Urine Cortisol:Creatinine Ratio in Healthy and Sick Cats

Urine cortisokcreatinine ratios (UCCR) were determined from single urine samples obtained by cystocentesis in 47 cats allotted into 2 groups: 31 healthy cats and 16 sick, hospitalized cats with assorted clinical illnesses. The mean (± standard deviation) UCCR for healthy cats was 5.9 ± 7.0 (median, 3.2; range, 0.6 to 27.8). Age or gonadal status had no significant effect on the magnitude of UCCR within this group. However, sick cats had significantly higher UCCR (P = .002) when compared with healthy cats. The mean UCCR for sick cats was 19.6 ± 19.2 (median, 14.8; range, 1.7 to 75.1). This report establishes a reference range for UCCR in 31 normal cats and provides evidence that health status affects UCCR in cats. J Vet Intern Med 1996;10:123–126. Copyright © 1996 by the American College of Veterinary Internal Medicine .     

Relationships Between Degree of Azotaemia and Blood Pressure,Urinary Protein:Creatinine Ratio and Fractional Excretion of Electrolytes in Dogs with Renal Azotaemia

Blood pressure (BP) was measured in 31 renal azotaemic dogs by oscillometric measurement at the posterior tibia artery, and urine and blood samples were collected. Haematology, blood chemistry and urinalysis were performed and urinary protein:creatinine ratio (UPC) and fractional excretions of electrolytes (FE_e) were calculated. The results showed that only 19% of dogs with renal azotaemia were hypertensive, whereas almost all of them had high urinary protein and electrolyte excretions. There was no association between BP, UPC and FE_e. A positive correlation was found between all pairs of electrolyte fractional excretions. When the severity of renal impairment was observed using plasma creatinine concentration, neither BP nor UPC was correlated. Only the FE _e was associated with the degree of azotaemia. The results suggest that dogs with renal azotaemia do not necessarily have hypertension. The fractional urinary excretion of electrolytes may be a good indicator for severity of renal dysfunction in azotaemic dogs.     

Transplantation Therapy of Cats with Chronic Renal Failure

Dialysis therapy is not a radical cure of chronic renal failure in cats,while renal transplantation is the cure method.Renal transplanta-tion requires rigorous examination of donor and receptor,and the procedure is strictly sterile.The main points of renal transplantation are:renal artery and vein sutured to abdominal aorta and posterior vena cava,respectively;ureter sutured to bladder;minimizing the time of thermal ischemia.Cats should be given immunosuppressant before the operation,and the drug should be administered throughout the life.Various indicators should be monitored regularly to prevent the occurrence of immunological rejection.     

Oxidative Stress and Neutrophil Function in Cats with Chronic Renal Failure

Background: Oxidative stress is an important component in the progression of chronic renal failure (CRF) and neutrophil function may be impaired by oxidative stress. Hypothesis: Cats with CRF have increased oxidative stress and decreased neutrophil function compared with control cats. Animals: Twenty cats with previously diagnosed renal failure were compared with 10 age‐matched control cats. Methods: A biochemical profile, CBC, urinalysis, antioxidant capacity, superoxide dismutase (SOD) enzyme activity, reduced to oxidized glutathione ratio (GSH : GSSG), and neutrophil phagocytosis and oxidative burst were measured. Statistical comparisons (2‐tailed t‐test) were reported as mean ± standard deviation. Results: The CRF cats had significantly higher serum blood urea nitrogen, creatinine, and phosphorus concentrations than control cats, and significantly lower PCV and urine specific gravity than control cats. The GSH : GSSG ratio was significantly higher in the CRF group (177.6 ± 197, 61.7 ± 33; P < .02) whereas the antioxidant capacity was significantly less in the CRF group (0.56 ± 0.21, 0.81 ± 0.13 Trolox units; P < .005). SOD activity was the same in control and CRF cats. Neutrophil oxidative burst after Escherichia coli phagocytosis, measured as an increase in mean fluorescence intensity, was significantly higher in CRF cats than controls (732 ± 253, 524 ± 54; P < .05). Conclusions: The higher GSH : GSSG ratio and lower antioxidant capacity in CRF cats is consistent with activation of antioxidant defense mechanisms. It remains to be determined if supplementation with antioxidants such as SOD beyond the level of control cats would be of benefit in cats with CRF.     

