Effects of serial ultrasound-guided renal biopsies on kidneys of healthy adolescent dogs

Ten healthy mixed-breed dogs were used to evaluate the functional and structural effects of serial ultrasound-guided renal biopsies obtained with an automated biopsy needle. In each dog, one lateral renal cortex was biopsied at 2, 4, and 6 months of age; the other kidney was the control. Five dogs had two tissue cores and five dogs had four tissue cores taken on each biopsy occasion, and one core was examined microscopically. One week before each biopsy and a month after the final biopsy, the glomerular filtration rate (GFR) was determined by renal scintigraphy. Dogs were then euthanized for evaluation of gross and microscopic lesions attributable to the biopsies. There was no difference between GFR values for biopsied kidneys and those of control kidneys ( P >0.05). Microscopic lesions were not identified in biopsies taken at 2 and 4 months, but focal lesions were found in three of 10 specimens taken at 6 months of age. At necropsy, six of 10 biopsied kidneys had small visible capsular scars, and linear tracts <2 mm wide were observed on cut surfaces in six of 10 biopsied kidneys cut transversely into slices 5 mm thick. Discrete light microscopic lesions were observed in 25 of 452 (5.5%) of randomly selected 6-mm-diameter sections of renal cortex from biopsied kidneys. We conclude that serial renal cortical biopsies can be obtained by our method from healthy adolescent dogs with minimal risk of inducing changes that might be confused with those of a progressive renal disease.     

COMPARISON OF GLOMERULAR NUMBER AND SPECIMEN LENGTH OBTAINED FROM 100 DOGS VIA PERCUTANEOUS ECHO-ASSISTED RENAL BIOPSY USING TWO DIFFERENT NEEDLES

Our objective was to evaluate possible differences in the number of glomeruli and length of renal biopsies collected in canine subjects by two different types of biopsy needles: a semiautomatic 18-gauge Trucut and an automated 18-gauge Jamshidi modified (Biopince). One hundred biopsy samples obtained from dogs of different ages and gender affected by different nephropathies were evaluated retrospectively. All animals were biopsied using one of the two different needles. Biopsies were performed under ultrasound guidance and evaluated by a single pathologist. Statistical analysis was performed to evaluate possible differences in the number of glomeruli and length of renal biopsies collected comparisons were determined between subgroups of dogs with or without the identification of renal interstitial infiltrates and/or fibrosis. Neither the mean difference of the number of glomeruli nor the length of tissue sample collected with the different needles was significantly different. Likewise, the average biopsy length did not differ in dogs with or without renal interstitial infiltrate in animals biopsied with either biopsy needle. Both the Biopince and the Trucut devices provide diagnostically adequate biopsy renal specimens using ultrasound-guidance.     

Glomerular lesions in dogs infected with Leishmania organisms

OBJECTIVE: To histologically identify glomerular lesions in dogs infected with Leishmania organisms. ANIMALS: 41 dogs (17 sexually intact males and 14 sexually intact and 10 ovariohysterectomized females) that had positive results when tested for leishmaniosis as determined by use of serologic evaluation (indirect fluorescent antibody test, titers of 1:80 to 1:640) and direct microscopic identification of the protozoal organisms. PROCEDURE: Urine samples were collected by use of cystocentesis and examined by qualitative SDS-agarose gel electrophoresis (AGE). All dogs had non-selective (glomerular) or mixed (glomerular and tubular) proteinemia. Specimens were obtained from each dog during ultrasound-assisted renal biopsy and used for histologic examination. Each specimen was stained with H&E, periodic acid-Schiff, Goldner's trichrome, methenamine silver, and Congo Red stains. Specimens were adequate for evaluation when they contained at least 5 glomeruli/section, except for specimens stained with Congo Red in which 1 glomerulus/section was adequate. RESULTS: Examination of renal biopsy specimens revealed various glomerular lesions in all dogs and interstitial or tubular (or both) lesions in 23 of 41 (55%) dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Glomerular lesions that develop in dogs during infection with Leishmania organisms can be classified histologically as mesangial glomerulonephritis, membranous glomerulonephritis, membranoproliferative glomerulonephritis, and focal segmental glomerulonephritis. Tubulointerstitial histopathologic conditions were not observed as the primary lesion, despite being evident in 23 of 41 (55%) dogs. Use of SDS-AGE for qualitative evaluation of proteinuria and successive collection of specimens during renal biopsies following diagnosis of nonselective glomerular proteinuria provides the possibility for early identification of renal lesions.     

