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Summers S, Michael HT, Szlosek D, Mack R. Blood fibroblast growth factor 23 concentration in cats with and without chronic kidney disease: a scoping review. J Feline Med Surg 2024; 26:1098612X241234984. [PMID: 38682929 PMCID: PMC11103316 DOI: 10.1177/1098612x241234984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
OBJECTIVES This study undertook a scoping review of research on blood fibroblast growth factor 23 (FGF-23) concentrations in healthy non-azotemic cats and cats with chronic kidney disease (CKD) to describe the volume and nature of existing literature, to determine whether published studies provide adequate evidence to support the use of FGF-23 as a biomarker in clinical practice and to identify any existing gaps in knowledge. METHODS PRISMA Extension for Scoping Reviews guidelines were used to design and perform the scoping review. Online databases were used to identify observational and clinical studies of blood FGF-23 concentrations in healthy cats and cats with CKD published before December 2022. Study and population characteristics and descriptive data on FGF-23 concentrations were extracted. RESULTS A total of 205 publications were reviewed; 17 were retained for inclusion. Most studies were retrospective. Most studies included cats with International Renal Interest Society stage 2-4 CKD, with some variation. Key concepts explored in the literature include FGF-23 concentrations by CKD stage, effect of dietary phosphate restriction on FGF-23 concentrations, relationship between FGF-23 concentrations and blood phosphorus, calcium and magnesium concentrations, and FGF-23 concentrations in cats with progressive CKD. FGF-23 concentrations tended to be higher in cats with CKD compared with healthy cats, with an overlap between healthy and CKD populations, and there was significant variation within stages of CKD. CONCLUSIONS AND RELEVANCE FGF-23 is a biomarker of interest for the management and monitoring of phosphate overload in cats. Studies support several potential clinical applications for measuring FGF-23 concentration in practice; however, evidence is limited. Research on FGF-23 in cats with CKD would benefit from longitudinal, prospective studies that standardize CKD diagnosis and categorize cats by stage using current guidelines. Studies should include cats with early-stage, non-azotemic CKD and use commercially available assays so such results are comparable across studies.
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Affiliation(s)
- Stacie Summers
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
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2
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Zambarbieri J, Fusi E, Bassi J, Scarpa P. Nutritional secondary hyperparathyroidism in a kitten, supported by immunoenzymatic measurement of feline intact parathyroid hormone. J Vet Diagn Invest 2023; 35:163-167. [PMID: 36625404 PMCID: PMC9999400 DOI: 10.1177/10406387221143463] [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] [Indexed: 01/11/2023] Open
Abstract
A 6-mo-old, intact male, domestic shorthair cat was referred with a history of poor growth, reluctance to move, and deformation of the nasal profile. The kitten had been fed a diet composed almost exclusively of a complementary pet food and tuna, which was similar to an all-meat diet. We detected osteopenia and hypocalcemia associated with severe parathyroid hormone (PTH) and calcitriol increases; we measured PTH concentrations with an immunoenzymatic method that has been validated in cats. Dietary correction, consisting of a complete and balanced wet pet food formulated for growth, resulted in normalization of calcium and PTH concentrations within 2 mo.
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Affiliation(s)
- Jari Zambarbieri
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Lodi, Italy
| | - Eleonora Fusi
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Lodi, Italy
| | - Jessica Bassi
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Lodi, Italy
| | - Paola Scarpa
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Lodi, Italy
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Coltherd JC, Staunton R, Colyer A, Gilham M, Rawlings J, Alexander JE, Logan DW, Butterwick R, Watson P, Bakke AM. Dietary calcium to phosphorus ratio affects postprandial phosphorus concentrations in feline plasma. Br J Nutr 2022; 128:1689-1699. [PMID: 34789346 PMCID: PMC9592954 DOI: 10.1017/s000711452100461x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 12/29/2022]
Abstract
The impact of dietary phosphorus on chronic renal disease in cats, humans and other species is receiving increasing attention. As Ca and P metabolism are linked, the ratio of Ca:P is an important factor for consideration when formulating diets for cats and other animals. Here, we describe a fully randomised crossover study including twenty-four healthy, neutered adult cats, investigating postprandial responses in plasma P, ionised Ca and parathyroid hormone (PTH) following one meal (50 % of individual metabolic energy requirement) of each of six experimental diets. Diets were formulated to provide P at either 0·75 or 1·5 g/1000 kcal (4184 kJ) from the soluble phosphorus salt sodium tripolyphosphate (STPP, Na5P3O10), variable levels of organic Ca and P sources, and an intended total Ca:P of about 1·0, 1·5 or 2·0. For each experimental diet, baseline fasted blood samples were collected prior to the meal, and serial blood samples collected hourly for 6 h thereafter. For all diets, a significant increase from baseline was observed at 120 min in plasma PTH (P < 0·001). The diet containing the highest STPP inclusion level and lowest Ca:P induced the highest peaks in postprandial plasma P and PTH levels (1·8 mmol/l and 27·2 pg/ml, respectively), and the longest duration of concentrations raised above baseline were observed at 3 h for P and 6 h for PTH. Data indicate that Ca:P modulates postprandial plasma P and PTH. Therefore, when formulating diets containing soluble P salts for cats, increasing the Ca:P ratio should be considered.
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Affiliation(s)
| | - Ruth Staunton
- Waltham Petcare Science Institute, Waltham-on-the-Wolds, Leicestershire, UK
| | - Alison Colyer
- Waltham Petcare Science Institute, Waltham-on-the-Wolds, Leicestershire, UK
| | - Matthew Gilham
- Waltham Petcare Science Institute, Waltham-on-the-Wolds, Leicestershire, UK
| | - John Rawlings
- Waltham Petcare Science Institute, Waltham-on-the-Wolds, Leicestershire, UK
| | - Janet E. Alexander
- Waltham Petcare Science Institute, Waltham-on-the-Wolds, Leicestershire, UK
| | - Darren W. Logan
- Waltham Petcare Science Institute, Waltham-on-the-Wolds, Leicestershire, UK
| | - Richard Butterwick
- Waltham Petcare Science Institute, Waltham-on-the-Wolds, Leicestershire, UK
| | - Phillip Watson
- Waltham Petcare Science Institute, Waltham-on-the-Wolds, Leicestershire, UK
| | - Anne Marie Bakke
- Waltham Petcare Science Institute, Waltham-on-the-Wolds, Leicestershire, UK
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Grelová S, Karasová M, Tóthová C, Kisková T, Baranová D, Lukáč B, Fialkovičová M, Micháľová A, Kunay L, Svoboda M. Relationship between FGF 23, SDMA, Urea, Creatinine and Phosphate in Relation to Feline Chronic Kidney Disease. Animals (Basel) 2022; 12:2247. [PMID: 36077967 PMCID: PMC9454452 DOI: 10.3390/ani12172247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease (CKD) is a common diagnosis in older cats, and its prevalence increases with age. Conventional indirect biomarkers of glomerular filtration rate (GFR) have their limitations, and are not efficient in detecting early decreases in glomerular filtration rate. Recently, symmetric dimethylarginine (SDMA) concentrations have been proposed as a novel biomarker of GFR for the early detection of CKD. This study discusses the relationship between SDMA, FGF 23 and previously used indicators of kidney function, mainly creatinine, urea and phosphate. Ninety-nine cats were included in this study. Based on their SDMA values, 48 cats had CKD and the remaining 51 cats were used as a healthy control group. Serum of these cats was assayed for creatinine, urea and phosphate concentrations as well as FGF 23 values, and correlations between them were evaluated. Cats with CKD had higher FGF 23 concentrations than healthy cats, and no correlation was found between FGF 23 and SDMA, nor between FGF 23 and phosphate. On the other hand, phosphate strongly correlated with SDMA, urea and creatinine, making it a possible independent factor of CKD progression.
