Nutritional management of pancreatitis and concurrent disease in dogs and cats

Nutrition is considered a key part of the management of pancreatitis in dogs and cats. While limited prospective research exists, experimental studies, retrospective studies, and anecdote allow for formulation of nutritional guidelines. Historically, fat has been considered the key nutrient of interest in pancreatitis; however, other nutrients and dietary factors, including energy density, digestibility, protein, carbohydrates, and fiber, are all of importance in these patients. Indeed protein particle size may be of greater significance than dietary fat in the management of pancreatitis in cats. Low-fat gastrointestinal diets are frequently recommended in the initial management of pancreatitis in dogs, while hydrolyzed diets are often considered first-line diets in cats with pancreatitis. The presence or absence of comorbid disease may also alter nutritional recommendations. When diseases occur concurrently, the dietary strategies for the most life-threatening illness, or the illness with the greatest impact on quality of life, is recommended to be prioritized. Many dogs and cats with pancreatitis can be transitioned back to their prediagnosis diet or another commercial maintenance diet, provided that significant comorbid disease is absent. Use of a low-fat diet in the long term may be prioritized in dogs with recurrent episodes of pancreatitis.

Ionized hypercalcemia can resolve with nutritional modification in cats with idiopathic hypercalcemia or chronic kidney disease

CASE SERIES SUMMARY

Cats with ionized hypercalcemia that were fed diets with either more than 200 mg calcium per 100 kilocalories (kcal), a calcium:phosphorus (Ca:P) ratio greater than 1.4:1 or both, based on diet history, were included in this case series. Ionized hypercalcemia was documented at least twice in all cats before enrollment. Cats were referred for evaluation of ionized hypercalcemia (n = 5) or were incidentally found to have ionized hypercalcemia (n = 5). After medical workups, cats were diagnosed with either idiopathic hypercalcemia (IHC; n = 7) or chronic kidney disease (n = 3). Cats receiving medications to treat IHC (eg, alendronate, corticosteroids) were excluded. Nutritional recommendations were made to transition the cats to diets with less thn 200 mg calcium per 100 kcal and a Ca:P ratio less than 1.4:1. Ionized calcium (iCa) concentrations were rechecked in all cats, with a median recheck time of 9 weeks (range 3-20). Of the 10 cats, nine (90%) had a decrease in iCa. Of the 10 cats, six (60%) became normocalcemic after the diet change, three (30%) had a partial response and one (10%) did not respond. Of the four cats that did not achieve normocalcemia with a change in diet, two (50%) received chia seeds (1-2 g per day), and at the next recheck, both cats' iCa concentrations had normalized. Three cats had a long-term follow-up. Ionized normocalcemia was maintained for at least two consecutive follow-up visits over a median follow-up period of 33 weeks (range 12-34).

RELEVANCE AND NOVEL INFORMATION

Dietary calcium concentrations and the dietary Ca:P ratio appear to be important variables in considering nutritional approaches for hypercalcemic cats.

Commercially available wearable health monitor in dogs is unreliable for tracking energy intake and expenditure

OBJECTIVE

Assess the accuracy of predicted daily energy requirement (pDER) reported by a triaxial accelerometer and activity monitor for dogs (FitBark 2; FitBark Inc) and determine whether the activity monitor accurately estimates the observed daily energy requirement (oDER). We hypothesized that the activity monitor would accurately estimate oDER in dogs and meet standards established for human devices.

ANIMALS

23 dogs between the ages of 1 and 10 years and variable sex, breed, and body weight were enrolled from May 5, 2021, through July 23, 2021.

METHODS

Dogs were weighed before and after the study period to ensure stable body weights. Owners recorded their dogs' daily caloric intake for the entire 28-day study period while the device monitored physical activity and calculated pDER. oDER was defined as the reported caloric intake required to maintain a stable body weight over a 28-day period. pDER and oDER were compared using Bland-Altman graphs, Passing-Bablock analysis, and Lin's Concordance correlation analysis. P ≤ .05 was considered significant.

RESULTS

23 apparently healthy dogs completed the study. There was no significant difference between starting body weights and ending body weights (P= .5). The activity monitor overpredicted 28-day pDER compared to 28-day oDER in the majority (18/23, 78.3%) of dogs. Based on Bland-Altman analysis, Passing-Bablok regression, and Lin's concordance correlation analysis, there was poor agreement between the pDER and oDER.

CLINICAL RELEVANCE

The activity monitors consistently reported inaccurate pDER compared to oDER. Its usability for estimating pDER is of limited clinical and research utility based on the results of this study.

Clinician prescribing practices for managing canine idiopathic acute diarrhea are not evidence based

Objective

To characterize clinician preferences and justification for preferred methods for managing canine idiopathic acute diarrhea (IAD) and compare results to evidence-based literature.

sample

284 surveys from veterinarians in small animal first-opinion practice.

Methods

Veterinarians were asked to complete a survey (61 questions) including background demographic information, practice type and location, duration in practice, and management questions for canine IAD pertaining to nutritional, probiotic, antimicrobial, antidiarrheal, benign neglect, and other therapies. The survey was available between May 5, 2021, and August 30, 2021.

Results

Respondents reported that their preferred first-line therapy for canine IAD included dietary modification (41.3% of respondents), probiotics (20.1%), antimicrobials (21.2%), antidiarrheal medications (13.0%), and benign neglect (4.3%). The percentage of respondents who reported each therapy as either extremely effective or very effective for canine IAD varied by treatment, as follows: antimicrobials (75.2%), dietary modification (59.13%), antidiarrheal medications (42.5%), probiotics (35.5%), and benign neglect (6.52%). Perceptions of effectiveness, efficiency of treatment, and clinician justification for use were variable among treatments. Reported practice styles were occasionally in disagreement with evidence-based methods of canine IAD management.

Clinical Relevance

Current clinical management of IAD is not consistently in agreement with evidence-based recommendations. The results of this study underscore the continued need to evaluate veterinary prescribing practice trends compared to evidence-based recommendations and promote dissemination of new information.

Gut microbiota promoting propionic acid production accompanies diet-induced intentional weight loss in cats

Rodent models and human clinical studies have shown gut microbiota-derived short-chain fatty acids (SCFAs) play roles in obesity and insulin resistance. These roles have been minimally explored in cats, where in the USA an estimated 60% of cats are overweight or obese. Overweight/obese research cats (n = 7) were transitioned from a maintenance diet to a reduced calorie diet fed ad libitum for seven days, then calories were restricted to achieve 1-2% weight loss per week for an additional 77 days. Cats then received their original maintenance diet again for 14 days. Significant intentional weight loss was noted after calorie restriction (adjusted p < 0.0001). 16S rRNA gene amplicon sequencing and targeted SCFA metabolomics were performed on fecal samples. Fecal microbial community structure significantly differed between the four study phases (PERMANOVA p = 0.011). Fecal propionic acid was significantly higher during diet-induced weight loss (adjusted p < 0.05). Spearman correlation revealed the relative abundances of Prevotella 9 copri (ρ = 0.6385, p = 0.0006) and Blautia caecimuris (ρ = 0.5269, p = 0.0068) were significantly correlated with propionic acid composition. Like humans, obese cats experienced an altered microbial community structure and function, favoring propionic acid production, during diet-induced weight loss.