Renal biopsy in the normal cat: development of a modified disposable biopsy needle

A disposable biopsy needle was modified to reduce the length of the obturator tip and specimen notch. The modified needle was then used to take renal biopsy specimens at four sites from each kidney in four cats. Twenty-nine samples of renal tissue were obtained and the average numbers of glomeruli per specimen length compared favourably with similar studies using the standard needle.     

Diagnostic comparison of needle and wedge biopsy specimens of the liver in dogs and cats

OBJECTIVE: To compare morphologic diagnoses determined from needle biopsy specimens obtained from the livers of dogs and cats with morphologic diagnoses determined from wedge biopsy specimens. DESIGN: Prospective study. ANIMALS: 124 dogs and cats. PROCEDURE: 2 needle biopsy specimens were obtained from each animal; wedge biopsy specimens were obtained from the same liver lobe during laparotomy or postmortem examination. Histologic features were scored independently by 3 individuals; a morphologic diagnosis was rendered after histologic features were scored. Cases were included only if at least 2 of the 3 examiners agreed on the morphologic diagnosis; the definitive diagnosis was considered to be the morphologic diagnosis rendered for the wedge biopsy specimen. Physical characteristics (length, width, surface area, degree of fragmentation, and number of portal triads for needle biopsy specimens and surface area for wedge biopsy specimens) were determined. RESULTS: Definitive diagnoses included hepatic necrosis (n = 10), cholangitis-cholangiohepatitis (13), chronic hepatitis-cirrhosis (12), canine vacuolar hepatopathy (11), portosystemic vascular anomaly-microvascular dysplasia (17), neoplasia (10), miscellaneous hepatic disorders (18), and no hepatic disease (33). For individual examiners, the morphologic diagnosis assigned to needle biopsy specimens agreed with the morphologic diagnosis assigned to wedge biopsy specimens for 56 and 67% of the specimens. All 3 examiners agreed on the morphologic diagnosis assigned to needle and wedge biopsy specimens for 44 and 65% of the specimens, respectively. Morphologic diagnoses assigned to needle biopsy specimens concurred with the definitive diagnosis for 59 of 124 (48%) animals. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that needle biopsy specimens of the liver from dogs and cats must be interpreted with caution.     

Glomerular disease

Glomerular diseases are a leading cause of chronic kidney disease in dogs but seem to be less common in cats. Glomerular diseases are diverse, and a renal biopsy is needed to determine the specific glomerular disease that is present in any animal. Familial glomerulopathies occur in many breeds of dogs. However, most dogs with glomerular disease have acquired glomerular injury that is either immune-complex mediated or due to systemic factors, both of which are believed to be the result of a disease process elsewhere in the body (i.e., neoplastic, infectious, and noninfectious inflammatory disorders). A thorough clinical evaluation is indicated in all dogs suspected of having glomerular disease and should include an extensive evaluation for potential predisposing disorders. Nonspecific management of dogs with glomerular disease can be divided into 3 major categories: (1) treatment of potential predisposing disorders, (2) management of proteinuria, and (3) management of uremia and other complications of glomerular disease and chronic kidney disease. Specific management of specific glomerular diseases has not been fully studied in dogs. However, it may be reasonable to consider immunosuppressive therapy in dogs that have developed a form of glomerulonephritis secondary to a steroid-responsive disease (e.g., systemic lupus erythematosus) or have immune-mediated lesions that have been documented in renal biopsy specimens. Appropriate patient monitoring during therapy is important for maximizing patient care. The prognosis for dogs and cats with glomerular disease is variable and probably dependent on a combination of factors. The purpose of this article is to discuss the general diagnosis and management of dogs with glomerular disease.     

