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Segev G, Cortellini S, Foster JD, Francey T, Langston C, Londoño L, Schweighauser A, Jepson RE. International Renal Interest Society best practice consensus guidelines for the diagnosis and management of acute kidney injury in cats and dogs. Vet J 2024; 305:106068. [PMID: 38325516 DOI: 10.1016/j.tvjl.2024.106068] [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: 06/11/2023] [Revised: 12/10/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
Acute kidney injury (AKI) is defined as an injury to the renal parenchyma, with or without a decrease in kidney function, as reflected by accumulation of uremic toxins or altered urine production (i.e., increased or decreased). AKI might result from any of several factors, including ischemia, inflammation, nephrotoxins, and infectious diseases. AKI can be community- or hospital-acquired. The latter was not previously considered a common cause for AKI in animals; however, recent evidence suggests that the prevalence of hospital-acquired AKI is increasing in veterinary medicine. This is likely due to a combination of increased recognition and awareness of AKI, as well as increased treatment intensity (e.g., ventilation and prolonged hospitalization) in some veterinary patients and increased management of geriatric veterinary patients with multiple comorbidities. Advancements in the management of AKI, including the increased availability of renal replacement therapies, have been made; however, the overall mortality of animals with AKI remains high. Despite the high prevalence of AKI and the high mortality rate, the body of evidence regarding the diagnosis and the management of AKI in veterinary medicine is very limited. Consequently, the International Renal Interest Society (IRIS) constructed a working group to provide guidelines for animals with AKI. Recommendations are based on the available literature and the clinical experience of the members of the working group and reflect consensus of opinion. Fifty statements were generated and were voted on in all aspects of AKI and explanatory text can be found either before or after each statement.
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Affiliation(s)
- Gilad Segev
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem, Israel.
| | - Stefano Cortellini
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, UK
| | - Jonathan D Foster
- Department of Nephrology and Urology, Friendship Hospital for Animals, Washington DC, USA
| | - Thierry Francey
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Catherine Langston
- Veterinary Clinical Science, The Ohio State University, Columbus, OH, USA
| | - Leonel Londoño
- Department of Critical Care, Capital Veterinary Specialists, Jacksonville, FL, USA
| | - Ariane Schweighauser
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Rosanne E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, UK
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Beeston D, Jepson R, Cortellini S. Evaluation of presentation, treatment and outcome in hypertensive emergency in dogs and cats: 15 cases (2003-2019). J Small Anim Pract 2022; 63:784-791. [PMID: 35811381 PMCID: PMC9796549 DOI: 10.1111/jsap.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/25/2022] [Accepted: 06/14/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Hypertensive emergency is well recognised in human medicine, yet there is limited veterinary evidence. This study aimed to determine the presentation, treatment and outcome in dogs and cats with hypertensive emergency. MATERIALS AND METHODS A retrospective case series of dogs and cats with hypertensive emergency identified as follows: acute history with non-invasive Doppler systolic blood pressure greater than 180 mmHg and target organ damage including acute onset seizures, altered mentation with or without lateral recumbency or blindness. Data collected included signalment, history, physical examination and clinicopathological findings, systolic blood pressure, antihypertensive treatment and outcome. RESULTS Seven dogs and eight cats were included presenting with seizures (n=9), blindness (n=4), altered mentation with (n=2) or without (n=2) lateral recumbency. Median age was 9 years (range 1 to 15) and duration of clinical signs before presentation was 1.5 days (range 1 to 15). Median systolic blood pressure on presentation was 230 mmHg (range 190 to 300). Amlodipine was the most common first-line agent (n=10), followed by hydralazine (n=4) and hypertonic saline (n=1). Aetiology of hypertensive emergency was acute kidney injury (n=9), idiopathic hypertension (n=3), hyperthyroidism (n=1), lymphoma (n=1) and suspected cutaneous and renal glomerular vasculopathy (n=1). Five cats and three dogs survived to discharge with an overall survival of 53.3%. CLINICAL SIGNIFICANCE Hypertensive emergencies had various presenting signs in this series. AKI was considered to be the cause of hypertension in the majority of patients. Further evaluation of treatment for hypertensive emergencies is warranted, considering almost half of the cases did not survive to discharge.