Severe polycystic liver disease in a cat

Case summary

Ductal plate malformations (DPMs) are poorly documented in the veterinary literature, particularly those of the polycystic liver disease (PCLD) phenotype. A 13-year-old female spayed cat presented with progressive icterus, abdominal distension, weight loss and elevated liver enzymes. Initial empirical treatment consisting of amoxicillin/clavulanate, ursodiol and later prednisolone was attempted; however, clinical signs progressed. On abdominal ultrasound, numerous large hepatic cystic masses were noted, characterized by an anechoic center with a heterogeneous, hyperechoic wall. A post-mortem examination confirmed numerous hepatic cysts, the larger of which resulted in hemorrhage and subsequent hemoabdomen. Histologically, these cysts were determined to be of biliary origin, and a diagnosis of PCLD was assigned.

Relevance and novel information

Herein, we present a detailed report of clinical, gross and histologic findings in a cat clinically affected by PCLD. This case demonstrates that cysts present in this congenital disease can ultimately lead to hepatobiliary malfunction and clinical decline via marked expansion of cysts, compression of the liver and hemoabdomen from cyst rupture. DPMs, specifically PCLD, should be considered in cats presenting with multifocal large hepatic cysts.

Measuring 25-hydroxyvitamin D in cats: comparison of a whole-blood lateral flow assay, 2 dried-blood-spot tests, and serum LC-MS/MS

Measuring 25-hydroxyvitamin D (25D) can be a challenge in veterinary medicine because of laboratory accessibility and required sample volume. We compared 2 dried-blood-spot (DBS) tests and a lateral flow assay (LFA) to the gold standard, liquid chromatography-tandem mass spectrometry (LC-MS/MS). We hypothesized that there would be good agreement among the tests, within a clinically significant limit of agreement of ± 25 nmol/L. We collected blood from 6 healthy purpose-bred 2-y-old cats at 6 times over 6 wk, and measured 25D concentrations with all 4 tests. Agreement of the 3 candidate tests and LC-MS/MS was evaluated via Bland-Altman analysis, Passing-Bablok regression, and Lin correlation coefficients. Bland-Altman analysis demonstrated that the mean bias was >± 25 nmol/L for all 3 candidate tests in comparison to serum LC-MS/MS concentrations. The 95% CIs for the mean bias did not include zero, further supporting the presence of significant bias among methods. Additionally, all 3 tests had poor agreement with serum LC-MS/MS concentrations when analyzed by Lin correlation coefficient analysis, and bias between methods was further characterized by Passing-Bablok analysis. Based on these results, none of these 3 tests is recommended as an alternative to LC-MS/MS testing for 25D measurement in cats.

Fecal identification markers impact the feline fecal microbiota

Fecal diagnostics are a mainstay of feline medicine, and fecal identification markers help to distinguish individuals in a multi-cat environment. However, the impact of identification markers on the fecal microbiota are unknown. Given the increased interest in using microbiota endpoints to inform diagnosis and treatment, the objective of this study was to examine the effects of orally supplemented glitter and crayon shavings on the feline fecal microbiota (amplicon sequencing of 16S rRNA gene V4 region). Fecal samples were collected daily from six adult cats that were randomized to receive oral supplementation with either glitter or crayon for two weeks, with a two-week washout before receiving the second marker. No adverse effects in response to marker supplementation were seen for any cat, and both markers were readily identifiable in the feces. Microbiota analysis revealed idiosyncratic responses to fecal markers, where changes in community structure in response to glitter or crayon could not be readily discerned. Given these findings, it is not recommended to administered glitter or crayon shavings as a fecal marker when microbiome endpoints are used, however their clinical use with other diagnostics should still be considered.

Evaluation of serum 25-hydroxyvitamin D, C-reactive protein, and haptoglobin as biomarkers in dogs newly diagnosed with histoplasmosis

BACKGROUND

Serum 25-hydroxyvitamin (OH)D, C-reactive protein (CRP), and haptoglobin are useful biomarkers in various infectious diseases and inflammatory disorders in dogs, but their utility in histoplasmosis is unknown.

OBJECTIVE

Determine if serum 25(OH)D, CRP, and haptoglobin concentrations are different in dogs with histoplasmosis compared to healthy controls and whether serum globulin, albumin, CRP, or haptoglobin are associated with 25(OH)D concentration.

ANIMALS

Twenty-two client-owned dogs (histoplasmosis, n = 12; controls, n = 10).

METHODS

Prospective case-control study. Dogs with histoplasmosis were categorized as pulmonary, disseminated, or gastrointestinal (GI) tract. Serum 25(OH)D was measured using modified high-performance liquid chromatography (HPLC). Serum CRP and haptoglobin were measured with ELISA assays.

RESULTS

Dogs with histoplasmosis were grouped as disseminated (n = 8) and GI tract (n = 4). No dogs had pulmonary tract involvement alone. Dogs with histoplasmosis (median, interquartile range [IQR]; 11.6 ng/mL, 16.8) had lower serum 25(OH)D concentrations than controls (35.7 ng/mL, 17.6; P < .001). Serum CRP and haptoglobin concentrations were higher in dogs with histoplasmosis (CRP: median, IQR; 63.5 mg/L, 37.1 and haptoglobin: 459.7 mg/dL, 419.6) than controls (CRP: 1.9 mg/L, 2; P < .001 and haptoglobin: 85.5 mg/dL, 106.7; P = .003). Serum 25(OH)D concentration was positively associated with fold change in serum albumin concentration (ρ = 0.77; P < .001), and negatively associated with fold change in serum globulin (ρ = -0.61; P = .003) and CRP concentrations (ρ = -0.56; P = .01).

CONCLUSION AND CLINICAL IMPORTANCE

Assay of serum 25(OH)D, CRP, and haptoglobin could have clinical value in dogs with histoplasmosis.

Pharmacodynamic Biomarkers for Biosimilar Development and Approval: A Workshop Summary

The US Food and Drug Administration (FDA) Biosimilars Guidance describes how biosimilars may be approved based on clinical pharmacokinetic and pharmacodynamic (PD) biomarker data, without comparative clinical studies with efficacy end points. This type of clinical development program, however, has only been implemented for a small number of FDA-approved biosimilar products over the last decade. To encourage the use of PD biomarkers in biosimilar development and approval, the Duke-Margolis Center for Health Policy collaborated with the FDA to host a two-day virtual public workshop entitled "Pharmacodynamic Biomarkers for Biosimilar Development and Approval" on September 20-21, 2021. The public workshop was a forum for global regulators, biopharmaceutical developers, and academic researchers to discuss the current and future role of PD biomarkers in improving the efficiency of biosimilar development and approval. The workshop objectives included: (i) discuss the current and potential future state of leveraging PD biomarkers for biosimilar development and approval; (ii) summarize the FDA's initiatives to advance biosimilar development; (iii) describe stakeholders' experience with PD biomarkers in biosimilar development; and (iv) explain research efforts to promote broader application of PD biomarkers in biosimilar development. This document summarizes presentations and panel discussions from each session of the two-day September 2021 public workshop covering the application of PD biomarkers for biosimilar development.