Pilot evaluation of a vacuum-assisted biopsy instrument for percutaneous renal biopsy in dogs

Kidney biopsies in dogs are commonly obtained using automated spring-loaded biopsy instruments. Interpretation of biopsies from dogs with glomerular disease requires examination of at least 5-10 glomeruli, with at least two biopsies usually required for full evaluation. The purpose of this study was to compare quality and interpretability of renal biopsies obtained from healthy dogs with a large-gauge, vacuum-assisted biopsy instrument versus two biopsies obtained with a spring-loaded biopsy needle. Twenty dogs were randomized into two groups, and percutaneous, ultrasound-guided renal biopsies were evaluated using standard criteria. There were no significant differences in the number of biopsies that contained renal tissue, cortex, or medulla. Biopsies obtained with either instrument contained an adequate number of glomeruli and an equivalent number of arterioles and severity of tissue compression. Differences included easier penetration of the renal capsule and collection of sufficient tissue for interpretation with only one instrument pass when using the vacuum-assisted device (vs two passes required with the spring-loaded instrument). Before use in client-owned dogs, future studies should evaluate whether these differences are clinically relevant advantages in the diagnostic evaluation of dogs with kidney disease, and determine the prevalence and severity of complications when using this larger gauge device.     

Glomerular lesions in renal biopsies of Saimiri boliviensis (primate) examined by light and electron microscopy and immunohistochemistry

In order to determine the existence of glomerular lesions in Saimiri boliviensis, renal biopsies were performed in 20 clinically healthy animals of similar age and both sexes. Biopsies were obtained by laparotomy with a Tru-Cut biopsy needle. Mesangioproliferative glomerulonephritis characterized by an increased number of mesangial cells and increased mesangial matrix was present in 35% of the animals. Proliferative glomerulonephritis characterized by increased numbers of epithelial and endothelial cells with narrowed capillary lumen, and membranous glomerulonephritis characterized by diffuse thickening, wrinkling, and occasional lamellation of basement membranes, were present in 15% of the samples. Ultrastructural features included increased mesangial matrix, fusion of the visceral epithelial foot processes, thickened glomerular basement membranes, and incipient lamellation. Immunohistochemical examination revealed granular deposits of immunoglobulin M in the cytoplasm of mesangial cells and in the mesangial matrix in 50% of the samples.     

Familial glomerulonephropathy in a litter of beagles

Membranoproliferative glomerulonephropathy was diagnosed in 5 of 7 adult Beagles from the same litter. Dogs were raised in more than 1 area of the United States. One died without evidence of renal disease when it was 3 years old. At 8 years of age, 2 dogs developed signs of uremia, including polyuria, polydipsia, and infrequent episodes of anorexia and vomiting. Serum biochemical variables and urine specific gravity values were consistent with renal azotemia. Both dogs had proteinuria. Although healthy, 3 of the 4 remaining Beagles had proteinuria. Of these 3, only 1 was azotemic. Membranoproliferative glomerulonephritis was diagnosed on the basis of results of histologic examination of renal biopsy specimens from 4 of the dogs. Electron microscopy performed on 3 of the renal biopsy specimens revealed identical lesions, consisting of an extremely thickened glomerular basement membrane with multilaminar splitting. Immunoglobulin or amyloid deposits were not detected. On the basis of similar clinicopathologic abnormalities, common genetic background, and identical histopathologic and electron microscopic findings, familial renal disease was diagnosed. Additional studies involving other related Beagles are needed to identify the hereditary nature of membranoproliferative glomerulonephropathy in Beagles.     