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Affiliation(s)
- Simona Grelová
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy, 04001 Košice, Slovakia
| | - Martina Karasová
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy, 04001 Košice, Slovakia
| | - Csilla Tóthová
- Clinic of Ruminants, University of Veterinary Medicine and Pharmacy, 04001 Košice, Slovakia
| | - Terézia Kisková
- Faculty of Science, University of Pavol Jozef Šafárik, 04154 Košice, Slovakia
| | - Darina Baranová
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy, 04001 Košice, Slovakia
| | - Branislav Lukáč
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy, 04001 Košice, Slovakia
| | - Mária Fialkovičová
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy, 04001 Košice, Slovakia
| | - Alena Micháľová
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy, 04001 Košice, Slovakia
| | - Lukáš Kunay
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy, 04001 Košice, Slovakia
| | - Miroslav Svoboda
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy, 04001 Košice, Slovakia
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5
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Zambarbieri J, Moretti P, Giordano A, Scarpa P. Analytical Validation of a New Immunoenzymatic Method for the Measurement of Feline Parathyroid Hormone in Cats with Chronic Kidney Disease. Animals (Basel) 2021; 11:ani11113100. [PMID: 34827832 PMCID: PMC8614346 DOI: 10.3390/ani11113100] [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: 09/17/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Parathyroid hormone (PTH) is involved in many metabolic diseases, such as chronic kidney disease (CKD) and calcium disorders, and its measurement could be of clinical utility. However, available methods for the measurement of feline PTH are limited and not widely accessible. The aim of this study was to perform the analytical validation of a new method for PTH measurement in cats. Thirty-eight cats affected with CKD were included. The analytical protocol provided an evaluation of the precision, accuracy, and storage stability at different temperatures. The method investigated showed good precision and accuracy and good stability for 1 week of storage at freezing temperatures. The method was validated in cats, allowing its future use in diagnostic procedures. Abstract The determination of parathyroid hormone (PTH) in cats could be of clinical utility in many metabolic disorders, such as renal diseases, hypercalcemia, or nutritional imbalances. However, the available methods for the measurement of feline PTH are limited, not widely available, and need radioimmunoassays. The aim of this study was to perform the analytical validation of a new immunoenzymatic method for the measurement of feline PTH. Thirty-eight cats affected with chronic kidney disease (CKD) were included. PTH was measured using a two-site immunoenzymatic method validated in humans and dogs (ST AIA-PACK® Intact PTH, Tosoh Bioscience, Tessenderlo, Belgium). The analytical validation provided the evaluation of precision (intra-assay and inter-assay), accuracy (linearity under dilution (LUD) and spike recovery test (SRT)), and the storage stability of serum samples at 20 °C, 4 °C, and −20 °C. The method showed good precision (intra-assay CVs (coefficient of variations) 3.19–9.61%; inter-assay CVs 9.26–15.28%). In both the intra- and inter-assays, the highest imprecision was found with the low concentration pool (9.61% and 15.28%) and accuracy (LUD and SRT r2 = 0.99, p < 0.001), while the stability was optimal up until 7 days at −20 °C (−7.7%). The method was successfully validated in cats, allowing its future use in diagnostic procedures.
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Tang PK, Geddes RF, Jepson RE, Elliott J. A feline-focused review of chronic kidney disease-mineral and bone disorders - Part 2: Pathophysiology of calcium disorder and extraosseous calcification. Vet J 2021; 275:105718. [PMID: 34329743 DOI: 10.1016/j.tvjl.2021.105718] [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: 10/07/2020] [Revised: 06/23/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
Derangements in mineral metabolism are one of the main entities in chronic kidney disease-mineral and bone disorder (CKD-MBD). This is the second of a two-part review of the physiology and pathophysiology of calcium homeostasis in feline CKD-MBD. While dysregulation in calcium homeostasis is known to contribute to the development of vascular calcification in CKD, evidence characterising the relationship between serum calcium concentration and nephrocalcinosis and nephrolithiasis is limited. Recently, fibroblast growth factor 23 (FGF23) and α-Klotho have gained increased research interest and been shown to be important biomarkers for the prediction of CKD progression in human patients. However, conflicting evidence exists on their role in calcium homeostasis and vascular and soft tissue calcification. This review details the pathophysiology of calcium disorders associated with CKD-MBD and its implications on vascular and soft tissue mineralisation in human and feline patients. Further prospective studies investigating the clinical consequences of calcium disturbances in cats with CKD are warranted and this may provide additional insight into the pathophysiology of feline CKD-MBD.
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Affiliation(s)
- Pak-Kan Tang
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, United Kingdom.
| | - Rebecca F Geddes
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
| | - Rosanne E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, United Kingdom
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7
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Stockman J, Villaverde C, Corbee RJ. Calcium, Phosphorus, and Vitamin D in Dogs and Cats: Beyond the Bones. Vet Clin North Am Small Anim Pract 2021; 51:623-634. [PMID: 33653533 DOI: 10.1016/j.cvsm.2021.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Calcium, phosphorus, and vitamin D are nutrients that play a key role in maintaining normal organ, cell, and tissue function. Much is known about their role in bone metabolism, but these nutrients are also important in renal health, urinary tract disease, and multiple other organ systems. It is nutritionally important to meet the physiologic requirements for each of these nutrients, but the interplay between them should also be considered.
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Affiliation(s)
- Jonathan Stockman
- Department of Clinical Veterinary Sciences, LIU College of Veterinary Medicine, Long Island University, 720 Northern Boulevard, Brookville, NY 11548, USA
| | | | - Ronald Jan Corbee
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht 3584 CM, The Netherlands.
