Canine interstitial nephritis with special reference to glomerular lesions and filariasis

Evaluation of renal values during treatment for heartworm disease in 27 client-owned dogs

BACKGROUND

Canine heartworm disease (CHD) caused by Dirofilaria immitis remains a common preventable disease with increasing incidence in some parts of the USA. The treatment guidelines of the American Heartworm Society (AHS) currently recommend monthly macrocyclic lactone administration, 28 days of doxycycline given orally every 12 h and three injections of melarsomine dihydrochloride (1 injection on day 2 of treatment followed 30 days later by 2 injections 24 h apart). Minocycline has also been utilized when doxycycline is unavailable. The systemic effects of CHD, which particularly impact cardiac and renal function, have been described, with infected dogs often experiencing renal damage characterized by an increase in serum concentrations of renal biomarkers. Although the AHS treatment protocol for CHD has been shown to be safe and effective in most cases, the potential for complications remains. No study as of yet has evaluated changes in symmetric dimethylarginine (SDMA), a sensitive marker of renal function, during treatment for CHD. The purpose of the present study was to evaluate renal function in dogs by measuring serum creatinine and SDMA concentrations during the adulticide treatment period.

METHODS

Serum creatinine and SDMA concentrations were measured in 27 client-owned dogs affected by CHD at the following time points: prior to starting doxycycline or minocycline therapy (baseline), during doxycycline or minocycline therapy (interim), at the time of the first dose of melarsomine (first dose), at the time of the second dose of melarsomine (second dose) and at the dog's follow-up visit after treatment, occurring between 1 and 6 months after completion of therapy (post-treatment). Concentrations of creatinine and SDMA were compared between time points using a mixed effects linear model.

RESULTS

Mean SDMA concentrations following the second dose of melarsomine were significantly lower (-1.80 ug/dL, t-test, df = 99.067, t = -2.694, P-Value = 0.00829) than baseline concentrations. There were no other statistically significant differences in the concentration of either biomarker between the baseline and the other time points in CHD dogs undergoing treatment.

CONCLUSIONS

The results suggest that the current AHS protocol may not have a substantial impact on renal function.

Evaluation of serum biomarkers and proteinuria for the early detection of renal damage in dogs with heartworm (Dirofilaria immitis)

Glomerulonephropathy associated with Dirofilaria immitis (heartworm) is relatively frequent in infected dogs. Given the importance and the scarcity of studies focused on its prevalence and diagnosis, the objective was to determine the prevalence of proteinuria and functional indicators of glomerular filtration rate in dogs with heartworm disease and discuss its utility in the detection of renal impairment. Sera and urine from 47 infected dogs were analyzed in a reference laboratory. Urea, creatinine, plasma proteins and serum symmetric dimethylarginine (SDMA) were analyzed in sera, while the UPC ratio was performed in urine. Dogs were further evaluated for the presence/absence of microfilariae, pulmonary and systemic hypertension, and the parasite burden was assessed. The results showed that 19.1 % of dogs showed proteinuria (UPC > 0.5) and 17 % showed borderline proteinuria (UPC 0.2-0.5). Creatinine and SDMA were high (>1.8 mg/dl and ≥18 μg/dl, respectively) in 4.2 % of dogs. UPC ratio was significantly increased in dogs with high parasite burden and in dogs with microfilariemia (p < 0.05). Dogs with pulmonary hypertension showed higher increases in proteinuria as well, which was probably due to the chronicity of the infection. No significant differences were found in serum and urine values regarding systemic blood pressure. Despite the limitations of this study, proteinuria/borderline proteinuria was present in 36.2 % of dogs with heartworm disease, and this may be due to glomerular disease. Therefore, the detection of proteinuria, along with other renal biomarkers in the diagnostic protocols, could help identify kidney alterations or risk of renal damage in heartworm disease.

Pathological changes in kidneys, livers and spleens of Brugia pahangi-infected jirds (Meriones unguiculatus)

The major organs, other than lymphatics, of jirds (Meriones unguiculatus) with prepatent and chronic patent infections of Brugia pahangi were studied by standard histological, electron microscopical and fluorescent antibody techniques. Changes observed and not previously described in detail or in large numbers of animals are reported. Multifocal non-suppurative interstitial nephritis was observed in 4% of animals with patent infections of 163 days duration and in 69% of animals with patent infections of 274 days duration. Glomerular changes were not observed in kidneys of any animals infected with B. pahangi. The occurrence of large granulomata composed of lymphocytes, macrophages, eosinophils and giant cells in the liver and smaller granulomata in the spleen correlated with patency of infections but microfilariae or worm antigens were not observed in these areas. Amyloid deposits were demonstrated in the spleens of 4% of animals with patent infections of 163 days duration and in 38% of animals with patent infections of 274 days duration but were not seen in uninfected animals of the same age or animals receiving only challenge inoculations of 28 days duration.

A retrospective study of the clinical hematology and the serum biochemistry tests made on canine dirofilariasis cases in an animal hospital population in Bangkok, Thailand

Heartworm disease, caused by the filarial nematode, Dirofilaria immitis, is a major, potentially life-threatening disease of dogs, with worldwide distribution and global significance. It is not only of veterinary importance but it also has zoonotic potential in many regions. It is considered as an endemic disease in Thailand, although clinical data about the disease is rarely reported. The objectives of this study were to characterize the clinical hematology and the biochemistry of canine dirofilariasis cases admitted to Chulalongkorn University, Small Animal Teaching Hospital in Bangkok, Thailand, from 2001-2003. All hematology and serum biochemistry parameter interpretations were based on reference values. A total of 1023 dogs were evaluated in this study. Dogs were divided into three groups based on their heartworm classification (microfilaremic, occult and negative). The major hematological findings in microfilaremic dogs were a mild to moderate anemia, mild to severe thrombocytopenia, marked leukocytosis, moderate to marked neutrophilia, eosinophilia and monocytosis. The most common serum biochemical abnormalities in microfilaremic dogs included increased alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase with a mean+/-SD of 311+/-299, 82+/-76 and 50+/-38 IU/L, respectively. It is likely that this parasitic infection led to the impairment of the hematological and biochemical status of the infected dogs. We believe that investigation of these laboratory based parameters, when associated with the clinical signs, is a very important approach to be considered in the routine clinical follow up, as well as being important for therapeutic evaluations.