ULTRASOUND-GUIDED TISSUE-CORE BIOPSY OF LIVER, SPLEEN AND KIDNEY IN NORMAL DOGS

Six normal dogs were subjected to ultrasound-guided biopsy of the liver, spleen and kidney to examine the accuracy of the technique (i.e. the presence of targeted tissue) and the histologic quality of the biopsies. Five consecutive tissue-core biopsies of each organ were taken on one or more occasions. The accuracy of the technique was 77% for hepatic, 90% for splenic, 53.5% for left kidney and 40% for right kidney biopsies. The histologic quality of the liver and kidney samples was sufficient, although for some samples the diagnostic value was limited by their size and in renal samples either cortical or medullary tissue was sometimes lacking. In contrast, the quality of the splenic sections was not good. The effect of reused and resterilized needles on the quality of the specimens was evaluated by histologic inspection of the samples and by the amount of biopsies lacking tissue. All tissue samples, including those taken with reused or resterilized needles had sharp-cut edges. Twenty-two of the total number of 120 biopsies (18%) contained no tissue. Absence of tissue in the samples was observed in biopsies taken with all needle types. The animals were observed for possible complications of the repeated needle biopsy. Apart from one case of hematuria, no complications were encountered.     

Ultrasound-guided biopsy

Ultrasound-guided biopsy is a good and feasible technique in dogs. Although we have only used it for biopsy of liver and kidney, it can have further uses. In our use of ultrasound-guided biopsy of kidney and liver, we have found that we can achieve adequate biopsy samples using the Franklin modified Vim-Silverman and Tru Cut biopsy of kidney and liver. The fine-needle biopsies of the liver were adequate for examination of hepatocytes but inadequate to evaluate structure owing to small size of the sample. In contrast, the renal fine-needle samples were both poor in quality and quantity. This technique has the advantages of being noninvasive, quick, and easy, and it can be performed with the patient under local anesthesia. It has an advantage over blind percutaneous biopsy because the needle can be visualized in the organ and the organ scanned after biopsy for possible complications. Another advantage is that, unlike other radiographic biopsy procedures, ionizing radiation is not used for imaging.     

Ultrasound-guided biopsy

Ultrasound-guided biopsy is a good and feasible technique in dogs. Although we have only used it for biopsy of liver and kidney, it can have further uses. In our use of ultrasound-guided biopsy of kidney and liver, we have found that we can achieve adequate biopsy samples using the Franklin modified Vim-Silverman and Tru Cut biopsy of kidney and liver. The fine-needle biopsies of the liver were adequate for examination of hepatocytes but inadequate to evaluate structure owing to small size of the sample. In contrast, the renal fine-needle samples were both poor in quality and quantity. This technique has the advantages of being noninvasive, quick, and easy, and it can be performed with the patient under local anesthesia. It has an advantage over blind percutaneous biopsy because the needle can be visualized in the organ and the organ scanned after biopsy for possible complications. Another advantage is that, unlike other radiographic biopsy procedures, ionizing radiation is not used for imaging.     

Renal biopsy: methods and interpretation.

Renal biopsy most often is indicated in the management of dogs and cats with glomerular disease or acute renal failure. Renal biopsy can readily be performed in dogs and cats via either percutaneous or surgical methods. Care should be taken to ensure that proper technique is used. When proper technique is employed and patient factors are properly addressed, renal biopsy is a relatively safe procedure that minimally affects renal function. Patients should be monitored during the post biopsy period for severe hemorrhage, the most common complication. Accurate diagnosis of glomerular disease, and therefore, accurate treatment planning,requires that the biopsy specimens not only be evaluated by light microscopy using special stains but by electron and immunofluorescent microscopy.     

Renal biopsy in the normal cat: examination of the effects of repeated needle biopsy

Three healthy cats were subjected to percutaneous renal biopsy of the left kidney on three occasions at monthly intervals. Three other cats were subjected to three consecutive biopsy attempts on one occasion using the left kidney. Thereafter the six cats were monitored clinically and by means of laboratory analyses of blood and urine until euthanasia four weeks after the last biopsy. Cautious insertion of the biopsy needle in an attempt to avoid over penetration of the kidney resulted in failure to obtain renal tissue on six occasions but in all 12 specimens which did contain renal tissue, glomeruli were present. Major blood vessels were present in two biopsy specimens. At necropsy, radiographic and histological studies demonstrated renal parenchymal and vascular changes in the biopsied kidneys which were similar to but less severe than those produced by a single biopsy attempt. This confirmed that avoidance of damage to major renal vessels is important and suggested that, with care, repeated biopsies need be no more harmful to the kidney than a single biopsy.     