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8
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Lin J, Lin L, Chen S, Yu L, Chen S, Xia Z. Serum fibroblast growth factor 23 (FGF-23): associations with hyperphosphatemia and clinical staging of feline chronic kidney disease. J Vet Diagn Invest 2021; 33:288-293. [PMID: 33543676 DOI: 10.1177/1040638720985563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fibroblast growth factor 23 (FGF-23) is an independent monitor of the progression of chronic kidney disease (CKD) in human medicine, and FGF-23 may have value as a biomarker in feline CKD. We evaluated the relationship between serum FGF-23 and CKD stages, and the effect of age on FGF-23 in normal cats. We measured FGF-23 and intact parathyroid hormone (iPTH) concentrations by ELISA, with intra- and inter-assay CVs ≤ 15%. The percentage recovery of FGF-23 and iPTH remained stable for up to 7 d in samples stored at -20°C and -80°C. We measured FGF-23 in 304 cats, among which 196 were diagnosed with CKD. The 108 clinically healthy cats were divided into 5 subgroups based on growth stage (0-2 y, 3-6 y, 7-10 y, 11-14 y, ≥ 15 y). No statistical difference was found in FGF-23 among age groups (p = 0.15) or by sex in healthy subjects. Using the International Renal Interest Society guideline, 34 cats were defined as CKD stage 1, 74 stage 2, 51 stage 3, and 37 stage 4. FGF-23 was higher in cats in all CKD stages than in controls. Higher serum phosphorus was observed in stage 3 (p = 0.04) and 4 (p < 0.01) compared to controls. iPTH increased as CKD progressed. Pearson analysis indicated a positive linear relationship between FGF-23 and iPTH (control: r = 0.70, p < 0.01; CKD: r = 0.46, p = 0.02). FGF-23 may be a useful biomarker of feline CKD and may precede hyperphosphatemia in advanced feline CKD.
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Affiliation(s)
- Jiabao Lin
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Luqi Lin
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Siyu Chen
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Lifang Yu
- Veterinary Teaching Hospital, China Agricultural University, Beijing, China
| | - Songjie Chen
- Veterinary Teaching Hospital, China Agricultural University, Beijing, China
| | - Zhaofei Xia
- College of Veterinary Medicine, China Agricultural University, Beijing, China
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9
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Laflamme D, Backus R, Brown S, Butterwick R, Czarnecki-Maulden G, Elliott J, Fascetti A, Polzin D. A review of phosphorus homeostasis and the impact of different types and amounts of dietary phosphate on metabolism and renal health in cats. J Vet Intern Med 2020; 34:2187-2196. [PMID: 33159358 PMCID: PMC7694857 DOI: 10.1111/jvim.15961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/11/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
Elevated concentrations of serum phosphate are linked with progression and increased case fatality rate in animals and humans with chronic kidney disease. Elevated concentrations of serum phosphate can be a risk factor for development of renal and cardiovascular diseases or osteoporosis in previously healthy people. In rodents, an excess intake of dietary phosphorus combined with an inverse dietary calcium : phosphorus ratio (<1 : 1) contributes to renal calcification. Renal injury also has occured in cats fed experimental diets supplemented with highly soluble phosphate salts, especially in diets with inverse calcium : phosphorus ratios. However, not all phosphorus sources contribute similarly to this effect. This review, which focuses on cats, summarizes the published evidence regarding phosphorus metabolism and homeostasis, including the relative impact of different dietary phosphorus sources, and their impact on the kidneys. No data currently shows that commercial cat foods induce renal injury. However, some diets contain high amounts of phosphorus relative to recommendations and some have inverse Ca : P ratios and so could increase the risk for development of kidney disease. While limiting the use of highly soluble phosphates appears to be important, there are insufficient data to support a specific upper limit for phosphate intake. This review also proposes areas where additional research is needed in order to strengthen conclusions and recommendations regarding dietary phosphorus for cats.
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Affiliation(s)
| | - Robert Backus
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Scott Brown
- College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | | | | | - Jonathan Elliott
- Royal Veterinary College, University of London, London, United Kingdom
| | - Andrea Fascetti
- Department of Molecular Biosciences, University of California, Davis, California, USA
| | - David Polzin
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
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Laflamme DP. Understanding the Nutritional Needs of Healthy Cats and Those with Diet-Sensitive Conditions. Vet Clin North Am Small Anim Pract 2020; 50:905-924. [PMID: 32646606 DOI: 10.1016/j.cvsm.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Diets for cats must provide complete nutrition and meet the needs of the individual patient. There is no single diet that is perfect for all cats, and veterinarians must consider the needs of the cat as well as the preferences of the owners when making dietary recommendations. This article focuses on the interface between animal factors and nutritional needs in cats and is divided into 3 sections. Section 1 addresses the dietary needs of healthy cats, including differences among life stages. Section 2 addresses common myths regarding feline nutrition. Section 3 addresses common nutrient-sensitive conditions in cats, including sarcopenia of aging.
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Affiliation(s)
- Dottie P Laflamme
- Veterinary Communications, 473 Grandma's Place, Floyd, VA 24091, USA.
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11
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Halfen DP, Caragelasco DS, Nogueira JPDS, Jeremias JT, Pedrinelli V, Oba PM, Ruberti B, Pontieri CFF, Kogika MM, Brunetto MA. Evaluation of Electrolyte Concentration and Pro-Inflammatory and Oxidative Status in Dogs with Advanced Chronic Kidney Disease under Dietary Treatment. Toxins (Basel) 2019; 12:toxins12010003. [PMID: 31861622 PMCID: PMC7020431 DOI: 10.3390/toxins12010003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022] Open
Abstract
An integrated study on the effect of renal diet on mineral metabolism, fibroblast growth factor 23 (FGF-23), total antioxidant capacity, and inflammatory markers has not been performed previously. In this study, we evaluated the effects of renal diet on mineral metabolism, oxidative stress and inflammation in dogs with stage 3 or 4 of chronic kidney disease (CKD). Body condition score (BCS), muscle condition score (MCS), serum biochemical profile, ionized calcium (i-Ca), total calcium (t-Ca), phosphorus (P), urea, creatinine, parathyroid hormone (PTH), FGF-23, interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor alpha (TNF-α) and total antioxidant capacity (TAC) were measured at baseline (T0) and after 6 months of dietary treatment (T6). Serum urea, P, t-Ca, i-Ca, PTH, FGF-23, IL-6, IL-10, TNF-α and TAC measurements did not differ between T0 and T6. Serum creatinine (SCr) was increased at T6 and serum PTH concentrations were positively correlated with serum SCr and urea. i-Ca was negatively correlated with urea and serum phosphorus was positively correlated with FGF-23. Urea and creatinine were positively correlated. The combination of renal diet and support treatment over 6 months in dogs with CKD stage 3 or 4 was effective in controlling uremia, acid–base balance, blood pressure, total antioxidant capacity, and inflammatory cytokine levels and in maintaining BCS and MCS.