Dietary fiber aids in the management of canine and feline gastrointestinal disease

Dietary fiber describes a diverse assortment of nondigestible carbohydrates that play a vital role in the health of animals and maintenance of gastrointestinal tract homeostasis. The main roles dietary fiber play in the gastrointestinal tract include physically altering the digesta, modulating appetite and satiety, regulating digestion, and acting as a microbial energy source through fermentation. These functions can have widespread systemic effects. Fiber is a vital component of nearly all commercial canine and feline diets. Key features of fiber types, such as fermentability, solubility, and viscosity, have been shown to have clinical implications as well as health benefits in dogs and cats. Practitioners should know how to evaluate a diet for fiber content and the current knowledge on fiber supplementation as it relates to common enteropathies including acute diarrhea, chronic diarrhea, constipation, and hairball management. Understanding the fundamentals of dietary fiber allows the practicing clinician to use fiber optimally as a management modality.

Randomized controlled trial demonstrates nutritional management is superior to metronidazole for treatment of acute colitis in dogs

OBJECTIVE

To describe the outcome of dietary management of canine noninfectious acute colitis with or without concurrent oral administration of metronidazole using a randomized controlled clinical trial.

ANIMALS

59 client-owned dogs with noninfectious acute colitis.

PROCEDURES

Dogs with acute noninfectious colitis were enrolled in a 30-day diet trial after exclusion of parasitic infectious etiologies (fecal centrifugation floatation, Giardia/Cryptosporidium antigen testing) and systemic disease (CBC, biochemistry, urinalysis). Dogs were randomized into 3 placebo-controlled groups: group 1, easily digestible diet + placebo tablet; group 2, easily digestible diet + metronidazole tablet; and group 3, psyllium-enhanced easily digestible diet + placebo tablet. Dogs were evaluated serially using fecal scoring for time to remission, average fecal score, relapse after remission, and dysbiosis index.

RESULTS

Median remission time was significantly different among the 3 groups (P < .01) with median times of 5 days (range, 4 to 10) for group 1, 8.5 days (range, 7 to 12) for group 2, and 5 days (range, 3 to 6) for group 3. Metronidazole addition affected the fecal dysbiosis index negatively at days 7 to 10. No adverse effects or complications were noted throughout the study.

CLINICAL RELEVANCE

For canine noninfectious acute colitis, dietary management with an easily digestible diet with or without psyllium enhancement proved a superior management strategy compared to metronidazole. The omission of metronidazole reduced the adverse impact significantly on intestinal microbiota. Longitudinal clinical trials are necessary to compare the long-term response, stability, and complications associated with dietary management alone versus combined dietary and antimicrobial therapy for canine acute colitis.

Home-cooked diets cost more than commercially prepared dry kibble diets for dogs with chronic enteropathies

OBJECTIVE

Nutrition plays a fundamental role in the management of canine chronic enteropathies (CCEs). Dog owners may elect to feed home-cooked diets (HCDs) rather than veterinary commercially prepared diets (CPDs) because of perceived lower costs. There is a paucity of data comparing costs of these options. We hypothesize there will be differences in costs between complete and balanced HCDs and nutritionally comparable CPDs.

SAMPLE

6 Home-cooked diets.

PROCEDURES

Six HCD recipes (2 highly digestible, 2 limited antigen, 2 low-fat) were formulated by 2 board-certified veterinary nutritionists to mimic the nutritional and ingredient profiles of veterinary CPDs for management of CCEs. The cost (in US$ on a per 100 kilocalorie [kcal] basis) of each recipe was determined via collection of ingredient prices from 3 grocery stores combined with supplement prices from online retailers. Prices of CPDs were obtained from a national online retailer. Maintenance energy requirements of 1.6 X (70 X BWkg0.75), where BWkg represents body weight in kilograms, were calculated for 3 dog sizes (5, 20, and 40 kg), and costs of feeding maintenance energy requirements with HCDs versus dry and canned CPDs were compared with a Kruskal-Wallis test and post hoc testing.

RESULTS

The median costs of all dry and canned CPDs and HCDs were $0.29 (range, $0.18 to $0.46), $1.01 (range, $0.77 to $1.20), and $0.55 (range, $0.35 to $1.14), respectively. Feeding complete and balanced HCDs cost more than feeding dry CPDs (P < .001), but not canned CPDs (P > .99).

CLINICAL RELEVANCE

Dry CPDs cost the least for nutritional management of CCEs. There is a wide range of costs for both CPDs and HCDs.

Effect of calcifediol supplementation on renin-angiotensin-aldosterone system mediators in dogs with chronic kidney disease

Background

Chronic kidney disease (CKD) leads to low serum concentrations of vitamin D metabolites. Thus, hypovitaminosis D associated with CKD might contribute to disease progression via increased concentration of renin angiotensin aldosterone system (RAAS) mediators.

Objectives

To evaluate whether supplementation with calcifediol affects equilibrium concentrations of selected mediators of the RAAS. We hypothesized that vitamin D supplementation will decrease concentration of circulating RAAS mediators in dogs with CKD.

Animals

Six client‐owned adult dogs with IRIS Stage 2 and 3 CKD.

Methods

Prospective study. Serum 25‐hydroxyvitamin D (25[OH]D), 1,25‐dihydroxyvitamin D (1,25[OH]₂D), 24,25‐dihydroxyvitamin D (24,25[OH]₂D), RAAS mediators (angiotensin I/II/III/IV/1‐5/1‐7, and aldosterone), and surrogate angiotensin converting enzyme (ACE) activity (calculated by the ratio of angiotensin II to angiotensin I) were evaluated at baseline, after 3 months of calcifediol supplementation, and 2 months after discontinuing administration of supplement.

Results

All serum vitamin D metabolite concentrations increased significantly by month 3 (P < .001): 25(OH)D (median 250 ng/mL; range, 204‐310), compared to baseline (median 43.2 ng/mL; range, 33.8‐58.3 ng/mL); 1,25(OH)₂D (median 66.1 pg/mL; range, 57.3‐88.1 pg/mL) compared to baseline (median 35.2 pg/mL; range, 29.3‐56.7 pg/mL); 24,25(OH)₂D (median 68.4 ng/mL; range, 22.1‐142.0 ng/mL) compared to baseline (median 14.4 ng/mL; range, 9.0‐21.3 ng/mL). Calculated ACE activity was significantly lower at month 3 (median 0.5; range, 0.4‐1.0) compared to baseline (median 0.7; range, 0.6‐1.3; P = .01). There were no significant differences in any of the evaluated RAAS variables at any other time‐point.

Conclusions and Clinical Importance

Short‐term calcifediol supplementation in this small group of CKD dogs appeared to decrease ACE activity.