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Affiliation(s)
- D. Beeston
- Queen Mother Hospital for AnimalsRoyal Veterinary CollegeBrookmans ParkAL9 7TAUK
| | - R. Jepson
- Queen Mother Hospital for AnimalsRoyal Veterinary CollegeBrookmans ParkAL9 7TAUK
| | - S. Cortellini
- Queen Mother Hospital for AnimalsRoyal Veterinary CollegeBrookmans ParkAL9 7TAUK
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Ogrodny A, Jaffey JA, Kreisler R, Acierno M, Jones T, Costa RS, da Cunha A, Westerback E. Effect of inhaled albuterol on whole blood potassium concentrations in dogs. J Vet Intern Med 2022; 36:2002-2008. [PMID: 36178135 DOI: 10.1111/jvim.16552] [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: 11/28/2022] Open
Abstract
BACKGROUND Albuterol by inhalation (IH) is a common treatment for hyperkalemia in humans but its effect on blood potassium concentrations in dogs is unknown. OBJECTIVE Determine whether albuterol (IH) decreases blood potassium concentrations in healthy normokalemic dogs and if effects are dose-dependent. ANIMALS Ten healthy dogs. METHODS Prospective, crossover experimental study. Albuterol sulfate was administered at a low-dose (90 μg) in phase I and, 7 days later, high-dose (450 μg) in phase II. Blood potassium and glucose concentrations (measured via blood gas analyzer) and heart rates were obtained at baseline and then 3, 5, 10, 15, 30, 60, 90, 120, 180, and 360 minutes after inhaler actuation. RESULTS Blood potassium concentrations decreased rapidly after albuterol delivery with a significant reduction compared to baseline within 30 minutes in both phases (P = .05). The potassium nadir concentration of phase I occurred at 60 minutes (mean, SD; 4.07 mmol/L, 0.4) and was significantly decreased from baseline, (4.30 mmol/L, 0.3; t(9) = 2.40, P = .04). The potassium nadir concentration of phase II occurred at 30 minutes (mean, SD; 3.96 mmol/L, 0.39) and was also significantly decreased from baseline, (4.33 mmol/L, 0.4; t(9) = 2.22, P = .05). The potassium nadir concentration decreased by 0.1 mmol/L for each 10 μg/kg increase in dose of albuterol (P = .01). Five dogs had ≥1 hyperglycemic measurement (ie, >112 mg/dL). No median heart rate was tachycardic nor was any mean blood glucose concentration hyperglycemic at any time point. CONCLUSION AND CLINICAL IMPORTANCE Albuterol IH decreases blood potassium concentrations in a dose-dependent manner without clinically meaningful alterations to heart rate or blood glucose concentrations in healthy dogs. The mean decrease in potassium concentration at the high-dose of albuterol was modest (0.38 mmol/L).
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Affiliation(s)
- Andrezej Ogrodny
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Jared A Jaffey
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Rachael Kreisler
- Department of Primary Care, Shelter, and Community Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Mark Acierno
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Teela Jones
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Renata S Costa
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Anderson da Cunha
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Emily Westerback
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
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Paes-Leme FDO, de Souza EM, Ceregatti MG, Campos MTG, Vaz de Melo PD, da Costa-Val AP. Cystatin C assay validation using the immunoturbidimetric method to evaluate the renal function of healthy dogs and dogs with acute renal injury. Vet World 2022; 15:1595-1600. [PMID: 35993081 PMCID: PMC9375203 DOI: 10.14202/vetworld.2022.1595-1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Acute kidney injury (AKI) is associated with a grave prognosis. A clinical assessment of kidney function can be performed based on the glomerular filtration rate (GFR). Cystatin C (CysC) can indicate the GFR or kidney function and its measurement is currently performed using immunological methods such as nephelometry, immunoturbidimetry, and enzyme-linked immunosorbent assays in human medicine. However, these techniques are not specific for use in veterinary medicine. This study aimed to validate an immunoturbidimetric assay for serum CysC (sCy) in dogs, determine the sCy reference intervals for healthy dogs, evaluate sCy stability in serum samples, and compare sCy with serum creatinine (sCr) in healthy dogs and dogs with AKI.