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Affiliation(s)
- Doris Pereira Halfen
- School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, São Paulo, SP 05508-270, Brazil; (D.P.H.); (D.S.C.); (V.P.); (B.R.); (M.A.B.)
| | - Douglas Segalla Caragelasco
- School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, São Paulo, SP 05508-270, Brazil; (D.P.H.); (D.S.C.); (V.P.); (B.R.); (M.A.B.)
| | - Juliana Paschoalin de Souza Nogueira
- Animal Sciences Department, College of Agricultural, Consumer & Environmental Sciences, University of Illinois at Urbana-Champaign, Champaign, IL 217-333-3131, USA; (J.P.d.S.N.); (P.M.O.)
| | - Juliana Toloi Jeremias
- Nutrition Development Center, Grand Food Industria e Comercio Ltda (Premier Pet), Dourado, SP 13590-000, Brazil; (J.T.J.); (C.F.F.P.)
| | - Vivian Pedrinelli
- School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, São Paulo, SP 05508-270, Brazil; (D.P.H.); (D.S.C.); (V.P.); (B.R.); (M.A.B.)
| | - Patrícia Massae Oba
- Animal Sciences Department, College of Agricultural, Consumer & Environmental Sciences, University of Illinois at Urbana-Champaign, Champaign, IL 217-333-3131, USA; (J.P.d.S.N.); (P.M.O.)
| | - Bruna Ruberti
- School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, São Paulo, SP 05508-270, Brazil; (D.P.H.); (D.S.C.); (V.P.); (B.R.); (M.A.B.)
| | | | - Marcia Mery Kogika
- School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, São Paulo, SP 05508-270, Brazil; (D.P.H.); (D.S.C.); (V.P.); (B.R.); (M.A.B.)
- Correspondence:
| | - Marcio Antonio Brunetto
- School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, São Paulo, SP 05508-270, Brazil; (D.P.H.); (D.S.C.); (V.P.); (B.R.); (M.A.B.)
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12
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Sargent HJ, Jepson RE, Chang YM, Biourge VC, Bijsmans ES, Elliott J. Fibroblast growth factor 23 and symmetric dimethylarginine concentrations in geriatric cats. J Vet Intern Med 2019; 33:2657-2664. [PMID: 31568615 PMCID: PMC6872607 DOI: 10.1111/jvim.15590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 07/24/2019] [Indexed: 01/02/2023] Open
Abstract
Background Fibroblast growth factor 23 (FGF23) is a phosphaturic hormone that is increased in azotemic cats with chronic kidney disease (CKD) and predictive of the onset of azotemia in older cats. The introduction of symmetric dimethylarginine (SDMA) as a biomarker of glomerular filtration rate has led to the identification of cats in which SDMA is increased, but plasma creatinine concentrations remains within reference range. There is currently little understanding of the metabolic changes present in such cats. Objectives To examine the relationship between plasma FGF23 and SDMA concentrations in non‐azotemic geriatric cats. Animals Records of a cross section of client‐owned cats (n = 143) without azotemic CKD. Methods Clinicopathological information was obtained from cats (≥ 9 years) from records of 2 first opinion practices. The relationship between plasma SDMA and FGF23 concentrations was examined using Spearman's correlation and variables compared using the Mann‐Whitney U test. Results Cats with increased SDMA concentrations had significantly higher plasma FGF23 (P < .001) and creatinine (P < .001) concentrations compared to cats with SDMA concentrations within reference range. A weak positive relationship was demonstrated between plasma FGF23 and SDMA concentrations (r = .35, P < .001) and between plasma FGF23 and creatinine (r = .23, P = .005) concentrations. Conclusions and Clinical Importance More cats with increased SDMA concentrations had higher FGF23 concentrations than those with SDMA concentrations within the reference range, suggesting the presence of an alteration in phosphate homeostasis. Further studies are warranted to identify influencing factors and to explore the utility of FGF23 concentration to inform management of cats with early stage CKD.
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Affiliation(s)
- Hannah J Sargent
- Department of Comparative Biomedical Science, Royal Veterinary College, University of London, London, United Kingdom
| | - Rosanne E Jepson
- Department of Clinical Science and Services Royal Veterinary College, University of London, London, United Kingdom
| | - Yu-Mei Chang
- Research Support Office, Royal Veterinary College, University of London, London, United Kingdom
| | | | | | - Jonathan Elliott
- Department of Comparative Biomedical Science, Royal Veterinary College, University of London, London, United Kingdom
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Valle E, Prola L, Vergnano D, Borghi R, Monacelli F, Traverso N, Bruni N, Bovero A, Schiavone A, Nery J, Bergero D, Odetti P. Investigation of hallmarks of carbonyl stress and formation of end products in feline chronic kidney disease as markers of uraemic toxins. J Feline Med Surg 2019; 21:465-474. [PMID: 30015556 PMCID: PMC10814538 DOI: 10.1177/1098612x18783858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Cats are commonly affected by chronic kidney disease (CKD). Many reactive carbonyl intermediates and end products originating from the oxidative stress pathways are recognised as uraemic toxins and may play a role in CKD progression. The aim of the present study is to confirm whether carbonyl end-product formation is higher in cats affected by CKD and to assess whether an angiotensin-converting enzyme inhibitor (ACEi) might affect these hallmarks. METHODS Twenty-two cats were divided into three groups: a control group (CG), cats with CKD and cats with CKD treated with an ACEi. Serum levels of pentosidine, carboxymethyllysine, advanced oxidation protein products, malondialdehyde, methylglyoxal and hexanoyl-lysine were measured. In addition, biochemical parameters and systolic blood pressure were evaluated. After checking for normality, comparisons between groups were performed followed by multiple comparison tests. P values ⩽0.05 were considered significant. Correlations between concentrations of the considered biomarkers and of the other metabolic parameters were investigated. RESULTS Advanced oxidation protein products, malondialdehyde and hexanoyl-lysine concentrations were significantly higher in CKD and ACEi-treated groups compared with the CG ( P <0.05). Carboxymethyllysine increased in the ACEi-treated group when compared with the CG, whereas intermediate values of these biomarkers were found in the CKD group ( P <0.05). The ACEi-treated group showed the highest values of carboxymethyllysine, advanced oxidation protein products and hexanoyl-lysine. By contrast, the CKD group had the highest concentration of malondialdehyde. No statistically significant difference was found in the levels of pentosidine or methylglyoxal. End products correlated with creatinine and urea and with each other. CONCLUSIONS AND RELEVANCE Significantly high concentrations of both intermediate and end products of carbonyl/oxidative stress were detected in CKD cats. This is the first study to have concurrently taken into account several uraemic toxins and biochemical parameters in cats affected by CKD.