Escherichia coli pathotype contamination in raw canine diets

OBJECTIVE

To investigate the prevalence of Escherichia coli contamination and E coli virulence gene signatures consistent with known E coli pathotypes in commercially available conventional diets and raw-meat-based diets (RMBDs).

SAMPLE

40 diets in total (19 conventionally cooked kibble or canned diets and 21 RMBDs) obtained from retail stores or online distributors.

PROCEDURES

Each diet was cultured for E coli contamination in 3 separate container locations using standard microbiological techniques. Further characterization of E coli isolates was performed by polymerase chain reaction-based pathotype and virulence gene analysis.

RESULTS

Conventional diets were negative in all culture based testing. In RMBDs, bacterial contamination was similar to previous reports in the veterinary literature, with 66% (14/21) of the RMBDs having positive cultures for E coli. Among the 191 confirmed E coli isolates from these diets, 31.9% (61/191) were positive for virulence genes. Categorized by pathotype, isolates presumptively belonging to the neonatal meningitis E coli pathotype (15.7% [30/191]) were the most common, followed by enterohemorrhagic E coli (10.5% [20/191]), enteropathogenic E coli (5.8% [11/191]), uropathogenic E coli (2.1% [4/191]), and diffusely adherent E coli (1.6% [3/191]).

CLINICAL RELEVANCE

The results of this study reaffirmed the bacteriologic risks previously associated with RMBDs. Furthermore, potential zoonotic concerns associated with identified pathotypes in these diets may have significant consequences for owners in the animals' home environment. Potential risk associated with bacterial contamination should be addressed in animals fed RMBDs.

Myxedema Coma and Acute Hepatopathy in a Dog with Severe Atherosclerosis

A 9-year-old male intact mixed-breed dog was presented to The Ohio State University Veterinary Medical Center for evaluation of two days' duration of weakness, lethargy, inappetence, and one episode of vomiting the day of presentation. On presentation, the dog was depressed and tetraparetic. He was noted to be icteric and dehydrated. Obesity and truncal alopecia with a "rat tail" appearance were observed. Diagnostic testing revealed evidence of an acute hepatopathy and peritonitis. Given the dog's neurologic status, physical examination abnormalities, including a "tragic facial expression", and hyperlipidemia, there was concern for possible myxedema coma. A thyroid panel was consistent with hypothyroidism. The dog experienced respiratory arrest prior to initiation of therapy, and an autopsy confirmed the presence of subacute necrotizing cholangiohepatitis, marked atherosclerosis, and severe thyroid atrophy. These clinical and pathologic changes were supportive of myxedema coma.

Nutritional Management for Dogs and Cats with Chronic Kidney Disease

The nutritional management of canine and feline chronic kidney disease and protein-losing nephropathy is discussed. Special attention is paid to assessment of body composition (body weight, body condition score, and muscle condition score) and the dysrexia that often occurs with kidney disease. Various nutrients of concern are discussed and specific dietary options are provided.

Short-term efficacy of epidural pain management in dogs undergoing cystoscopy

Background

The effects of epidural anesthesia in dogs undergoing cystoscopy are unknown.

Objective

To investigate the effect of epidural analgesia on postcystoscopy pain in dogs.

Animals

Twenty‐six dogs undergoing routine cystoscopy for lower urinary tract disease.

Methods

Prospective, randomized, blinded observational study. Dogs were assigned either to a treatment group that received epidural anesthesia (preservative free morphine sulfate, 0.09 mg/kg; 1% ropivacaine, 0.2 mg/kg; total volume delivered, 1 mL/4.5 kg of body weight to a maximum of 10 mL; n = 9) or to a nonepidural control group (n = 13). Vital signs were monitored for 24 hours, and sedation and pain scores, behavioral assessments, and presence or absence of complications was evaluated for 5 days postprocedure.

Results

All dogs tolerated the epidural without complications. Four dogs were removed from the study because of status unblinding, lack of patient cooperation, or incomplete follow‐up. No significant differences were noted in postprocedural pain scores in dogs that received epidural analgesia. Significant differences in postprocedural pain scores were noted in the nonepidural control group. No significant differences were noted in vital signs, behavioral assessments, or the proportion of dogs with a 50% increase in pain scores between the epidural and nonepidural groups.

Conclusions and Clinical Importance

Epidural anesthesia was well‐tolerated. Dogs not receiving the epidural had poor postprocedural pain control. A consistent benefit for the epidural vs nonepidural group could not be identified. Additional studies are required to better assess the impact and efficacy of epidural anesthesia for cystoscopic procedures.

Assessment of commercial companion animal kefir products for label accuracy of microbial composition and quantity

Kefir is a fermented beverage containing yeast and bacteria produced by the fermentation of water or milk with kefir grains. Lack of regulation for probiotic-containing fermented food sold for companion dogs and cats creates the potential for misreporting on viable microbial counts, taxonomy, and label claims. In this study, the microbiota of six companion animal kefir products were measured quantitatively using standard plating techniques. Microbial composition of these products was also characterized by using high-resolution, long-read amplicon sequencing of the 16S rRNA gene. Five products (83%) listed specific microorganisms, and four products (66%) guaranteed colony forming units (CFU)/g on their label. To enumerate viable lactic acid bacteria (LAB), two lots of each homogenized product were plated upon opening and following 14 d on deMan Rogosa and Sharpe (MRS) agar and incubated under anaerobic and aerobic conditions. Results from point of opening revealed that all commercial kefir products with a guaranteed CFU/g overstated the number of microorganisms present by at least 1 log, with only one product exceeding 1 × 109 CFU/g. Sequencing results demonstrated that none of the labels claiming specific bacterial genera and species on their labels were correct, and all products contained at least three additional bacterial species above the minimum detectable threshold (0.001% relative abundance) that were not disclosed by the manufacturer. In addition to the incorrect viable CFU and bacterial taxonomies, several of the product labels and websites contained a wide range of health claims, none of which are supported by the companion animal literature. Our results demonstrate a low level of accuracy in the labeling of commercial kefir products intended for use in dogs and cats. Regulatory agencies, veterinarians, pet food professionals, and pet owners must scrutinize these products and demand a higher level of accuracy and quality in the future.

Effects of calcifediol supplementation on markers of chronic kidney disease-mineral and bone disorder in dogs with chronic kidney disease

Background

Chronic kidney disease‐mineral and bone disorder (CKD‐MBD) in dogs is associated with hypovitaminosis D, increased parathyroid hormone (PTH), and increased fibroblast growth factor‐23 (FGF‐23) concentrations. Best practice for vitamin D metabolite supplementation in CKD‐MBD remains unknown.

Objective

To provide an extended‐release calcifediol supplement to dogs with CKD and to measure its effects on variables indicative of CKD‐MBD.

Animals

Ten dogs with International Renal Interest Society stages 2 and 3 CKD.

Methods

In a prospective study, dogs received a calcifediol supplement for 84 days. Serum 25‐hydroxyvitamin D (25[OH]D), 1,25‐dihydroxyvitamin D (1,25[OH]₂D), 24,25‐dihydroxyvitamin D (24,25[OH]₂D), creatinine, calcium, phosphorus, PTH, plasma FGF‐23 concentrations, and urine profiles were measured monthly during supplementation. Urine calcium to creatinine (UCa/Cr) ratios and fractional excretion of calcium, phosphorus, and sodium were determined.