The Effect of Experimental Cystitis and Iatrogenic Blood Contamination on the Urine Protein/Creatinine Ratio in the Dog

The effect of experimentally induced cystitis and iatrogenic blood contamination on the urine protein/creatinine ratio (U P/C) was evaluated in 17 dogs. Before they were included in the study, all dogs were judged to be healthy on the basis of physical examination, serum concentrations of urea nitrogen and creatinine, complete urinalysis, and a U P/C less than 0.4. A single urine sample was contaminated with increasing quantities of canine fresh whole blood (PCV = 42%; total protein = 6.2 g/dl). When added blood was equal to or greater than 25% of the total urine sample volume, the U P/C exceeded 3.5, a finding consistent with nephrotic range proteinuria. When added blood was 10% of the total urine sample volume, the U P/C was less than 1.8. Eleven Beagles underwent routine laparotomy during which a cystotomy was done. The median U P/Cs on postoperative days 1 and 2 were significantly increased compared with preoperative values (P less than 0.05); no U P/C exceeded 2.0. Renal biopsies performed on postoperative day 3 eliminated renal proteinuria as a source of urine protein. Five dogs had bacterial cystitis experimentally induced. At 72 and 96 hours after bacterial inoculation, the median U P/Cs were significantly increased (P less than 0.05); individual values ranged from 1.5 to 40.8. Renal biopsies performed between 5 and 6 days after inoculation eliminated renal proteinuria as a source of urine protein. Cytologic evaluation of urine sediment in each group did not correlate with the magnitude of the increase in the U P/C. The U P/C significantly increased in each model of lower urinary tract inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Muscle Potassium Content and Potassium Gluconate Supplementation in Normokalemic Cats With Naturally Occurring Chronic Renal Failure

Muscle potassium content and supplementation with potassium gluconate were evaluated in normokalemic cats with chronic renal failure (CRF). Affected cats received standard medical therapy for renal failure and either placebo (sodium gluconate! or potassium gluconate. At the beginning of the study and after 6 months of supplementation, glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were estimated using ³H-inulin and ¹⁴C-tetraethylammo-nium bromide (TEA) clearances. Muscle potassium content was determined in biopsy specimens using atomic absorption spectroscopy. Muscle biopsy samples obtained from cats with CRF before treatment had significantly lower muscle potassium content than did those from normal control cats. Over the 6-month period of supplementation, muscle potassium content increased both in cats with CRF that received potassium gluconate and in those that received placebo (sodium gluconate). Serum potassium concentration and fractional excretion of potassium remained relatively unchanged in both groups of cats throughout the treatment period. There were no significant differences in the percentage change in GFR and ERPF between treatment groups over the 6-month time period. Median values for pH, HCO₃, and total CO₂ at 6 months were higher than baseline in the potassium gluconate group but lower than baseline in the sodium gluconate group.     

Computed Tomographic Angiography of the Pancreas in Cats with Chronic Diabetes Mellitus Compared to Normal Cats

Background

Diabetes mellitus (DM) is a common endocrinopathy in cats. No known diagnostic test or patient characteristic at the time of diagnosis can predict likely disease course, unlike in people in whom computed tomographic angiography (CTA) is used. No published data exist regarding the CTA appearance of the pancreas in cats with DM, and thus, it is unknown what if any CTA variables should be further assessed for associations with pancreatic endocrine function.

Hypothesis/Objectives

A significant difference in pancreatic attenuation, volume, and size will be identified between normal cats and those with chronic DM on CTA.

Animals

Ten healthy control cats and 15 cats with naturally occurring DM present for >12 months.

Methods

Prospective cross‐sectional study comparing pancreatic attenuation, enhancement pattern, size, volume, pancreatic volume‐to‐body weight ratio (V:BW), pancreatic arterial: portal phase ratio (A:P), time‐to‐arterial enhancement, and time‐to‐peak portal enhancement on CTA between sedated healthy control cats and those with chronic DM.

Results

The pancreas in cats with chronic DM was significantly larger, had higher volume, higher V:BW, and shorter time‐to‐peak portal enhancement on CTA when compared to normal cats.

Conclusions and Clinical Importance

Peak portal enhancement time, pancreatic size, pancreatic volume, and V:BW can be used to differentiate normal sedated cats from those with chronic DM by CTA. These variables warrant further investigation to identify possible associations with endocrine function.     