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Affiliation(s)
- Emanuela Valle
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Liviana Prola
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Diana Vergnano
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Roberta Borghi
- Department of Internal Medicine and Medical Specialties, Genoa, Italy
| | | | - Nicola Traverso
- Department of Internal Medicine and Medical Specialties, Genoa, Italy
| | | | | | - Achille Schiavone
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Joana Nery
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Domenico Bergero
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Patrizio Odetti
- Department of Internal Medicine and Medical Specialties, Genoa, Italy
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Marks SL, Kook PH, Papich MG, Tolbert MK, Willard MD. ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats. J Vet Intern Med 2018; 32:1823-1840. [PMID: 30378711 PMCID: PMC6271318 DOI: 10.1111/jvim.15337] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/24/2018] [Accepted: 09/05/2018] [Indexed: 12/12/2022] Open
Abstract
The gastrointestinal (GI) mucosal barrier is continuously exposed to noxious toxins, reactive oxygen species, microbes, and drugs, leading to the development of inflammatory, erosive, and ultimately ulcerative lesions. This report offers a consensus opinion on the rational administration of GI protectants to dogs and cats, with an emphasis on proton pump inhibitors (PPIs), histamine type-2 receptor antagonists (H2 RAs), misoprostol, and sucralfate. These medications decrease gastric acidity or promote mucosal protective mechanisms, transforming the management of dyspepsia, peptic ulceration, and gastroesophageal reflux disease. In contrast to guidelines that have been established in people for the optimal treatment of gastroduodenal ulcers and gastroesophageal reflux disease, effective clinical dosages of antisecretory drugs have not been well established in the dog and cat to date. Similar to the situation in human medicine, practice of inappropriate prescription of acid suppressants is also commonplace in veterinary medicine. This report challenges the dogma and clinical practice of administering GI protectants for the routine management of gastritis, pancreatitis, hepatic disease, and renal disease in dogs and cats lacking additional risk factors for ulceration or concerns for GI bleeding. Judicious use of acid suppressants is warranted considering recent studies that have documented adverse effects of long-term supplementation of PPIs in people and animals.
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Affiliation(s)
- Stanley L. Marks
- Department of Medicine & EpidemiologySchool of Veterinary Medicine, University of California, DavisDavisCalifornia
| | - Peter H. Kook
- Vetsuisse Faculty, Clinic for Small Animal Internal Medicine, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Mark G. Papich
- Department of Molecular Biomedical SciencesNorth Carolina State University, College of Veterinary MedicineRaleighNorth Carolina
| | - M. K. Tolbert
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine, Texas A & M UniversityCollege StationTexas
| | - Michael D. Willard
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine, Texas A & M UniversityCollege StationTexas
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15
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van den Broek DHN, Geddes RF, Williams TL, Chang YM, Elliott J, Jepson RE. Calcitonin Response to Naturally Occurring Ionized Hypercalcemia in Cats with Chronic Kidney Disease. J Vet Intern Med 2018; 32:727-735. [PMID: 29469976 PMCID: PMC5867022 DOI: 10.1111/jvim.15051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/29/2017] [Accepted: 01/05/2018] [Indexed: 12/27/2022] Open
Abstract
Background Hypercalcemia is commonly associated with chronic kidney disease (CKD) in cats. Objectives To explore the calcitonin response to naturally occurring ionized hypercalcemia in cats with azotemic CKD, and to assess the relationship of plasma calcitonin with ionized calcium, alkaline phosphatase (ALP), and urinary calcium excretion. Animals Thirty‐three client‐owned cats with azotemic CKD and ionized hypercalcemia from first opinion practice. Methods Cohort study. Calcitonin was measured with an immunoradiometric assay in heparinized plasma. Simple correlations were assessed with Kendall's rank correlation, and the within‐subject correlations of calcitonin with ionized calcium and other clinicopathological variables were calculated with a bivariate linear mixed effects model. Results Calcitonin concentrations above the lower limit of detection (>1.2 pg/mL; range, 1.7–87.2 pg/mL) were observed in 11 of 33 hypercalcemic cats (responders). Blood ionized calcium concentration did not differ significantly between responders (median, 1.59 [1.46, 1.66] mmol/L) and nonresponders (median, 1.48 [1.43, 1.65] mmol/L; P = 0.22). No evidence was found for calcitonin and ionized calcium to correlate between cats (τb = 0.14; P = 0.31; n = 33), but significant positive correlation was evident within individual responders over time (within‐subject correlation coefficient [rwithin], 0.83; 95% confidence interval [CI], 0.63–0.92). Calcitonin correlated negatively over time with plasma ALP (rwithin, −0.55; 95% CI, −0.79 to −0.16). Conclusions and Clinical Importance Calcitonin does not appear to have an important role in calcium metabolism in cats with CKD.
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Affiliation(s)
- D H N van den Broek
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
| | - R F Geddes
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
| | - T L Williams
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Y-M Chang
- Research Support Office, Royal Veterinary College, University of London, London, United Kingdom
| | - J Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, United Kingdom
| | - R E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
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16
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Tolbert MK, Olin S, MacLane S, Gould E, Steiner JM, Vaden S, Price J. Evaluation of Gastric pH and Serum Gastrin Concentrations in Cats with Chronic Kidney Disease. J Vet Intern Med 2017; 31:1414-1419. [PMID: 28833548 PMCID: PMC5598879 DOI: 10.1111/jvim.14807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/07/2017] [Accepted: 07/13/2017] [Indexed: 12/22/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a highly prevalent condition in cats. Advanced CKD is associated with hyporexia and vomiting, which typically are attributed to uremic toxins and gastric hyperacidity. However, gastric pH studies have not been performed in cats with CKD. Hypothesis/Objectives To determine if cats with CKD have decreased gastric pH compared to age‐matched, healthy cats. Based on previous work demonstrating an association of hypergastrinemia and CKD, we hypothesized that cats with CKD would have decreased gastric pH compared to healthy, age‐matched control cats. Animals 10 CKD cats; 9 healthy control cats. Methods All cats with concurrent disease were excluded on the basis of history, physical examination, CBC, plasma biochemistry profile, urinalysis, urine culture, serum total thyroxine concentration, and serum symmetric dimethylarginine concentration (controls only) obtained within 24 hours of pH monitoring and assessment of serum gastrin concentrations. Serum for gastrin determination was collected, and 12‐hour continuous gastric pH monitoring was performed in all cats. Serum gastrin concentration, mean pH, and percentage time that gastric pH was strongly acidic (pH <1 and <2) were compared between groups. Results No significant differences in serum gastrin concentrations were observed between groups (medians [range]: CKD, 18.7 ng/dL [<10–659.0]; healthy, 54.6 ng/dL [<10–98.0]; P‐value = 0.713) or of any pH parameters including mean ± SD gastric pH (CKD, 1.8 ± 0.5; healthy, 1.6 ± 0.3; P‐value = 0.23). Conclusions and Clinical Importance These findings suggest that cats with CKD may not have gastric hyperacidity compared to healthy cats and, therefore, may not need acid suppression. Thus, further studies to determine if there is a benefit to acid suppression in cats with CKD are warranted.