Results

All serum vitamin D metabolite concentrations increased significantly by day 84 (P < .001): [25(OH)D (median 249.9 ng/mL; range, 149.7‐469.9 ng/mL) compared to baseline (median 50.2 ng/mL; range, 31.3‐66.0 ng/mL); 1,25(OH)₂D (median 66.1 pg/mL; range, 56.9‐88.1 pg/mL) compared to baseline (median 37.3 pg/mL; range, 29.3‐56.7 pg/mL); 24,25(OH)₂D (median 81.4 ng/mL; range, 22.1‐151.7 ng/mL) compared to baseline (median 15.4 ng/mL; range, 6.9‐40.6 ng/mL)]. There were no significant differences in calcium, phosphorus, PTH concentrations, UCa/Cr or fractional excretion of calcium. No dog developed ionized hypercalcemia. Plasma FGF‐23 concentrations increased by day 84 (median 1219 pg/mL; range, 229‐8824 pg/mL) compared to baseline (median 798 pg/mL; range, 103‐4.145 pg/mL) (P < .01).

Conclusions and Clinical Importance

Calcifediol supplementation for 84 days was well‐tolerated in dogs with IRIS stages 2 and 3 CKD. It remains to be determined how long‐term supplementation would affect CKD progression and QOL.

Association between vitamin D metabolites, vitamin D binding protein, and proteinuria in dogs

BACKGROUND

Proteinuria has been associated with progression of renal disease and increased morbidity and mortality in dogs and people. In people, proteinuria also has been associated with hypovitaminosis D. Little is known about the relationship between vitamin D metabolism and proteinuria in dogs.

OBJECTIVES

To further elucidate vitamin D status in dogs with protein-losing nephropathy (PLN) and minimal to no azotemia. We hypothesized that vitamin D metabolites would be lower in dogs with PLN compared to healthy dogs.

ANIMALS

Twenty-three client-owned adult dogs with PLN and 10 healthy control dogs.

METHODS

Serum 25-hydroxyvitamin D (25[OH]D), 1,25-dihydroxyvitamin D (1,25[OH]₂ D), 24,25-dihydroxyvitamin D (24,25[OH]₂ D), serum vitamin D binding protein (VDBP), and urine 25(OH)D concentrations were measured.

RESULTS

Compared to healthy dogs, dogs with PLN had lower concentrations of all vitamin D metabolites (P < .01). Correlations (rho; 95% confidence interval [CI]) in dogs with PLN are reported. Serum 25(OH)D and 24,25(OH)₂ D concentrations were positively correlated with albumin (r = 0.47; 0.07-0.74), and 24,25(OH)₂ D was negatively correlated with urine protein-to-creatinine ratio (UPC; r = -0.54; -0.78 to -0.16). Urine 25(OH)D-to-creatinine ratio was negatively correlated with serum albumin concentration (r = -0.77; -0.91 to -0.50) and positively correlated with UPC (r = 0.79; 0.53-0.91). Serum VDBP concentration was positively correlated with serum albumin concentration (r = 0.53; 0.05-0.81).

CONCLUSIONS AND CLINICAL IMPORTANCE

Dogs with PLN have decreased serum concentrations of vitamin D metabolites. Urine 25(OH)D-to-creatinine ratio and UPC are correlated in PLN dogs. Future studies are needed to assess additional management strategies for dogs with PLN.

Vitamin C in Health and Disease: A Companion Animal Focus

Vitamin C is synthesized in the liver in most species, including dogs and cats, and is widely distributed through body tissues. Vitamin C has an important physiologic role in numerous metabolic functions including tissue growth and maintenance, amelioration of oxidative stress, and immune regulation. It is also a co-factor in the production of important substances such as catecholamines and vasopressin. Decreased vitamin C levels have been documented in a wide variety of diseases, and in critically ill human patients may be associated with increased severity of disease and decreased survival. Intravenous supplementation with vitamin C has been proposed as a potential life-saving treatment in conditions such as septic shock, and results of small some human trials are promising. Data in companion in animals is very limited, but the possible benefits and , seemingly low risk of adverse effects , and the low cost of this treatment make vitamin C therapy a promising area of future investigation in critically ill dogs and cats.

Intra- and inter-rater reliability in the cross-sectional area of feline lumbar epaxial musculature evaluated via abdominal CT scan

OBJECTIVES

The aim of this study was to evaluate the intra- and inter-rater reliability of epaxial muscle cross-sectional area measurement on feline CT images and to determine the relationship between normalized epaxial muscle area (EMA) and subjective muscle condition score (MCS).

METHODS

Feline transverse CT images including the junction of the 13th thoracic vertebrae/13th rib head were retrospectively reviewed. Right and left epaxial muscle circumference and vertebral body height were measured and an average normalized EMA (ratio of epaxial area:vertebral height) was calculated for each image. Measurements were performed by three individuals blinded to the clinical data and were repeated 1 month later. Intra- and inter-rater reliability of EMA was assessed with concordance correlation coefficient (CCC), and Bland-Altman analysis was performed to assess bias and limits of agreement (LoA) between and within observers at different time points. In cats for which MCS data were available, EMA was compared between differing MCSs via the Kruskal-Wallis test, with Bonferroni-corrected Wilcoxon rank-sum post-hoc analysis.

RESULTS

In total, 101 CT scans met the inclusion criteria for reliability analysis, 29 of which had muscle condition information available for analysis. Intra-rater EMA CCC ranged from 0.84 to 0.99 with minimal bias (range -0.16 to 0.08) and narrow LoA. Inter-rater EMA CCC ranged from 0.87 to 0.94, bias was larger (range -0.46 to 0.66) and LoA were wider when assessed between observers. Median EMA was significantly lower in cats with severe muscle atrophy (2.76, range 1.28-3.96) than in all other MCS groups (P <0.0001 for all comparisons).

CONCLUSIONS AND RELEVANCE

Measurement of EMA on CT showed strong intra-rater reliability, and median EMA measurements were significantly lower in cats with severe muscle wasting, as assessed on physical examination. Further studies correlating EMA to lean muscle mass in cats are needed to determine whether this method may be useful to quantify muscle mass in patients undergoing a CT scan.

Diagnostic utility of thoracic radiographs and abdominal ultrasound in canine immune-mediated hemolytic anemia

The utility of thoracic radiographs and abdominal ultrasound to identify abnormalities in canine immune-mediated hemolytic anemia (IMHA) is evaluated. Dogs with regenerative anemias and a clinical diagnosis of IMHA that had thoracic radiographs or abdominal ultrasound performed as part of the evaluation were included. The utility of imaging studies was assessed based on a previously utilized scheme. Patient population and clinical signs were consistent with previous reports of IMHA. In 38 out of 50 dogs, the same clinical evaluation and assessment would have been performed without thoracic radiographs. In 32 out of 64 dogs, the same clinical evaluation and assessment would have been performed without abdominal ultrasound. The results indicate that thoracic radiographs and abdominal ultrasound are of variable utility in identifying concurrent abnormalities in canine patients with IMHA. Prospective studies should be designed to further investigate whether abnormalities identified on imaging studies are related to the IMHA or affect patient prognosis.