Retinol-Binding Protein in Serum and Urine of Hyperthyroid Cats before and after Treatment with Radioiodine

Background: Retinol-binding protein (RBP) is suggested as a clinically useful marker of renal function in cats.
Hypothesis: Serum and urinary RBP concentrations in hyperthyroid (HT) cats differ from those in healthy (H) cats; radioiodine (¹³¹I) treatment influences serum and urinary RBP concentrations in HT cats.
Animals: Ten HT and 8 H cats.
Methods: RBP concentration was evaluated in feline serum and urine samples from a prospective study.
Results: There was a significant ( P = .003) difference in the urinary RBP/creatinine (uRBP/c) ratios of H (−) and untreated HT (1.4 ± 1.5 × 10⁻² μg/mg) cats. Serum total thyroxine concentration (1.8 ± 1.9 μg/dL, 24 weeks) and uRBP/c (0.6 ± 1.0 × 10⁻² μg/mg, 24 weeks) decreased significantly ( P < .001) in HT cats at all time points after treatment with ¹³¹I, and these variables were significantly correlated with one another ( r = 0.42, P = .007). Serum RBP concentrations from HT cats (199 ± 86 μg/L) did not differ significantly ( P = .98) from those of H cats (174 ± 60) and did not change after treatment with ¹³¹I (182 ± 124 μg/L, P = .80).
Conclusion and Clinical Importance: The presence of urinary RBP in HT cats is a potential marker of tubular dysfunction that is correlated to thyroid status, although it is independent of circulating RBP concentrations. The decreased uRBP/c combined with the absence of changes in serum RBP after treatment suggests that the suspected tubular dysfunction was partly reversible with treatment of ¹³¹I.     

Comparison of Serum Concentrations of Symmetric Dimethylarginine and Creatinine as Kidney Function Biomarkers in Cats with Chronic Kidney Disease

Background

Symmetric dimethylarginine (SDMA) has been shown to be an accurate and precise biomarker for calculating estimated glomerular filtration rate (GFR) in humans, as well as a more sensitive biomarker than serum creatinine concentration (sCr) for assessing renal dysfunction.

Objectives

The purpose of this retrospective study was to report on the utility of measuring serum SDMA concentrations in cats for detection of chronic kidney disease (CKD) before diagnosis by conventional measurement of sCr.

Animals

Chronic kidney disease cats (n = 21) included those persistently azotemic for ≥3 months (n = 15), nonazotemic cats with GFR >30% decreased from median GFR of normal cats (n = 4), and nonazotemic cats with calcium oxalate kidney stones (n = 2). Healthy geriatric cats (n = 21) were selected from the same colony.

Methods

Symmetric dimethylarginine concentrations (liquid chromatography‐mass spectroscopy) and sCr (enzymatic colorimetry) were determined retrospectively from historical data or banked serum samples in azotemic cats or at the time GFR (iohexol clearance) was measured in nonazotemic cats.

Results

Serum SDMA (r = −0.79) and sCr (r = −0.77) concentrations were significantly correlated to GFR (both P < .0001). Symmetric dimethylarginine became increased before sCr in 17/21 cats (mean, 17.0 months; range, 1.5–48 months). Serum SDMA had higher sensitivity (100%) compared with sCr (17%), but lower specificity (91% versus 100%) and positive predictive value (86% versus 100%).

Conclusion and Clinical Importance

Using serum SDMA as a biomarker for CKD allows earlier detection of CKD in cats compared with sCr, which may be desirable for initiating renoprotective interventions that slow progression of CKD.     

Renal Clearance, Urinary Excretion of Endogenous Substances, and Urinary Diagnostic Indices in Healthy Neonatal Foals

Urine (U) and serum (S) were obtained every 2 hours during a 12- or 24-hour period from eight healthy 96-hour-old pony or horse foals. Dams' milk samples were obtained concurrently. Urine volume was measured during this 12- or 24-hour period. The mean amount of urine produced was 148 +/- 20 ml/kg/day. Baseline urinalyses were evaluated on all foals at two days of age, before any manipulation. Urine generally was dilute (less than 1.008) but the specific gravity was as high as 1.027 in one normal foal. Continuous (12 or 24 hour) urinary catheterization resulted in bacteriuria but not white blood cells in the urine. Prolonged catheterization did not cause foals to become febrile or exhibit clinical signs of cystitis or other illness. Urinary electrolyte excretion, urinary electrolyte clearances, and fractional electrolyte excretions (FE) were measured. When compared with normal values reported in adult horses, excretion, clearance, and FE were similar for sodium (Na) but higher for potassium (K), phosphorus (P), and calcium (Ca). There were no significant differences between data collected during different time periods, and it was concluded that the use of single sample urine/serum estimates of fractional excretion in the neonatal foal was an appropriate indicator of the renal handling of electrolytes, and when viewed in conjunction with urinalysis and other serum parameters, a valuable aid to evaluating renal function.     