Serum fluoride concentrations,biochemical and histopathological changes associated with prolonged sevoflurane anaesthesia in horses

The volatile anaesthetic sevoflurane is degraded to fluoride (F-) and a vinyl ether (Compound A), which have the potential to harm kidney and liver. Whether renal and hepatic injuries can occur in horses is unknown. Cardiopulmonary, biochemical and histopathological changes were studied in six healthy thoroughbred horses undergoing 18 h of low-flow sevoflurane anaesthesia. Serum F- concentrations were measured and clinical laboratory tests performed to assess hepatic and renal function before and during anaesthesia. Necropsy specimens of kidney and liver were harvested for microscopic examination and compared to pre-experimental needle biopsies. Cardiopulmonary parameters were maintained at clinically acceptable levels throughout anaesthesia. Immediately after initiation of sevoflurane inhalation, serum F- levels began to rise, reaching an ongoing 38-45 micromol 1(-1) plateau at 8 h of anaesthesia. Serum biochemical analysis revealed only mild increases in glucose and creatinine kinase and a decrease in total calcium. Beyond 10 h of anaesthesia mild, time-related changes in urine included increased volume, glucosuria and enzymuria. Histological examination revealed mild microscopic changes in the kidney involving mainly the distal tubule, but no remarkable alterations in liver tissue. These results indicate that horses can be maintained in a systemically healthy state during unusually prolonged sevoflurane anaesthesia with minimal risk of hepatocellular damage from this anaesthetic. Furthermore, changes in renal function and morphology observed after sevoflurane inhalation are judged minimal and appear to be clinically irrelevant; they may be the result of anaesthetic duration, physiological stressors, sevoflurane (or its degradation products) or other unkown factors associated with these animals and study conditions.     

ULTRASOUND LOCALIZATION AND GUIDANCE FOR RENAL BIOPSY IN THE HORSE

Real-time ultrasonography was used to assist percutaneous renal biopsies in seven normal horses. Ultrasound (US) guidance and blind biopsy following US localization were compared. Ten biopsies (seven right kidney and three left kidney) were performed. A transverse approach to the lateral border of the right kidney through the 17th intercostal space was favored, with the needle angle being approximately perpendicular to the body wall. Both biopsy techniques were effective, but blind biopsy following US localization was favored as it was easily performed by one operator without the need for specialized biopsy equipment. The spleen had a variable location and its penetration with the biopsy needle was necessary to obtain two left kidney biopsies. Macroscopic and microscopic hematuria was observed postbiopsy in one and four horses, respectively, out of six horses examined. Perirenal hemorrhage was a prominent finding on necropsy in five of six horses euthanized.     

The new age of renal biomarkers: does SDMA solve all of our problems?

Within clinical small animal practice, diagnosis of both chronic kidney disease and acute kidney injury is common. To assess renal function, measurement of glomerular filtration rate is considered the gold standard. Currently, routine tests of kidney function include surrogate markers of glomerular filtration rate such as serum creatinine, and urea, each with their own limitations, whilst urine protein to creatinine ratio gives an indication of glomerular and tubular handling of protein, and urine specific gravity information about urine concentrating ability by the kidney. These parameters are used together with historical and physical examination data to give a diagnosis of kidney disease following which creatinine, proteinuria and blood pressure are used to stage chronic kidney disease and, together with urine output, grade acute kidney injury according to the International Renal Interest Society. However, there has been much concern that creatinine is insensitive when used to indicate early decline in renal function and this has highlighted the need for additional methods of diagnosing and monitoring these patients, with the potential to allow earlier therapeutic intervention. Symmetric dimethylarginine is a novel biomarker, which has been shown to perform as a surrogate marker of glomerular filtration rate in small animals. This article will review current research on symmetric dimethylarginine and the ways in which it may be utilised in small animal practice; current research supports the use of symmetric dimethylarginine as a screening test for detection of early chronic kidney disease according to International Renal Interest Society guidelines, but further research is required in to the usefulness of symmetric dimethylarginine as a tool for monitoring disease and the effect of non-renal influences.     