Vitamin D metabolism in dogs with and without hypercalciuric calcium oxalate urolithiasis

Background

There are abnormalities in vitamin D metabolism in people with calcium nephrolithiasis, but limited data are available on vitamin D status in dogs with calcium oxalate (CaOx) urolithiasis.

Objective

To compare serum concentrations of vitamin D metabolites in dogs with and without hypercalciuric CaOx urolithiasis.

Animals

Thirty‐eight dogs with (n = 19) and without (n = 19) a history of CaOx urolithiasis and hypercalciuria.

Methods

Retrospective cross‐sectional study. Serum 25‐hydroxyvitamin D [25(OH)D], 1,25‐dihydroxyvitamin D [1,25(OH)₂D], and 24,25‐dihydroxyvitamin D [24,25(OH)₂D] were measured. The ratios of 25(OH)D/24,25(OH)₂D and 1,25(OH)₂D/25(OH)D were compared between cases and controls.

Results

There were no significant differences between cases and controls when comparing 25(OH)D, 24,25(OH)₂D, 1,25(OH)₂D, or 1,25(OH)₂D/25(OH)D. Cases had higher 25(OH)D/24,25(OH)₂D (median = 1.40, range = 0.98‐1.58) compared to controls (median = 1.16, range = 0.92‐2.75; P = .01). There was overlap in the ranges for 25(OH)D/24,25(OH)₂D between cases and controls, but 6 cases (32%) had ratios above the control dog range. There was a moderate positive correlation between the ratio of 25(OH)D/24,25(OH)₂D and urinary calcium‐to‐creatinine ratios (r = 0.40, 95% confidence interval = 0.10‐0.64; P = .01).

Conclusions and Clinical Importance

These data suggest that decreased conversion of 25(OH)D to 24,25(OH)₂D occurs in a subset of dogs with CaOx urolithiasis. Abnormalities in vitamin D metabolism might contribute to stone risk in dogs.

Amino acid status in dogs with protein-losing nephropathy

Background

Proteinuria in dogs with kidney disease can contribute to protein‐energy wasting and malnutrition. Little is known about amino acid (AA) status in dogs with protein‐losing nephropathy (PLN).

Objectives

The purpose of our study was to further elucidate AA status in PLN dogs, with the hypothesis that PLN dogs would have altered AA status as compared to healthy dogs.

Animals

Thirty client‐owned PLN dogs were compared to 10 healthy control dogs.

Methods

Prospective observational study. Dogs with PLN that were presented to the teaching hospital were enrolled. Plasma AA profiles were measured using an automated high‐performance liquid chromatography AA analyzer.

Results

Compared to control dogs, PLN dogs had significantly lower concentrations of leucine, threonine, histidine, glycine, proline, asparagine, tyrosine, o‐hydroxyproline, and serine, as well as sums of both essential and nonessential AA (P < .05). Dogs with PLN had significantly lower ratios of tyrosine‐to‐phenylalanine and glycine‐to‐serine (P < .05), and a significantly greater ratio of valine‐to‐glycine (P < .05).

Conclusions and Clinical Importance

Dogs with PLN have altered AA status compared to healthy dogs. These findings could have therapeutic implications in determining optimal management of PLN dogs, such as providing AA supplementation along with other standard treatment.

Computed Tomography of Lobular Dissecting Hepatitis in a Young Golden Retriever

A 9 mo old female intact golden retriever presented for evaluation of chronic lethargy and decreased appetite. The serum biochemistry profile revealed increased liver enzymes consistent with a mixed hepatocellular and cholestatic pattern. A multiphase computed tomography angiography was performed to evaluate for a portosystemic shunt. Numerous hyperattenuating nodules were identified throughout the liver on the noncontrast-enhanced series. Histologic evaluation of percutaneous needle biopsy samples of a liver nodule showed a rare form of hepatitis called lobular dissecting hepatitis. Lobular dissecting hepatitis should be considered as a differential in young dogs with precontrast hyperattenuating hepatic nodules on noncontrast-enhanced computed tomography.

Factors associated with survival in dogs with chronic kidney disease

Background: Chronic kidney disease (CKD) is associated with morbidity and mortality in dogs. Plasma fibroblast growth factor‐23 (FGF‐23) concentration is an independent predictor of CKD progression and survival in cats and people with CKD.

Objectives: To investigate the relationship among FGF‐23, parathyroid hormone (PTH), vitamin D metabolites, and other clinical variables with survival time in dogs with CKD.

Animals: Twenty‐seven azotemic CKD dogs.

Methods: Dogs were recruited prospectively into the study and followed until death or study conclusion. Dogs were International Renal Interest Society (IRIS) staged into stage 2 (n = 9), stage 3 (n = 12), and stage 4 (n = 6) CKD. Survival times were calculated from the date of study inclusion. Univariable Cox regression was used to assess variables associated with survival including body condition score (BCS), muscle condition score, hematocrit, creatinine, CKD stage, serum phosphorus, urine protein:creatinine ratio (UPC), calcium phosphorus product (CaPP), PTH, 25‐hydroxyvitamin D, 1,25‐‐dihydroxyvitamin D, and FGF‐23 concentrations.

Results: Significant hazard ratios (hazard ratio; 95% confidence interval; P value) were as follows: BCS < 4/9 (1.579; 1.003‐2.282; P = .05), muscle atrophy (2.334; 1.352‐4.030; P = .01), increased creatinine (1.383; 1.16‐1.64; .01), hyperphosphatemia (3.20; 1.357‐7.548; P = .005), increased UPC (3.191; 1.310‐7.773; P = .01), increased CaPP (4.092; 1.771‐9.454; P = .003), and increased FGF‐23 (2.609; 1.090‐6.240; P = .05). Survival times for each IRIS CKD stage were significantly different (P = .01).

Conclusions and Clinical Importance: Multiple variables, including FGF‐23, were associated with duration of survival in CKD dogs. FGF‐23 could be a prognostic marker in dogs with CKD.

The effect of diet, adiposity, and weight loss on the secretion of incretin hormones in cats

Degree of adiposity and dietary macronutrient composition affect incretin hormone secretion in humans and mice, but little is known about their effect in cats. In this study, 7 overweight cats were fed a maintenance diet (MD) for at least 2 wk followed by a reduced calorie diet (RCD), which was lower in fat and higher in carbohydrates and fiber. Cats were fed ad libitum initially, and then, food was restricted to achieve 1%-2% loss of body weight weekly (11 wk). When lean, cats were fed MD for 2 wk. A standardized meal test (SMT) using a third diet was performed after at least 7 d on each diet, before and after weight loss (four SMT's total). Glucose, insulin, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic peptide (GIP) concentrations were measured immediately before and over 6 h after feeding the SMT. Area under the curve (AUC) was compared for GLP-1, GIP, and insulin concentrations using 2-way analysis of variance. Leaner cats had increased GIP_AUC compared to obese cats (P = 0.025). There was a trend toward increased GIP_AUC on RCD compared to the MD (P = 0.085). There was a moderate negative correlation between body fat percentage and GLP-1_AUC (r = -0.45; P = 0.05). There was no effect of diet on GLP-1_AUC. In conclusion, degree of adiposity and dietary macronutrient content could be important in determining GIP responses not only acutely but also on a long-term basis. Further investigation of GIP responses in cats should take both diet and degree of adiposity into account.