Materials and Methods: Forty-three dogs were divided into a control group (n = 19) and an AKI group (n = 24). An immunoturbidimetric method including commercially available human CysC calibrated with canine CysC was used to evaluate canine serum samples.
Results: An average recovery of 97% was observed for canine serum samples. The reference interval for CysC in healthy dogs was 0.57–1.29 mg/L. The sCy concentration in dogs with AKI was significantly higher (2.82 ± 1.46 mg/L) than in healthy dogs (0.93 ± 0.18 mg/L). Statistical analysis confirmed a strong correlation between sCy and sCr (r = 0.94; p < 0.05) in dogs with AKI.
Conclusion: The immunoturbidimetric method of evaluating sCy yielded satisfactory results and can be used for canine samples when a species-specific calibrator is used. Furthermore, sCy is a reliable marker of renal dysfunction in dogs. It is best to store samples for sCy evaluation at temperatures between 4°C and 8°C.
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Affiliation(s)
| | - Eliana Matias de Souza
- Department of Clinics and Surgery, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Mariah Gois Ceregatti
- Department of Clinics and Surgery, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marco Túlio Gomes Campos
- Department of Clinics and Surgery, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Adriane Pimenta da Costa-Val
- Department of Clinics and Surgery, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Ross L. Acute Kidney Injury in Dogs and Cats. Vet Clin North Am Small Anim Pract 2022; 52:659-672. [DOI: 10.1016/j.cvsm.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rimer D, Chen H, Bar-Nathan M, Segev G. Acute kidney injury in dogs: Etiology, clinical and clinicopathologic findings, prognostic markers, and outcome. J Vet Intern Med 2022; 36:609-618. [PMID: 35103347 PMCID: PMC8965273 DOI: 10.1111/jvim.16375] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/15/2022] [Accepted: 01/20/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common, potentially fatal condition. OBJECTIVES To characterize the etiologies, clinical and clinicopathologic findings, hospitalization period, and outcome of dogs with AKI and to identify markers of negative prognosis. ANIMALS Two hundred forty-nine client-own dogs diagnosed with AKI and hospitalized at a veterinary teaching hospital. METHODS Retrospective study. Search of medical records for dogs with AKI. RESULTS Common clinical signs included lethargy (225/249, 90%), anorexia (206/249, 83%), and vomiting (168/249, 68%). Etiologies included ischemic/inflammatory (144/249, 58%), infectious (19/249, 8%), nephrotoxicosis (14/249, 6%), or other (13/249, 5%). Hospital-acquired AKI was diagnosed in 9% (23/249) of the dogs. Median presentation and peak serum creatinine (sCr) concentrations were 4 mg/dL (range, 1.1-37.9) and 4.6 mg/dL (range, 1.1-43.1), respectively. Dogs were classified to AKI grades as follows: Grade I, 6 (2%), Grade II, 38 (15%), Grade III, 89 (36%), Grade IV, 77 (31%), and Grade V, 39 (16%). One hundred and sixty-four (66%) dogs survived. There was a positive association between death and AKI grade (P = .009). The case fatality rate was higher among dogs with anuria compared with dogs without anuria (50% vs 28%, respectively; odds ratio [95% confidence interval]: 2.5 [1.39-4.6]; P = .002). Forty-seven (18.8%) dogs underwent hemodialysis, of which 60% survived. CONCLUSION AND CLINICAL IMPORTANCE Two-thirds of dogs with AKI survived. Hospital-acquired AKI was common. The severity of AKI, as reflected by presence of anuria, AKI grade, and other body organs involvement, was associated with the outcome.