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Affiliation(s)
- M K Tolbert
- University of Tennessee College of Veterinary Medicine, Knoxville
| | - S Olin
- University of Tennessee College of Veterinary Medicine, Knoxville
| | - S MacLane
- Appalachian Animal Hospital, Piney Flats, TN
| | - E Gould
- University of Tennessee College of Veterinary Medicine, Knoxville
| | - J M Steiner
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX
| | - S Vaden
- North Carolina State University College of Veterinary Medicine, Raleigh, NC
| | - J Price
- University of Tennessee College of Veterinary Medicine, Knoxville
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17
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Harjes LM, Parker VJ, Dembek K, Young GS, Giovaninni LH, Kogika MM, Chew DJ, Toribio RE. Fibroblast Growth Factor-23 Concentration in Dogs with Chronic Kidney Disease. J Vet Intern Med 2017; 31:784-790. [PMID: 28419560 PMCID: PMC5435078 DOI: 10.1111/jvim.14707] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/29/2016] [Accepted: 02/27/2017] [Indexed: 02/06/2023] Open
Abstract
Background Chronic kidney disease (CKD) is associated with hyperphosphatemia, decreased vitamin D metabolite concentrations, and hyperparathyroidism. This syndrome is known as CKD‐mineral bone disorder (CKD‐MBD). Recently, it has been shown that an increase in fibroblast growth factor‐23 (FGF‐23) concentration is an early biomarker of CKD in people. It is an independent risk factor for both progression of renal disease and survival time in humans and cats with CKD. Information about FGF‐23 in healthy dogs and those with CKD is lacking. Objectives To measure FGF‐23 concentration in dogs with different stages of CKD and determine its association with factors involved in CKD‐MBD, including serum phosphorus and parathyroid hormone (PTH) concentrations. A secondary aim was to validate an ELISA for measurement of plasma FGF‐23 concentration in dogs. Animals Thirty‐two client‐owned dogs with naturally occurring CKD and 10 healthy control dogs. Methods Prospective cross‐sectional study. An FGF‐23 ELISA was used to measure plasma FGF‐23 concentration in dogs and their association with serum creatinine, phosphorus, calcium, and PTH concentrations. Results Plasma FGF‐23 concentrations increased with severity of CKD and were significantly different between IRIS stages 1 and 2 versus stages 3 and 4 (P < .0001). Increases in FGF‐23 concentrations were more frequent than hyperparathyroidism or hyperphosphatemia in this cohort. Serum creatinine and phosphorus concentrations were the strongest independent predictors of FGF‐23 concentration. Conclusions and clinical importance Plasma FGF‐23 concentrations increase in dogs with CKD as disease progresses. Plasma FGF‐23 concentrations appear to be useful for further study of the pathophysiology of CKD‐MBD in dogs.
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Affiliation(s)
- L M Harjes
- Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
| | - V J Parker
- Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
| | - K Dembek
- Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
| | - G S Young
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - L H Giovaninni
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil
| | - M M Kogika
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil
| | - D J Chew
- Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
| | - R E Toribio
- Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
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Geddes RF, Biourge V, Chang Y, Syme HM, Elliott J. The Effect of Moderate Dietary Protein and Phosphate Restriction on Calcium-Phosphate Homeostasis in Healthy Older Cats. J Vet Intern Med 2016; 30:1690-1702. [PMID: 27527663 PMCID: PMC5032885 DOI: 10.1111/jvim.14563] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 06/25/2016] [Accepted: 07/18/2016] [Indexed: 12/12/2022] Open
Abstract
Background Dietary phosphate and protein restriction decreases plasma PTH and FGF‐23 concentrations and improves survival time in azotemic cats, but has not been examined in cats that are not azotemic. Hypothesis Feeding a moderately protein‐ and phosphate‐restricted diet decreases PTH and FGF‐23 in healthy older cats and thereby slows progression to azotemic CKD. Animals A total of 54 healthy, client‐owned cats (≥ 9 years). Methods Prospective double‐blinded randomized placebo‐controlled trial. Cats were assigned to test diet (protein 76 g/Mcal and phosphate 1.6 g/Mcal) or control diet (protein 86 g/Mcal and phosphate 2.6 g/Mcal) and monitored for 18 months. Changes in variables over time and effect of diet were assessed by linear mixed models. Results A total of 26 cats ate test diet and 28 cats ate control diet. There was a significant effect of diet on urinary fractional excretion of phosphate (P = 0.045), plasma PTH (P = 0.005), and ionized calcium concentrations (P = 0.018), but not plasma phosphate, FGF‐23, or creatinine concentrations. Plasma PTH concentrations did not significantly change in cats fed the test diet (P = 0.62) but increased over time in cats fed the control diet (P = 0.001). There was no significant treatment effect of the test diet on development of azotemic CKD (3 of 26 (12%) test versus 3 of 28 (11%) control, odds ratio 1.09 (95% CI 0.13–8.94), P = 0.92). Conclusions and Clinical Importance Feeding a moderately protein‐ and phosphate‐restricted diet has effects on calcium‐phosphate homeostasis in healthy older cats and is well tolerated. This might have an impact on renal function and could be useful in early chronic kidney disease.
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Affiliation(s)
- R F Geddes
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hatfield, UK.
| | | | - Y Chang
- Department of Comparative Biological Sciences, Royal Veterinary College, Camden, London, UK
| | - H M Syme
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hatfield, UK
| | - J Elliott
- Department of Comparative Biological Sciences, Royal Veterinary College, Camden, London, UK
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19
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Current Understanding of the Pathogenesis of Progressive Chronic Kidney Disease in Cats. Vet Clin North Am Small Anim Pract 2016; 46:1015-48. [PMID: 27461408 DOI: 10.1016/j.cvsm.2016.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In cats with chronic kidney disease (CKD), the most common histopathologic finding is tubulointerstitial inflammation and fibrosis. However, these changes reflect a nonspecific response of the kidney to any inciting injury. The risk of developing CKD is likely to reflect the composite effects of genetic predisposition, aging, and environmental and individual factors that affect renal function over the course of a cat's life. However, there is still little information available to determine exactly which individual risk factors predispose a cat to develop CKD. Although many cats diagnosed with CKD have stable disease for years, some cats show overtly progressive disease.
