Echo-assisted percutaneous renal biopsy in dogs. A retrospective study of 229 cases

Renal biopsies were carried out on 229 dogs using an echo-assisted, semi-automatic method. Complications arising after the biopsy were also evaluated. The biopsies were examined for the accuracy of diagnosis and the presence of histologically demonstrable primary renal pathologies. A retrospective study of the observed lesions and parenchymal echogenicity showed a correlation between these factors involving the tubulo-interstitial compartment. Histopathological renal lesions and their correlation with laboratory methods are the only parameters that allow a correct diagnostic, prognostic, and therapeutic work-up in cases of clinical kidney disease in canines.     

Comparison of renal biopsy techniques in dogs

To evaluate adequacy of biopsy specimens obtained and safety to the patient, the standard keyhole biopsy technique (using digital immobilization of the right kidney and placement of the biopsy needle up to the capsule before obtaining a tissue sample) was compared with 9 technical modifications. Adequacy was judged by the number of intact glomeruli observed in the specimen. Detection of transected blood vessels and renal pelvis was presumed to have predictive value for postbiopsy complications of hemorrhage and hydronephrosis. Needle biopsy specimens were also obtained from left and right kidneys by use of laparoscopic visualization and were compared with those obtained by use of the standard keyhole technique. Although the standard keyhole technique yielded the highest percentage of adequate biopsy specimens, there was no statistical difference between specimens obtained by this technique and those obtained by the modified technique or by laparoscope-guided biopsy. Also, significant difference in percentage of biopsy specimens with renal pelvis was not found between specimens obtained by the standard and modified techniques. For each technique, the biopsy core length was measured and the mean value was calculated. In this study, core length did not correlate with adequacy of the biopsy specimen.     

Investigation of Keyes skin biopsy instrument for intestinal biopsy versus a standard biopsy technique

A prospective, clinical trial was conducted using 12 dogs that were presented for intestinal biopsy. Comparisons were made between paired jejunal biopsies collected using a Keyes biopsy punch and a standard scissor excisional technique. There were no differences in speed of collection, diagnostic value of specimens, complication rates, or sample quality. In this study, the Keyes skin punch was found to be safe, rapid, and diagnostic in all animals. Based on results of this study, the use of a Keyes punch instrument can be recommended as an alternative to other open intestinal biopsy methods.     

Evaluation of laparoscopy for obtaining renal biopsy specimens from dogs and cats

Laparoscopic direction of renal biopsy was evaluated in 37 dogs and 1 cat suspected of having renal disease. Specimens adequate for morphologic diagnosis were obtained in 37 cases (97%). Eleven of the 38 animals were necropsied and the biopsy diagnosis was confirmed in 10 of the cases (91%). Excessive pericapsular hemorrhage and severe hematuria developed in 1 dog. Three dogs (8%) had macroscopic hematuria for 24 hours after biopsy.     

Endoscopic renal evaluation and biopsy of Chelonia

Sixty-nine tortoises, turtles and terrapins representing 28 species of the order Chelonia, class Reptilia were evaluated by endoscopy for renal disease. Under general anaesthesia, coelomic and/or extracoelomic endoscopic evaluations and biopsies of the kidney(s) were undertaken. Endoscopic approaches required a 2 to 4 mm skin incision in the prefemoral fossa, and minimal blunt dissection through the subcutaneous tissues. For the coelomic approach the coelomic aponeurosis of the transverse and oblique abdominal muscles was penetrated so that the cranioventral kidney(s) could be examined and biopsied. The extracoelomic approach required the endoscope to be advanced in a caudodorsal direction, between the coelomic aponeurosis and the broad iliacus muscle, so that the dorsolateral kidney(s) could be examined and biopsied. Both techniques were safe and effective for obtaining renal biopsies for histological examination and microbiological culture. Several renal pathologies were identified including glomerulonephrosis, tubulonephrosis, interstitial nephritis, uric acid accumulation, tubulonephritis, glomerulonephritis, renal oedema, glomerulosclerosis, nephrosclerosis, soft tissue mineralisation, and pyelonephritis. Several infectious conditions were identified, including a predominance of Gram-negative bacterial infections, two cases of hexamitiosis, and one case of mycobacteriosis.     