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Affiliation(s)
- Dar Rimer
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Hilla Chen
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Mali Bar-Nathan
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Abstract
Fluid overload (FO) is characterized by hypervolemia, edema, or both. In clinical practice it is usually suspected when a patient shows evidence of pulmonary edema, peripheral edema, or body cavity effusion. FO may be a consequence of spontaneous disease, or may be a complication of intravenous fluid therapy. Most clinical studies of the association of FO with fluid therapy and risk of harm define it in terms of an increase in body weight of at least 5–10%, or a positive fluid balance of the same magnitude when fluid intake and urine output are measured. Numerous observational clinical studies in humans have demonstrated an association between FO, adverse events, and mortality, as have two retrospective observational studies in dogs and cats. The risk of FO may be minimized by limiting resuscitation fluid to the smallest amount needed to optimize cardiac output and then limiting maintenance fluid to the amount needed to replace ongoing normal and pathological losses of water and sodium.
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Affiliation(s)
- Bernie Hansen
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
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Cole LP, Jepson R, Dawson C, Humm K. Hypertension, retinopathy, and acute kidney injury in dogs: A prospective study. J Vet Intern Med 2020; 34:1940-1947. [PMID: 32677736 PMCID: PMC7517860 DOI: 10.1111/jvim.15839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Systemic hypertension (SH) is a potential complication of acute kidney injury (AKI) in dogs. OBJECTIVE To describe the prevalence of SH and hypertensive retinopathy in dogs with AKI, to investigate the relationship between SH and severity of AKI and to assess possible factors associated with SH. ANIMALS Fifty-two dogs with AKI. METHODS Prospective observational study of dogs presenting to a tertiary referral center that fulfilled the International Renal Interest Society (IRIS) guidelines for the diagnosis of AKI. Systolic blood pressure measurement, urine protein/creatinine ratio (UPCR), urine output, presence of hypertensive retinopathy and fluid overload (FO), survival to discharge and duration of hospitalization were subsequently assessed. The prevalence of SH was calculated and the relationship between SH and recorded factors was examined by nonparametric statistics. RESULTS The prevalence of SH (≥160 mm Hg) on admission or during hospitalization was 75% (39/52) and in 56% (22/39) of cases this was severe (≥180 mm Hg). Sixteen percent (7/43) of dogs had evidence of hypertensive retinopathy and 77% (24/31) dogs had UPCR >0.5. Forty-two percent (22/52) dogs had FO on admission or during hospitalization. There was no association between SH and IRIS AKI grade, oligo/anuria, survival to discharge, duration of hospitalization or proteinuria. Dogs with FO on presentation were more likely to be hypertensive at admission compared to dogs without FO (P = .02). Dogs that did not survive to discharge were more likely to have FO (P = .007). CONCLUSIONS AND CLINICAL IMPORTANCE Systemic hypertension is common in dogs with AKI. Systemic hypertension might be associated with FO, which itself is associated with nonsurvival. Monitoring for SH and FO is therefore warranted in dogs with AKI.
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Affiliation(s)
- Laura Pearl Cole
- Clinical Science & Services, Royal Veterinary CollegeHatfieldUnited Kingdom
| | - Rosanne Jepson
- Clinical Science & Services, Royal Veterinary CollegeHatfieldUnited Kingdom
| | - Charlotte Dawson
- Clinical Science & Services, Royal Veterinary CollegeHatfieldUnited Kingdom
| | - Karen Humm
- Clinical Science & Services, Royal Veterinary CollegeHatfieldUnited Kingdom
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