Dietary management of presumptive protein-losing enteropathy in Yorkshire terriers

OBJECTIVES

To describe the clinical outcome of dietary management of Yorkshire terriers with protein-losing enteropathy without immunosuppressive/anti-inflammatory medications.

METHODS

Records were searched for Yorkshire terriers with hypoalbuminaemia and a clinical diagnosis of protein-losing enteropathy that were managed with diet and without immunosuppressive/anti-inflammatory medications. Serum albumin changes were compared using a one-way repeated measures ANOVA. Canine chronic enteropathy clinical activity index scores were compared using a Wilcoxon signed-rank test.

RESULTS

Eleven cases were identified. Clinical signs were variable including: diarrhoea, respiratory signs, vomiting, lethargy and weight loss. Diets fed included home cooked (n=5); Royal Canin Gastrointestinal Low Fat (n=4); Hill's Prescription Diet i/d Low Fat (n=1); or Purina HA Hypoallergenic (n=1). Clinical signs resolved completely in eight dogs, partially resolved in two dogs and failed to respond in one dog. In dogs that responded, albumin significantly improved from baseline (mean 14·9 g/L, sd ±3·7), at 2 to 4 weeks (mean 24·2 g/L, sd ±5·5, P=0·01), and at 3 to 4 months (mean 27·0 g/dL, sd ±5·9, P=0·01).

CLINICAL SIGNIFICANCE

These results indicate that dietary management of protein-losing enteropathy is a potential management strategy in Yorkshire terriers. Randomised clinical trials in Yorkshire terriers with protein-losing enteropathy are necessary to compare success rate, survival and quality of life with dietary management versus combined dietary and immunosuppressive/anti-inflammatory therapy.

Fibroblast Growth Factor-23 Concentration in Dogs with Chronic Kidney Disease

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.

Association of Vitamin D Metabolites with Parathyroid Hormone, Fibroblast Growth Factor-23, Calcium, and Phosphorus in Dogs with Various Stages of Chronic Kidney Disease

BACKGROUND

Hypovitaminosis D is associated with progression of renal disease, development of renal secondary hyperparathyroidism (RHPT), chronic kidney disease-mineral bone disorder (CKD-MBD), and increased mortality in people with CKD. Despite what is known regarding vitamin D dysregulation in humans with CKD, little is known about vitamin D metabolism in dogs with CKD.

OBJECTIVES

The purpose of our study was to further elucidate vitamin D status in dogs with different stages of CKD and to relate it to factors that affect the development of CKD-MBD, including parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), calcium, and phosphorus concentrations.

METHODS

Thirty-seven dogs with naturally occurring CKD were compared to 10 healthy dogs. Serum 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)₂ D], and 24,25-dihydroxyvitamin D [24,25(OH)₂ D], and PTH and FGF-23 concentrations were measured. Their association with serum calcium and phosphorus concentrations and IRIS stage was determined.

RESULTS

Compared to healthy dogs, all vitamin D metabolite concentrations were significantly lower in dogs with International Renal Interest Society (IRIS) stages 3 and 4 CKD (r [creatinine]: -0.49 to -0.60; P < .05) but not different in dogs with stages 1 and 2 CKD. All vitamin D metabolites were negatively correlated with PTH, FGF-23, and phosphorus concentrations (r: -0.39 to -0.64; P < .01).

CONCLUSIONS AND CLINICAL IMPORTANCE

CKD in dogs is associated with decreases in all vitamin D metabolites evaluated suggesting that multiple mechanisms, in addition to decreased renal mass, affect their metabolism. This information could have prognostic and therapeutic implications.

Proteinuria and lipoprotein lipase activity in Miniature Schnauzer dogs with and without hypertriglyceridemia

Spontaneous hyperlipidemia in rats causes glomerular disease. Idiopathic hypertriglyceridemia (HTG) is prevalent in Miniature Schnauzers, but its relationship with proteinuria is unknown. Decreased activity of major lipid metabolism enzymes, lipoprotein lipase (LPL) and hepatic lipase (HL), may play a role in the cyclic relationship between hyperlipidemia and proteinuria. These enzymes have also not been previously investigated in Miniature Schnauzers. The aims of this study were to determine the relationship between HTG and proteinuria in Miniature Schnauzers and to measure LPL and HL activities in a subset of dogs. Fifty-seven Miniature Schnauzers were recruited (34 with and 23 without HTG). Fasting serum triglyceride concentrations and urine protein-to-creatinine ratios (UPC) were measured in all dogs, and LPL and HL activities were determined in 17 dogs (8 with and 9 without HTG). There was a strong positive correlation between triglyceride concentration and UPC (r = 0.77-0.83, P < 0.001). Proteinuria (UPC ≥ 0.5) was present in 60% of dogs with HTG and absent from all dogs without HTG (P < 0.001). Proteinuric dogs were not azotemic or hypoalbuminemic. Dogs with HTG had a 65% reduction in LPL activity relative to dogs without HTG (P < 0.001); HL activity did not differ. Proteinuria occurs with HTG in Miniature Schnauzers and could be due to lipid-induced glomerular injury. Reduced LPL activity may contribute to the severity of HTG, but further assay validation is required.

Feline hyperparathyroidism: pathophysiology, diagnosis and treatment of primary and secondary disease

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.

Diet-induced obesity may affect the uterine immune environment in early-mid pregnancy, reducing NK-cell activity and potentially compromising uterine vascularization

OBJECTIVES

To investigate the effect of obesity in early-mid pregnancy on crucial pregnancy hormones and the uterine immune environment.

BACKGROUND

Obesity impacts reproductive ability, adversely affecting conception and leading to complications in pregnancy. Obesity is often regarded as a stress state and an immune disease, both of which may contribute to pregnancy failure. We previously demonstrated that stress in early pregnancy greatly alters progesterone secretion. As progesterone is an immunomodulator, altered progesterone secretion may adversely modify the maternal immune system. In the current study, we test the hypothesis that obesity during pregnancy adversely alters the uterine immune environment.

METHODS

An obese mouse model was created by feeding C57/BL6 mice on a high-fat (HF)/sugar diet for 12 weeks before pregnancy. Control mice were fed on lower-fat/sugar chow. Mice were mated, and on day 7.5 of pregnancy plasma progesterone and prolactin were measured by immunoassay. Cells from the uterus-draining inguinal lymph nodes were collected for analysis of the uterine immune response by flow cytometry.

