L. There were significant differences in the concentration of all biomarkers between the healthy and AKI-affected horses. Conclusion Horses with AKI all had biomarker concentrations higher than the healthy horses. None of the biomarkers made azotaemia recognisable in all affected horses. The obtained results indicate the need to create a serum and urinary biomarker panel to detect AKI.
Collapse
|
15
|
Third Generation Cephalosporin Resistant Enterobacterales Infections in Hospitalized Horses and Donkeys: A Case-Case-Control Analysis. Antibiotics (Basel) 2021; 10:antibiotics10020155. [PMID: 33557061 PMCID: PMC7913880 DOI: 10.3390/antibiotics10020155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/18/2022] Open
Abstract
In human medicine, infections caused by third-generation cephalosporin-resistant Enterobacterales (3GCRE) are associated with detrimental outcomes. In veterinary medicine, controlled epidemiological analyses are lacking. A matched case–case–control investigation (1:1:1 ratio) was conducted in a large veterinary hospital (2017–2019). In total, 29 infected horses and donkeys were matched to 29 animals with third-generation cephalosporin-susceptible Enterobacterales (3GCSE) infections, and 29 uninfected controls (overall n = 87). Despite multiple significant associations per bivariable analyses, the only independent predictor for 3GCRE infection was recent exposure to antibiotics (adjusted odds ratio (aOR) = 104, p < 0.001), but this was also an independent predictor for 3GCSE infection (aOR = 22, p < 0.001), though the correlation with 3GCRE was significantly stronger (aOR = 9.3, p = 0.04). In separated multivariable outcome models, 3GCRE infections were independently associated with reduced clinical cure rates (aOR = 6.84, p = 0.003) and with 90 days mortality (aOR = 3.6, p = 0.003). Klebsiella spp. were the most common 3GCRE (36%), and blaCTX-M-1 was the major β-lactamase (79%). Polyclonality and multiple sequence types were evident among all Enterobacterales (e.g., Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae). The study substantiates the significance of 3GCRE infections in equine medicine, and their independent detrimental impact on cure rates and mortality. Multiple Enterobacterales genera, subtypes, clones and mechanisms of resistance are prevalent among horses and donkeys with 3GCRE infections.
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Siwinska N, Zak A, Slowikowska M, Niedzwiedz A, Paslawska U. Serum symmetric dimethylarginine concentration in healthy horses and horses with acute kidney injury. BMC Vet Res 2020; 16:396. [PMID: 33081772 PMCID: PMC7576750 DOI: 10.1186/s12917-020-02621-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There are limited options to diagnose acute kidney injury (AKI) in horses. Symmetric dimethylarginine (SDMA) is routinely used in human and small animal medicine. The aim of this study was to assess serum SDMA concentrations in healthy horses and horses with AKI. The objective of this study was to evaluate the association of: 1) age, 2) sex, 3) body weight and 4) serum creatinine and urea levels on serum SDMA concentrations. Fifty-three healthy horses, including 17 foals (2-6 months of age) and 36 adult horses (3-29 years of age), and 23 horses with AKI were included in the study based on history, physical examination, blood analysis, urinalysis and an ultrasonographic examination of the urinary tract. Serum SDMA concentrations were measured using a non-species specific commercial ELISA test. RESULTS In healthy adult horses, the value of SDMA was 0.53 ± 0.14 μmol/L. The value was higher in foals (1.5 ± 0.4 μmol/L, P < 0.001). Horses with AKI had significantly higher concentrations of SDMA compared to healthy horses (1.76 ± 1.05 μmol/L, P < 0.001). In the healthy adult horses, there was no association of sex, age or body weight on SDMA. However, a significant positive relationship was found between serum creatinine and SDMA concentrations. CONCLUSIONS Healthy adult horses had SDMA values similar to those of other species. Foals had higher SDMA values. Therefore, different reference values should be created for them. The study confirmed an increased SDMA in horses with AKI. This, as well as the low influence of extrarenal factors on the SDMA values, may confirm its usefulness in the diagnosis of kidney dysfunction. Higher SDMA values may also indicate a more advanced degree of kidney dysfunction. Further research is required to determine whether SDMA could be used to detect kidney dysfunction in the asymptomatic stage of AKI.
Collapse
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
| | - Malwina Slowikowska
- 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
| | - Artur Niedzwiedz
- 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
| | - 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, Torun, Poland
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Wright S. Highlights of recent clinically relevant papers. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Savage VL, Marr CM, Bailey M, Smith S. Prevalence of acute kidney injury in a population of hospitalized horses. J Vet Intern Med 2019; 33:2294-2301. [PMID: 31436910 PMCID: PMC6766563 DOI: 10.1111/jvim.15569] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 07/01/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hospital-acquired acute kidney injury (AKI) in humans and dogs increases morbidity and nonsurvival. Azotemia at presentation has been associated with a poor outcome in horses; however, prevalence and consequences of hospital-acquired AKI are unreported. HYPOTHESIS/OBJECTIVES To evaluate the prevalence of AKI in hospitalized horses, risk factors associated with AKI, and the effect of AKI on short-term survival. We hypothesized that the prevalence of AKI in horses is similar to that reported in other domestic mammalian species and would be associated with nonsurvival. ANIMALS Adult horses hospitalized for >2 days from which a minimum of 2 measurements of serum creatinine concentration were available. METHODS Retrospective cohort study. Clinical records were reviewed and horses grouped according to their baseline serum creatinine concentration and change in serum creatinine concentration from baseline. The associations between signalment, diagnosis, and treatment variables, and the presence of azotemia or AKI were assessed using multinomial logistic regression. The relationship between these conditions and survival to discharge was evaluated. RESULTS Three hundred twenty-five horses were included; 4.3% (14/325) had azotemia at baseline and 14.8% (48/325) developed AKI. There were no significant associations between investigated risk factors and development of AKI. The presence of azotemia and AKI did not significantly affect survival to discharge (P = .08 and .81, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE The prevalence of AKI in this population of hospitalized horses is similar to that reported in dogs and humans; however, in this study population, there was less impact on morbidity and short-term survival.
Collapse
Affiliation(s)
- Victoria L. Savage
- Equine Referral Hospital, Langford Veterinary ServicesUniversity of BristolLangfordUnited Kingdom
| | | | - Michael Bailey
- Equine Referral Hospital, Langford Veterinary ServicesUniversity of BristolLangfordUnited Kingdom
| | - Sarah Smith
- Equine Referral Hospital, Langford Veterinary ServicesUniversity of BristolLangfordUnited Kingdom
| |
Collapse
|