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20
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Segev G, Meltzer H, Shipov A. Does Secondary Renal Osteopathy Exist in Companion Animals? Vet Clin North Am Small Anim Pract 2016; 46:1151-62. [PMID: 27436331 DOI: 10.1016/j.cvsm.2016.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Secondary renal hyperparathyroidism is an inevitable consequence of chronic kidney disease. In human patients, the disease is associated with decreased bone quality and increased fracture risk. Recent evidence suggests that bone quality is also decreased in companion animals, more pronouncedly in cats compared with dogs, likely because of a longer disease course. The clinical significance of these findings is yet to be determined. However, clinicians should keep in mind that animals with chronic kidney disease have decreased bone quality and increased fracture risk.
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Affiliation(s)
- Gilad Segev
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Hertzel Street, Rehovot 76100, Israel.
| | - Hagar Meltzer
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Hertzel Street, Rehovot 76100, Israel
| | - Anna Shipov
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Hertzel Street, Rehovot 76100, Israel
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21
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Finch NC. Hypercalcaemia in cats: The complexities of calcium regulation and associated clinical challenges. J Feline Med Surg 2016; 18:387-99. [PMID: 27143041 PMCID: PMC11132202 DOI: 10.1177/1098612x16643248] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PRACTICAL RELEVANCE Calcium is essential for many normal physiological processes within the body. Aberrations in calcium homeostasis leading to hypercalcaemia can result in clinical signs such as polyuriav and polydipsia, lethargy and weakness due to depressed excitability of muscle and nervous tissue, and gastrointestinal (GI) signs due to effects on GI smooth muscle. Hypercalcaemia in cats is mostly idiopathic, with chronic kidney disease and neoplasia also being common causes. CLINICAL CHALLENGES Hypercalcaemia can be a diagnostic challenge and a good understanding of the regulation of calcium homeostasis can aid in interpreting results of diagnostic tests. Furthermore, the management approach may depend on the underlying cause of hypercalcaemia, and also its severity and chronicity. AUDIENCE This review offers a comprehensive discussion of the regulation of calcium homeostasis, with a focus on the normal response to hypercalcaemia. It also discusses the diagnostic approach to, and management of, hypercalcaemia in cats, as well as specific aetiologies. This is relevant to all clinicians working with feline patients. EVIDENCE BASE The review draws evidence from peer-reviewed publications and also the author's own clinical experience.
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Affiliation(s)
- Natalie C Finch
- Bristol Renal, School of Clinical Sciences, University of Bristol, Bristol BS1 3NY, UK
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22
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Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I, Langston C, Lefebvre HP, White J, Quimby J. ISFM Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease. J Feline Med Surg 2016; 18:219-39. [PMID: 26936494 PMCID: PMC11148907 DOI: 10.1177/1098612x16631234] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
PRACTICAL RELEVANCE Chronic kidney disease (CKD) is one of the most commonly diagnosed diseases in older cats. In most cats, CKD is also a progressive disease and can be accompanied by a wide range of clinical and clinicopathological changes. These ISFM Consensus Guidelines have been developed by an independent panel of clinicians and academics to provide practical advice on the diagnosis and management of this complex disease. CLINICAL CHALLENGES Although CKD is a common clinical problem in cats, the manifestations of disease vary between individuals. Thus there is a need for careful and repeat evaluation of cats with CKD and adjustment of therapy according to individual needs. In addition to addressing problems arising from CKD and improving quality of life (QoL) for the patient, therapy may also target slowing the underlying progression of disease and hence prolonging life. While maintaining QoL is of paramount importance in our patients, this can be challenging when multiple therapies are indicated. In some cases it is necessary to prioritise therapy, given an understanding of what is likely to most benefit the individual patient. EVIDENCE BASE In preparing these Guidelines, the Panel has carefully reviewed the existing published literature, and has also graded the quality of evidence for different interventions to help to provide practical recommendations on the therapeutic options for feline CKD. This is a field of veterinary medicine that has benefited from some excellent published clinical research and further research findings will undoubtedly modify the recommendations contained in these Guidelines in the future.
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Affiliation(s)
| | | | - Serge Chalhoub
- Faculty of Veterinary Medicine, University of Calgary, Canada
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, UK
| | - Natalie Finch
- Bristol Renal, School of Clinical Sciences, University of Bristol, UK
| | | | | | - Hervé P Lefebvre
- Clinical Research Unit, National Veterinary School of Toulouse (ENVT), France
| | - Joanna White
- Small Animal Specialist Hospital, Sydney, Australia
| | - Jessica Quimby
- Department of Clinical Veterinary Sciences, Colorado State University, USA
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23
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Davis EM. Oral Manifestations of Chronic Kidney Disease and Renal Secondary Hyperparathyroidism: A Comparative Review. J Vet Dent 2015; 32:87-98. [PMID: 26415385 DOI: 10.1177/089875641503200202] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Recent epidemiological studies have demonstrated that significant associations exist between oral disease and diseases involving non-oral tissues. Occasionally, the roles may be reversed and the oral cavity can be severely affected by systemic disease originating in another part of the body. Renal secondary hyperparathyroidism is a common endocrinopathy that occurs as a consequence of chronic azotemic kidney disease. Renal osteodystrophy, the most dramatic clinical consequence of renal secondary hyperparathyroidism is uncommon, but can result in demineralization of maxillofacial bones, loosening of teeth, and pathological jaw fractures. The purpose of this report is to update the current understanding of the pathophysiology of this endocrine disease and to compare the oral manifestations of renal secondary hyperparathyroidism in humans and companion animals. A 50-year review of the veterinary literature was undertaken to examine the clinical presentation of renal osteodystrophy in dogs, and to determine what clinical consequences of renal secondary hyperparathyroidism have been reported in domestic cats.
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24
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Parker VJ, Gilor C, Chew DJ. Feline hyperparathyroidism: pathophysiology, diagnosis and treatment of primary and secondary disease. J Feline Med Surg 2015; 17:427-39. [PMID: 25896242 PMCID: PMC10816244 DOI: 10.1177/1098612x15581134] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PRACTICAL RELEVANCE Hyperparathyroidism exists in primary and secondary forms. Primary hyperparathyroidism has typically been considered a disease that uncommonly affects cats, but this condition is more prevalent than previous diagnoses would suggest. Secondary hyperparathyroidism may be caused by either nutritional influences (ie, nutritional secondary hyperparathyroidism) or chronic kidney disease (ie, renal secondary hyperparathyroidism). Tertiary hyperparathyroidism has yet to be documented in veterinary medicine, but it is possible that this condition occurs in some cats following longstanding renal secondary hyperparathyroidism. CLINICAL CHALLENGES Diagnosis of this group of calcium metabolic disorders presents a number of challenges for the clinician. For example, clinical signs can be non-specific and, especially in the case of primary hyperparathyroidism, there is often a low index of suspicion for the disease; careful sample handling is required for testing of parathyroid hormone (PTH) and ionized calcium levels; and there is currently no feline-specific assay for PTH, which has implications for test sensitivity and interpretation of results. AIMS This article briefly outlines PTH and calcium physiology by way of introduction to a review of PTH measurement and interpretation. Various forms of feline hyperparathyroidism are then described, encompassing diagnosis and treatment options.