B-mode and Doppler ultrasound of chronic kidney disease in dogs and cats

Ultrasound is the imaging test of choice for renal evaluation, because it provides information about the position, size, shape, internal architecture and hemodynamics of the kidneys without harming the patient. In chronic kidney disease, the main findings observed in B-mode ultrasound images are increased cortical echogenicity, loss of corticomedullary differentiation, reduced renal volume and irregular renal contour, and when these changes are associated, they are indicative of end-stage renal disease. However, the cause of kidney disease cannot be determined by ultrasonography, but must be confirmed by means of biopsy, although the presence of ultrasonographic changes indicative of the end-stage of the disease may contraindicate this procedure. The Doppler ultrasound test complements the ultrasonic B-mode examination and enables the assessment of renal perfusion based on a calculation of the hemodynamic indices, which are increased in cases of chronic kidney lesions, with higher values ??in the most severe cases. Thus, ultrasound examinations are not only useful in diagnostics but also play an important role in defining the prognosis of patients with chronic kidney disease.     

Jamshidi needle biopsy for diagnosis of bone lesions in small animals

Sixty-two bone lesions in 59 small animals were biopsied using a Jamshidi-type biopsy needle. In all instances, the Jamshidi needle biopsy diagnosis was confirmed or disputed by results of histologic examination of specimens obtained by surgical resection or by amputation or at necropsy. In 57 of 62 bone lesions, biopsy resulted in an accurate diagnosis of tumor vs nontumor, yielding an accuracy rate of 91.9%. The specific tumor type or lesion type was identified accurately by Jamshidi needle biopsy in 51 of 62 lesions, yielding an accuracy of 82.3%. Of the 62 bone lesions, 48 were intramedullary osteosarcoma and 62.5% of these were subclassified correctly by Jamshidi needle biopsy results as osteoblastic, chondroblastic, fibroblastic, osteoclastic, or poorly differentiated osteosarcoma. Jamshidi needle biopsy was easy, quick, and safe, and its high accuracy rate of diagnosis indicated that it should be a valuable aid for diagnosis of bone lesions in small animals.     

ULTRASOUND-GUIDED BIOPSY OF THE CANINE LIVER, KIDNEY, AND PROSTATE

Sixty-nine hepatic, 25 renal, and 16 prostatic biopsies were performed under ultrasound guidance using a biopsy guide. The majority (98 of 110) were tissue-core biopsies. Multiple attempts at obtaining a sample were required; however, in the kidney, the number of attempts was restricted to two. Adequate samples were obtained in 94% (65/69) hepatic, 88% (22/25) renal, and 94% (5/6) prostatic biopsies. Postbiopsy scanning did not demonstrate parenchymal hemorrhage. In three renal and one prostatic biopsy, gross hematuria, noted immediately following biopsy, resolved in 2–3 days. Animals with prostatic disease frequently had hematuria, making evaluation for this complication difficult. One animal died acutely 2 days following prostatic biopsy due to an unrelated problem, a ruptured aortic àneurysm. Complications were not encountered with the liver biopsy procedure. Animals biopsied under sedation tolerated the procedure well. The authors preferred to anesthetize uncooperative animals and those needing kidney biopsy to minimize the likelihood of complications. Problems encountered during the procedure, overlying bowel gas obscuring the target organ or poor visualization of the biopsy needle, were corrected by changing patient or transducer position or the procedure was postponed. The usefulness of the biopsy procedure is illustrated in four case reports.