Assessment of a point-of-care instrument for identification of primary hemostatic disorders in dogs

OBJECTIVE: To assess a point-of-care instrument for identification of primary hemostatic disorders in dogs. ANIMALS: 29 healthy dogs and 23 nonanemic dogs with primary hemostatic disorders (thrombocytopenia, n = 6; thrombopathia, 6; von Willebrand disease [vWD], 11). PROCEDURE: Citrated blood was obtained and closure times (CT) were determined by measuring the time required for occlusion of an aperture by a platelet plug within the point-of-care instrument. Reference ranges for CT were established, and CT were determined for dogs with primary hemostatic disorders. RESULTS: CT measured with adenosine diphosphate as the platelet agonist (ADP-CT) ranged from 52 to 86 seconds for healthy dogs (mean +/- 2 SD, 67 +/- 7.8 seconds; median, 65 seconds), and CT measured with epinephrine as the agonist (EPI-CT), from 97 to 225 seconds (151 +/- 38 seconds; 148 seconds). In thrombocytopenic dogs, ADP- and EPI-CT were prolonged (> 165 and > 264 seconds, respectively). Five of 6 dogs with thrombopathia had prolonged ADP-CT, whereas EPI-CT was prolonged in all 6 dogs. In all dogs with vWD, ADP-CT was prolonged; EPI-CT was prolonged in 10 of these dogs. Sensitivity and specificity for ADP-CT were 95.7 and 100%, respectively, and positive and negative predictive values, 100 and 96.7%, respectively, whereas for EPI-CT, these values were 95.7 and 82.8%, respectively, and 81.5 and 96%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: The point-of-care instrument allowed quick assessment of primary hemostasis in nonanemic dogs. Use of this instrument may be helpful for making decisions regarding management of dogs with primary hemostatic disorders.     

Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs

OBJECTIVE: To determine whether a diet used for dogs with renal failure (renal food [RF]) was superior to an adult maintenance food (MF) in minimizing uremic crises and mortality rate in dogs with spontaneous chronic renal failure. DESIGN: Double-masked, randomized, controlled clinical trial. ANIMALS: 38 dogs with spontaneous chronic renal failure. PROCEDURE: Dogs were randomly assigned to a group fed adult MF or a group fed RF and evaluated for up to 24 months. The 2 groups were of similar clinical, biochemical, and hematologic status. The effects of diets on uremic crises and mortality rate were compared. Changes in renal function were evaluated by use of serial evaluation of serum creatinine concentrations and reciprocal of serum creatinine concentrations. RESULTS: Compared with the MF, the RF had a beneficial effect regarding uremic crises and mortality rate in dogs with mild and moderate renal failure. Dogs fed the RF had a slower decline in renal function, compared with dogs fed the MF. CONCLUSIONS AND CLINICAL RELEVANCE: Dietary modifications are beneficial in minimizing extrarenal manifestations of uremia and mortality rate in dogs with mild and moderate spontaneous chronic renal failure. Results are consistent with the hypothesis that delay in development of uremic crises and associated mortality rate in dogs fed RF was associated, at least in part, with reduction in rate of progression of renal failure.     

Clinical evaluation of sodium sulfanilate clearance for the diagnosis of renal disease in dogs

Sodium sulfanilate (ss) clearance time was measured in 13 clinically normal dogs and in 24 dogs with suspected renal disease. The results were compared with those from more routine tests of renal function to assess whether measurement of ss clearance provided additional information about the degree of renal dysfunction. It was concluded that ss clearance is a more sensitive measure of renal dysfunction than is serum creatinine or blood urea nitrogen. Sodium sulfanilate half-life was increased before the complete loss of ability to concentrate urine; however, urine concentrating ability was impaired in some dogs with normal ss clearance. In dogs with glomerular disease, proteinuria developed before increased ss clearances. However, ss clearance was a more reliable method of monitoring the degree of renal dysfunction than was protein concentration in single urine samples.     

Development of a technique for serial bilateral renal biopsy in steers

A biopsy procedure was developed to provide serial kidney samples from standing steers. Ten clinically normal steers were given intramuscular injections of gentamicin sulfate, 4 mg/kg body weight. Renal biopsy was performed at 5 separate times. After feed was withheld for 24 h, laparoscopic surgery was performed in standing stocks. Acepromazine, xylazine, and butorphanol were used for sedation and analgesia, and 2% lidocaine was used for local anesthesia. Two incisions approximately 2 cm long were made in the paralumbar fossa to allow for trocar introduction. The abdomen was insufflated with CO2 and, with endoscopic guidance, a biopsy forceps used to remove a kidney sample 2 to 3 mm in diameter, by either a left or a right abdominal approach. Each operation was recorded on videotape, and images were also captured with a digital medical device system. Respiration, heart rate, temperature, appetite, attitude, and postural positions were evaluated at 12, 24, 48, and 72 h after surgery. The 51 laparoscopic procedures provided 48 renal samples (approximately 100 mg each). The 1st and 2nd samples were from the right kidney, and the 3rd sample was from either the left or the right kidney; the 4th and 5th samples were from the left kidney. Adhesions made an approach from the right side difficult for the 3rd sample. No clinical changes were observed in 9 steers after the procedure. One steer died after the 3rd procedure owing to hemorrhage.     