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Affiliation(s)
- Valerie J Parker
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon L Tharp Street, Columbus, OH 43210, USA
| | - Chen Gilor
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon L Tharp Street, Columbus, OH 43210, USA
| | - Dennis J Chew
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon L Tharp Street, Columbus, OH 43210, USA
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Abstract
PRACTICAL RELEVANCE Feline chronic kidney disease (CKD) is frequently encountered by veterinarians. Timely diagnosis and staging may facilitate the initiation of adequate therapy and improve the prognosis for patients. CLINICAL CHALLENGES Feline CKD is diagnosed based on the presence of compatible clinical signs and renal azotaemia, which implies that urinalysis (particularly urine specific gravity) is mandatory to confirm the diagnosis. Although the diagnosis of advanced feline CKD and associated complications is usually straightforward, based on complete blood and urine examination, all routine blood and urine tests have their limitations in detecting early CKD. Therefore, diagnosing early or non-azotaemic CKD is much more challenging. Although determination of glomerular filtration rate (GFR) would be ideal to identify early kidney dysfunction, practical limitations hamper its routine use in clinical practice. PATIENT GROUP CKD is typically a disease of aged cats, but may affect cats of all ages. Conclusive breed and sex predispositions for feline CKD are not reported. AUDIENCE This review is directed at practising veterinarians and provides an overview of the required diagnostic tests, the classification system established by the International Renal Interest Society, and the importance of and possible techniques for early detection of CKD. EVIDENCE BASE Staging of cats with CKD is essential as it directs management and provides a prognostic guide. Given that diagnosis at early disease stages is associated with more prolonged survival times, simple, inexpensive and accurate methods for early CKD diagnosis are needed. Techniques currently under investigation include limited sampling strategies to estimate GFR, clearance marker cut-off concentrations to identify cats with low GFR, new indirect GFR markers and urinary biomarkers.
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Affiliation(s)
- Dominique Paepe
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium.
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26
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Abstract
PRACTICAL RELEVANCE Treatment of feline chronic kidney disease (CKD) tends to focus on minimising the adverse effects of reduced renal function, rather than addressing an underlying cause. Despite this, and the progressive nature of CKD, treatment can improve quality of life and enable many cats to have long survival times. EVIDENCE BASE Strong evidence supports the provision of renal diets, which are protein and phosphorus restricted; compliance is improved by gradual dietary transition. Additional phosphorus restriction is achieved by the use of phosphate binding agents, although it is unknown if these yield similar survival benefits to those provided by renal diets. Interventions to control hypokalaemia and hypertension in affected cats are important to prevent serious complications. Administration of benazepril to cats with proteinuric kidney disease has been shown to significantly improve their appetite but not their survival. As CKD progresses, many cats will benefit from treatment to control clinical signs of uraemic gastroenteritis and anaemia.
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Affiliation(s)
- Rachel M Korman
- Feline Friendly Practice, Veterinary Specialist Services, Underwood 4009, Australia
| | - Joanna D White
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, New Zealand
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Reynolds B, Chetboul V, Nguyen P, Testault I, Concordet D, Carlos Sampedrano C, Elliott J, Trehiou-Sechi E, Abadie J, Biourge V, Lefebvre H. Effects of Dietary Salt Intake on Renal Function: A 2-Year Study in Healthy Aged Cats. J Vet Intern Med 2013; 27:507-15. [DOI: 10.1111/jvim.12074] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 01/16/2013] [Accepted: 02/07/2013] [Indexed: 01/26/2023] Open
Affiliation(s)
- B.S. Reynolds
- Unité de Recherche Clinique; Université de Toulouse; INP; Ecole Nationale Vétérinaire de Toulouse; Toulouse France
| | - V. Chetboul
- Unité de Cardiologie d'Alfort; Centre Hospitalier Universitaire Vétérinaire d'Alfort; Université Paris-Est; Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort France
- INSERM; France
| | - P. Nguyen
- Unité de Nutrition et d'Endocrinologie; Oniris; Nantes France
| | | | - D.V. Concordet
- UMR 1331 Toxalim; INRA; Université de Toulouse; INP; Ecole Nationale Vétérinaire de Toulouse; Toulouse France
| | - C. Carlos Sampedrano
- Unité de Cardiologie d'Alfort; Centre Hospitalier Universitaire Vétérinaire d'Alfort; Université Paris-Est; Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort France
| | - J. Elliott
- Department of Veterinary Basic Sciences; Royal Veterinary College; London UK
| | - E. Trehiou-Sechi
- Unité de Cardiologie d'Alfort; Centre Hospitalier Universitaire Vétérinaire d'Alfort; Université Paris-Est; Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort France
| | - J. Abadie
- Department of Pathology; Oniris; Nantes France
| | - V. Biourge
- Royal Canin SAS; Centre de Recherches; Aimargues France
| | - H.P. Lefebvre
- Unité de Recherche Clinique; Université de Toulouse; INP; Ecole Nationale Vétérinaire de Toulouse; Toulouse France
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Geddes RF, Finch NC, Syme HM, Elliott J. The role of phosphorus in the pathophysiology of chronic kidney disease. J Vet Emerg Crit Care (San Antonio) 2013; 23:122-33. [DOI: 10.1111/vec.12032] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 02/02/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Rebecca F. Geddes
- Department of Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane, North Mymms; Hatfield; AL9 7TA; UK
| | - Natalie C. Finch
- Department of Veterinary Basic Sciences; Royal Veterinary College; Royal College Street; Camden; London; NW1 0TU; UK
| | - Harriet M. Syme
- Department of Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane, North Mymms; Hatfield; AL9 7TA; UK
| | - Jonathan Elliott
- Department of Veterinary Basic Sciences; Royal Veterinary College; Royal College Street; Camden; London; NW1 0TU; UK
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29
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Finch N, Geddes R, Syme H, Elliott J. Fibroblast Growth Factor 23 (FGF-23) Concentrations in Cats with Early Nonazotemic Chronic Kidney Disease (CKD) and in Healthy Geriatric Cats. J Vet Intern Med 2013; 27:227-33. [DOI: 10.1111/jvim.12036] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 09/28/2012] [Accepted: 11/27/2012] [Indexed: 12/13/2022] Open
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