Serologic and Urinary PCR Survey of Leptospirosis in Healthy Cats and in Cats with Kidney Disease

Background

Although there is serologic evidence of exposure of cats to Leptospira spp., clinical disease is rarely reported in cats.

Objective

To compare the seropositivity and urinary polymerase chain reaction (PCR) status for Leptospira spp. between healthy (H) cats and cats with kidney disease (KD), to investigate the serovars potentially involved, and to evaluate potential risk factors.

Animals

Two hundred and forty client‐owned cats.

Methods

Cats were prospectively recruited and classified based on physical examination, complete blood count, serum biochemistry profile, and urinalysis (125 H and 115 KD cats). Leptospira spp. serology (titers ≥1 : 100 considered positive) and urinary PCR were performed in all cats. Data assessing risk factors, obtained from a questionnaire, were evaluated using logistic regression models.

Results

Seropositivity for Leptospira spp. was statistically different between groups: 7.2% (9/125) and 14.9% (17/114) in the H and KD, respectively (P = .05). The proportion of PCR‐positive cats was not. The most common serovars detected serologically were Pomona (n = 16) and Bratislava (n = 8). Risk factors for seropositivity included outdoor and hunting lifestyles (P = .03 and P < .001, respectively), the presence of another cat in the household (P < .01), and the sampling period, with the greatest number of cases identified between June and August (P =.02).

Conclusions

Seropositivity was significantly greater in KD cats, suggesting that the role of Leptospira spp. in KD in cats should be further investigated. The detection of urinary shedding of leptospires in several cats identifies a potential role in the transmission of the organism.     

Comparison between Urine Protein: Creatinine Ratios of Samples Obtained from Dogs in Home and Hospital Settings

Background

The urine protein:creatinine ratio (UPC) is used to quantify urine protein excretion and guide recommendations for monitoring and treatment of proteinuria.

Hypothesis/Objectives

Home urine samples will have lower UPCs than hospital samples. The objectives were to compare UPCs of samples collected in each setting and to determine whether environment of sample collection might affect staging, monitoring or treatment recommendations.

Animals

Twenty‐four client‐owned dogs.

Methods

Prospective, nonmasked study. Clients collected a urine sample from their dog at home and a second sample was collected at the hospital. Dogs receiving corticosteroids or angiotensin‐converting enzyme inhibitors were excluded, as were those with urine samples of inadequate volume, no protein on dipstick analysis, or active urine sediment. Samples were refrigerated after collection, dipstick and sediment evaluations were completed and each sample was frozen at −80°C within 12 hours. UPCs were performed on frozen samples within 2 months.

Results

From 81 paired samples, 57 were excluded. Of the remaining 24, 12/24 (50%) had higher hospital sample UPCs, 9/24 (38%) had identical UPCs, and 3/24 (12%) had lower hospital UPCs. The UPCs of hospital samples were higher than home samples for the total population (P = .005) and the subset with UPC > 0.5 (P = .001).

Conclusions

Setting and related circumstances of urine collection in dogs is associated with UPC differences; results are usually higher in hospital than in home samples. This difference has the potential to affect clinical interpretation.     