Ultrasound-guided percutaneous lung biopsy in sheep

Lung biopsies were taken through the ninth intercostal space on the two sides of the thorax of 10 clinically healthy sheep, using a Tru-Cut needle on one side and the Bard Biopty-System on the other. Nine of the 10 sheep remained clinically healthy, but one coughed transiently and had a mild bloody discharge from the right nostril immediately after the biopsy. The sheep were slaughtered 10 days later and the lungs and pleura were examined macroscopically; there were either no lesions or only small scars visible at the sites of the biopsies. However, well-developed subpleural nodules due to parasites were observed in some of the lungs. There were no adhesions between the costal and pulmonary pleurae. Of the 20 biopsy specimens, 18 were ideal for histological examination, and none of them was histologically normal. Mild interstitial pneumonia was diagnosed in 15 specimens, chronic bronchiolitis in nine specimens, and hyperplasia of smooth muscle or connective tissue in 17.     

The use of vacuum-assisted closure therapy for the treatment of distal extremity wounds in 15 dogs

Objective— To evaluate clinical outcome after vacuum-assisted closure (VAC) therapy in dogs with traumatic wounds located in the distal extremities and report our early experience with VAC.
Study Design— Retrospective study.
Animals— Dogs (n=15) with traumatic distal extremity wounds.
Methods— Medical records (1999–2003) of dogs with traumatic injuries to the distal extremities managed by VAC were evaluated. Data included signalment, location of wound, time until surgical intervention, wound reconstruction methods, orthopedic procedures, outcome, complications associated with VAC, and length of hospitalization.
Results— The mean number of days until reconstruction was 4.6 days (range, 2–7 days). Reconstructive surgery was successful in all cases. Mean hospitalization was 9.7 days (range, 6–16 days). Complications included dermatitis at the wound margin and loss of vacuum causing wound desiccation.
Conclusion— VAC therapy can be used to achieve adequate management of traumatic distal extremity wounds. VAC provides an effective method of securing skin grafts over the wound bed.
Clinical Relevance— VAC therapy can be used as an ancillary treatment for distal extremity wounds in dogs before surgical repair as well as a method for securing skin grafts to the wound bed.     

Technique for percutaneous pulmonary arterial catheterization in conscious dogs

A technique was developed to allow percutaneous placement and exchange of pulmonary arterial catheters in conscious dogs. Seven dogs were catheterized weekly for 5 weeks, using a 10-gauge over-the-needle cannula. A No. 7 F flow-directed catheter was passed through the cannula to measure right heart and pulmonary arterial pressures and to calculate cardiac output. The flow-directed catheter was removed and replaced with an arteriographic catheter, and a pulmonary arteriogram was performed. Placement in alternate jugular or saphenous veins each week resulted in successful catheterizations in all dogs evaluated.     

A percutaneous perineal approach for cystoscopy in male dogs

A percutaneous perineal approach is presented as a further technique for rigid cystoscopy in male dogs. The anatomy of the urethra in the male dog prevents rigid cystoscopy by non-surgical means but a fine flexible fibrescope may be used. Perineal urethrotomy and prepubic percutaneous puncture techniques using rigid endoscopes have been described; however, both have possible serious complications. This new procedure allows access for visual examination, biopsy and resection as necessary and appears to have few adverse sequelae.     

Clinical evaluation of urinary liver-type fatty acid-binding protein for the diagnosis of renal diseases in dogs

Liver-type fatty acid-binding protein (L-FABP) is a biomarker for the early detection of renal diseases in humans. L-FABP is a cytotoxic oxidation product secreted from the proximal tubules under ischemic and oxidative stress conditions. First, L-FABP gene expression in the kidney and liver was evaluated. Next, the urinary L-FABP concentrations in dogs with or without renal diseases were measured using a novel enzyme-linked immunosorbent assay kit. Urinary L-FABP was normalized relative to urinary creatinine (uCre) concentrations (µg/g uCre). Finally, the relationships between urinary L-FABP and renal biomarkers used in canine medicine or serum alanine transaminase (ALT) as an indicator of liver damage were examined. Serum and urine samples from 94 client-owned dogs including 23 dogs with renal diseases and 71 dogs without renal diseases were used for analysis. Relative L-FABP gene expression was confirmed both in the liver and kidney. Dogs with renal diseases had a significantly higher urinary L-FABP than those without, and its predictive cutoff value was 26 µg/g uCre. Urinary L-FABP was significantly correlated with serum creatinine (r=0.4674, P<0.01), urea nitrogen (r=0.4907, P<0.01), urine specific gravity (r=−0.5100, P<0.01), and urine protein/creatinine ratio (r=0.7216, P<0.01), but not with serum ALT. Hence, dogs with a high urinary L-FABP value were more likely to have renal diseases.