RESULTS

Diet-induced obesity increased the secretion of progesterone and altered a number of uterine natural killer (NK)- and T-cell responses. These included a marked reduction in the percentage of leucocyte-derived NK cells and reduced expression of interferon-γ (IFN-γ) in the NK cells compared with control mice.

CONCLUSIONS

Maternal obesity, induced by an HF diet, may lead to a reduction in the expression of IFN-γ in NK cells. NK-cell-derived IFN-γ is reported to be involved in supporting uterine spiral artery remodelling. Thus, obesity in early pregnancy may compromise vascularization by reducing the expression of IFN-γ-positive NK cells. Furthermore, the expression of uterine CD8(+) cells was reduced in the HF diet-fed mice, suggesting obesity may adversely alter the maternal immune adaptation that is essential for effective pregnancy.

Comparison of various solutions to dissolve critical care diet clots

BACKGROUND

Enteral feeding tubes are frequently placed in animals to provide assisted nutritional support; however, one major reported complication is clogging of the tubes. The goal of this study was to determine which solution is most effective at dissolving in vitro clots made using a veterinary canned critical care diet.

METHODS

Various solutions were tested for their ability to dissolve enteral feed clots, including water, meat tenderizers in water, predetermined amounts of pancreatic enzymes (with and without sodium bicarbonate) in water, carbonated beverages, and cranberry juice.

RESULTS

The solution that resulted in the greatest dissolution was ¼ teaspoon pancreatic enzymes and 325 mg sodium bicarbonate in 5 mL water, which was significantly better than all other solutions (water: P = 0.03; ¼ teaspoon pancreatic enzymes in water: P = 0.002; all others: P < 0.001). Water was significantly better than all carbonated beverages and cranberry juice (P < 0.001). The least successful solution was ½ teaspoon pancreatic enzymes and sodium bicarbonate in water.

CLINICAL RELEVANCE

Despite anecdotal reports of using carbonated beverages, cranberry juice, and ½ teaspoon pancreatic enzymes to unclog feeding tubes, all were significantly less effective than water. In vivo studies to evaluate the effectiveness of methods to unclog feeding tubes are warranted to further investigate these findings.

Iatrogenic water intoxication in two cats

OBJECTIVE

To describe 2 cats that developed acute iatrogenic water intoxication, one associated with a continuous infusion of water provided via an esophagostomy tube and one following SC administration of 5% dextrose in water (D5W).

CASE OR SERIES SUMMARY

A 10-year-old cat with squamous cell carcinoma was hospitalized for treatment of dehydration. Rehydration was provided with water via an esophagostomy tube at 5.7 mL/kg/h. After 30 hours of therapy, the cat was found dull and weak. Serum sodium was markedly decreased at 116 mmol/L (116 mEq/L). Supplemental water was stopped, and IV furosemide and mannitol were provided to eliminate free water. Hypertonic saline (1.5%) was administered IV to rapidly restore the sodium concentration. The serum sodium concentration corrected over 17 hours, and the cat was discharged without neurological complications. The second cat had previously received 300 mL D5W subcutaneously and represented 8 hours later with lethargy and paresis with a serum sodium level of 126 mmol/L (126 mEq/L). Intravenous fluid therapy was provided using 0.9% NaCl. Over the following day, the cat's mentation and paresis resolved and sodium concentrations normalized.

NEW OR UNIQUE INFORMATION PROVIDED

These 2 cases describe a presumed uncommon iatrogenic complication of severe hyponatremia due to water provided either via an esophagostomy tube or subcutaneously. While oral rehydration is often considered ideal, it may result in signs of water intoxication if not carefully monitored; additionally, D5W is never considered an acceptable fluid choice as a SC bolus. If promptly recognized, acute hyponatremia may be corrected rapidly with no lasting consequences.

Toxic shock syndrome in two dogs

Two young, unrelated, spayed female Labrador retrievers were evaluated for severe, diffuse, generalized erythema and edema of the skin. Both dogs exhibited signs of disseminated intravascular coagulopathy and were euthanized. On postmortem examination, toxic shock syndrome (TSS) was diagnosed based on histopathology and supported by skin cultures. TSS is a rarely reported disease in veterinary medicine and can cause acute and profound clinical signs. Rapid recognition of this disease process and immediate treatment may improve the clinical outcome.

Focus on nutrition: Nutritional management of protein-losing nephropathy in dogs

Optimal treatment of protein-losing nephropathy (PLN) should address both medical and nutritional issues. In nonazotemic dogs with PLN, the main nutrients of concern are protein, calories, omega-3 fatty acids, and sodium. In azotemic dogs with PLN, requirements for additional nutrients should be addressed. The amount of protein and the specific diet must be individualized for every patient with PLN because commercial dog foods differ greatly in protein and other nutrients. It is critical to avoid excessive dietary protein restriction, which may contribute to loss of lean body mass. A thorough diet history must be obtained to account for the animal's entire daily intake of protein and other nutrients.

Isolation of Cokeromyces recurvatus from the gastrointestinal tract in a dog with protein-losing enteropathy

The present case report describes the isolation of the fungus Cokeromyces recurvatus from the intestinal tract of a canine patient. Infection by this fungus is rare, having only been reported in 8 human beings and 1 cat. The fungus is not reported to exhibit tissue invasion. Cokeromyces recurvatus is most likely an opportunistic agent, and most cases described involve some degree of immunosuppression.

Differential changes in the hypothalamic-pituitary-adrenal axis and prolactin responses to stress in early pregnant mice

Stress can cause pregnancy failure but it is unclear how the mother's neuroendocrine system responds to stress to impair mechanisms establishing implantation. We analysed stress-evoked hypothalamic-pituitary-adrenal (HPA) axis responses in early pregnant mice. HPA axis secretory responses to immune stress in early-mid pregnancy were strong and similar to that in virgins, although activation of hypothalamic vasopressin neurones, rather than corticotrophin-releasing hormone neurones, may be more important in the stress response in pregnancy. The site and mode of detrimental glucocorticoid action in pregnancy is not established. Because circulating prolactin is important for progesterone secretion and pregnancy establishment, we also hypothesised that stress negatively impacts on prolactin and its neuroendocrine control systems in early pregnant mice. Basal prolactin secretion was profoundly inhibited by either immune or fasting stress in early pregnancy. Prolactin release is inhibited by tonic dopamine release from tuberoinfundibular (TIDA) neurones. However, immune stress did not increase TIDA neurone activity in the median eminence in pregnant mice [measured by 3,4-dihydroxyphenylacetic acid (DOPAC) content and the DOPAC:dopamine ratio]. By contrast, both immune stress and fasting caused weak induction of Fos in TIDA neurones. However, Fos induction does not always reflect dopamine secretion. Taken together, the data suggest that the stress-evoked profound reduction in prolactin secretion does not involve substantially increased dopamine activity as anticipated. In pregnancy, there was also attenuated recruitment of parvocellular paraventricular nucleus neurones and increased activation of brainstem noradrenergic nuclei after immune stress, indicating that other mechanisms may be involved in the suppression of prolactin secretion. In summary, low prolactin and increased circulating glucocorticoids together may partly explain how a mother's endocrine system mediates stress-induced pregnancy failure.