燕麦干草对藏羊尿中嘌呤衍生物、肌酐及马尿酸排出量的影响

通过研究燕麦干草不同限饲水平对藏羊尿中嘌呤衍生物(purine derivative,PD)、肌酐和马尿酸排出量的影响,为估测藏羊瘤胃微生物蛋白产量及揭示氮代谢机制提供依据。试验采用4×4拉丁方设计,选取5只体况体重相近(45±2)kg、健康的20月龄去势公藏羊,随机分为4组(其中1组为2只藏羊),分限饲试验和绝食试验两阶段进行。4个限饲水平分别被设定为自由采食量(voluntary intake,VI)的30%、50%、70%和90%,试验正试期采用全收尿法以测定藏羊尿中每天嘌呤衍生物的排出量。结果表明:(1)随着限饲水平的降低,马尿酸、PD及各组分排出量线性升高(P0.05),而肌酐排出量不受影响(P0.05)。(2)限饲期,PD、马尿酸排出量均与可消化有机物采食量(digestible organic matter intake,DOMI)线性正相关(P0.05)(3)利用尿中PD与DOMI所建立的模型估测藏羊内源PD排出量为0.09mmol/(kg BW0.75·d)。(4)绝食期,藏羊内源PD排出量为0.11mmol/(kg BW0.75·d)。结果提示,限饲水平与马尿酸、PD及各组分排出量呈负相关(P0.05),但与肌酐排出量无相关性(P0.05);根据PD与DOMI建立的模型估测出内源PD排出量与内源PD实际排出量接近,验证了模型的准确性。     

Comparison of Single,Averaged, and Pooled Urine Protein:Creatinine Ratios in Proteinuric Dogs Undergoing Medical Treatment

Background

Monitoring urine protein:creatinine ratios (UPC ) in dogs with protein‐losing nephropathy (PLN ) is challenging because of day‐to‐day variation in UPC results.

Hypothesis/Objectives

Determine whether single, averaged, or pooled samples from PLN dogs receiving medical treatment yield comparable UPC s, regardless of degree of proteinuria.

Animals

Twenty‐five client‐owned PLN dogs receiving medical treatment.

Methods

UPC ratios were prospectively measured in each dog utilizing 3 methods: single in‐hospital sample (day 3), average sample (days 1–3), and pooled sample (equal pooling of urine from days 1–3). Bland‐Altman analysis was performed to evaluate agreement between methods for all dogs, as well as in subgroups of dogs (UPC ≤4 or UPC >4).

Results

For all dogs, Bland‐Altman log‐transformed 95% limits of agreement were ?0.07–0.18 (single versus pooled UPC ), ?0.06–0.16 (single versus average UPC ), and ?0.06–0.04 (pooled versus average UPC ). For dogs with UPC ≤4, Bland‐Altman 95% limits of agreement were ?0.42–0.82 (single versus pooled UPC ), ?0.38–0.76 (single versus average UPC ), and ?0.27–0.25 (pooled versus average UPC ). For dogs with UPC >4, Bland‐Altman 95% limits of agreement were ?0.17–2.4 (single versus pooled UPC ), ?0.40–2.2 (single versus average UPC ), and ?0.85–0.43 (pooled versus average UPC ).

Conclusions and Clinical Importance

UPC ratios from all methods were comparable in PLN dogs receiving medical treatment. In PLN dogs with UPC >4, more variability between methods exists likely because of higher in‐hospital results, but whether this finding is clinically relevant is unknown.

     

Contrast‐Enhanced Ultrasound Examination for the Assessment of Renal Perfusion in Cats with Chronic Kidney Disease

Background

Contrast‐enhanced ultrasound examination (CEUS) is a functional imaging technique allowing noninvasive assessment of tissue perfusion. Studies in humans show that the technique holds great potential to be used in the diagnosis of chronic kidney disease (CKD). However, data in veterinary medicine are currently lacking.

Objectives

To evaluate renal perfusion using CEUS in cats with CKD.

Animals

Fourteen client‐owned cats with CKD and 43 healthy control cats.

Methods

Prospective case‐controlled clinical trial using CEUS to evaluate renal perfusion in cats with CKD compared to healthy control cats. Time‐intensity curves were created, and perfusion parameters were calculated using off‐line software. A linear mixed model was used to examine differences between perfusion parameters of cats with CKD and healthy cats.

Results

In cats with CKD, longer time to peak and shorter mean transit times were observed for the renal cortex. In contrast, a shorter time to peak and rise time were seen for the renal medulla. The findings for the renal cortex indicate decreased blood velocity and shorter total duration of enhancement, likely caused by increased vascular resistance in CKD. Increased blood velocity in the renal medulla has not been described before and may be because of a different response to regulatory factors in cortex and medulla.

Conclusions and Clinical Importance

Contrast‐enhanced ultrasound examination was capable of detecting perfusion changes in cats with CKD. Further research is warranted to assess the diagnostic capabilities of CEUS in early stage of the disease process.