Kidney ultrastructural lesions in dogs experimentally infected with Dirofilaria immitis (Leidy, 1856)

Kidneys of 16 beagles with experimentally induced heartworm (Dirofilaria immitis) infections and 4 heartworm-nai;ve dogs were studied by light and electron microscopy. The infections were induced either by subcutaneous injection of infective larvae or by the transplantation of adult parasites, and infection periods varied from 111 to 818 days and 365 to 923 days, respectively. One control group of heartworm-naïve dogs and four groups of heartworm-infected dogs, which were divided according to the type and the length of infection, were used. In the infected dogs, thickening of the glomerular basement membrane (GBM), the presence of dense deposits in the GBM, and foot process effacement were the most frequent lesions observed. In some dogs, electron dense deposits were seen in the GBM and the mesangium and/or enlargement of the mesangial matrix could be characterized. The longer the infection period, the thicker the GBM and the more common the occurrence of foot process effacement. In general, these alterations were more evident in animals that had been infected for more than 1 year, had high microfilaremia, and had 14 or more parasites in the main pulmonary artery and its branches. The presence of dense deposits suggests that the pathogenesis of kidney disease in dirofilariasis is associated with deposits of immune complexes in the membrane. The finding of ultrastructural changes in dogs with early prepatent infections suggests that immature heartworms, as well as microfilariae and possibly adult worms, contribute to the glomerulonephropathy.

Elaeophorosis in red deer caused by Elaeophora elaphi: lesions of natural disease

This is the first study of the lesions produced by Elaeophora elaphi, a filarial worm first reported in 1986. Only the morphologic characteristics of this species have been described previously. Samples for the study were taken from 74 red deer (Cervus elaphus), 1-10 years old, slaughtered in central Spain. Grossly, filariae were observed in the transverse, left, or right branches of the portal vein of 18 animals. In addition to filariae, whitish thrombi were found in the right and left branches of the portal vein in nine animals. Thrombi of similar characteristics were also observed in 12 deer in which no adult filariae were found. Microscopic changes were observed only in the right and left branches of the portal vein and consisted of thickening of the intima with surface formation of villi. Stroma of villi contained a moderate to intense infiltrate composed mainly of eosinophils and mononuclear cells. The tunica media of affected vessels was uniformly hypertrophic and in some cases presented a moderate inflammatory infiltrate similar to that observed in the stroma of villi. Thrombi consisted of a central area containing calcified filariae or cuticle debris, surrounded by giant cells and numerous lymphoid cells forming clearly defined nodules resembling lymphoid follicles. Thrombi were externally surrounded by a strip of connective tissue and beyond by endothelial cells that were occasionally continuous with the tunica intima. Other lesions probably associated with the infestation were multifocal granulomas in the periportal areas, lymphoid tissue formations in the hepatic parenchyma, and an interstitial nephritis.

Histological and immunohistological classification of canine glomerular disease

A histological and immunohistological study of the kidneys of 115 dogs, with and without clinical signs of spontaneous renal disease, was performed to prove the applicability of the WHO criteria for the classification of human glomerulopathy. Aside from the morphological investigation of paraffin and resin semithin sections, deposits of immunoglobulins, the complement component C3, and fibrinogen were observed immunoenzymatically in paraffin-embedded tissue specimens. From this, eight different types of glomerular lesions with various frequencies were identified: minor glomerular abnormalities (28 cases), focal and segmental hyalinosis and sclerosis (12 cases), focal glomerulonephritis (GN; 18 cases), diffuse membranous GN (nine cases), diffuse mesangial proliferative GN (2 cases), diffuse endocapillary proliferative GN (five cases), diffuse mesangiocapillary GN (25 cases), diffuse sclerosing GN (11 cases) und unclassified GN (two cases). In one case, renal dysplasia was diagnosed and two dogs did not present glomerular alterations. The results are discussed with regard to human glomerular diseases and pathogenic mechanisms.

Geriatric nutrition

In recent decades, veterinary medicine has become more successful in prolonging the healthy, useful lives of pets. As a result, the practitioner spends a greater part of each practice day caring for the geriatric animal, both healthy and unhealthy. Because of their longevity, older pets are typically regular family members, with owners who seek the finest health care possible for their pets. The practice of geriatric medicine most properly should begin not when the dog or cat reaches some specific "golden" age, but rather when the wiggly, robust puppy or kitten receives its first examination. Like all parts of a sound preventive program, geriatric nutrition best follows from a well-considered juvenile and adult nutrition program. Furthermore, once it becomes senior, the "well" geriatric is as much a candidate for a diet designed especially to accommodate old age changes as is his unhealthy contemporary. In fact, evidence suggests that appropriate dietary management of the healthy, but often subclinical, patient may help postpone the signs of dysfunction and increase quality and length of life. A knowledge of the most significant nutrients and the impact of each on aging systems is now, and will become increasingly more, important to the progressive, skillful veterinarian.

Heartworm infection

Dirofilaria immitis is an epizootic filarial parasite that most often infects domestic dogs. This article provides information about the life cycle of Dirofilaria immitis as well as the epidemiology, diagnosis, clinical signs, and treatment of heartworm infection.