Shelly Vaden - Academia.edu (original) (raw)

Papers by Shelly Vaden

Research paper thumbnail of Comparison of urine dipstick, sulfosalicylic acid, urine protein-to-creatinine ratio, and species-specific ELISA methods for detection of albumin in urine samples of cats and dogs

Javma-journal of The American Veterinary Medical Association, Apr 15, 2010

SMALL ANIMALS P ersistent proteinuria with an inactive urine sediment is an established marker of... more SMALL ANIMALS P ersistent proteinuria with an inactive urine sediment is an established marker of CKD. 1 Evidence also suggests an association between renal proteinuria and progression of CKD in dogs and cats; the greater the magnitude of proteinuria, the greater the risk for progression of renal disease and possible death. 2-5 Importantly, treatments that attenuated proteinuria in dogs and cats with CKD also have been associated with slowed progression of CKD, improved survival, or both. 4-8 For these reasons, screening for renal proteinuria and longitudinal assessment of renal proteinuria have received renewed interest. Proteinuria is a general term that describes any type of protein, such as albumin, globulins, Bence-Jones proteins, and others, in the urine. Proteinuria of renal origin results from 2 major mechanisms. The first is a loss of selective filtration that results in an increased Comparison of urine dipstick, sulfosalicylic acid, urine protein-to-creatinine ratio, and species-specific ELISA methods for detection of albumin in urine samples of cats and dogs

Research paper thumbnail of Recommendations for the treatment of glomerular disease without established pathology

Research paper thumbnail of Prevalence of aldosterone breakthrough in dogs receiving renin‐angiotensin system inhibitors for proteinuric chronic kidney disease

Journal of Veterinary Internal Medicine, Nov 1, 2022

BackgroundThe influence of aldosterone breakthrough (ABT) on proteinuria reduction during renin‐a... more BackgroundThe influence of aldosterone breakthrough (ABT) on proteinuria reduction during renin‐angiotensin system (RAS) inhibition for spontaneous proteinuric chronic kidney disease (CKDP) has not been determined in dogs.ObjectivesDetermine whether ABT occurs in dogs with CKDP and if it is associated with decreased efficacy in proteinuria reduction during RAS inhibitor treatment.AnimalsFifty‐six client‐owned dogs with CKDP and 31 healthy client‐owned dogs.MethodsProspective, multicenter, open‐label clinical trial. Dogs were treated with an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker alone or in combination at the attending clinician's discretion and evaluated at 5 time points over 6 months. Healthy dogs were used to determine the urine aldosterone‐to‐creatinine ratio cutoff that defined ABT. The relationship of ABT (present at ≥50% of visits) and proteinuria outcome (≥50% reduction in urine protein‐to‐creatinine ratio from baseline at ≥50% of subsequent visits) was evaluated. Mixed effects logistic regression was used to evaluate the relationship between clinical variables and outcomes (either successful proteinuria reduction or ABT).ResultsThirty‐six percent (20/56) of dogs had successful proteinuria reduction. Between 34% and 59% of dogs had ABT, depending on the definition used. Aldosterone breakthrough was not associated with proteinuria outcome. Longer duration in the study was associated with greater likelihood of successful proteinuria reduction (P = .002; odds ratio, 1.6; 95% confidence interval [CI], 1.2‐2.2).Conclusions and Clinical ImportanceAldosterone breakthrough was common in dogs receiving RAS inhibitors for CKDp but was not associated with proteinuria outcome.

Research paper thumbnail of Glomerular Disease

Clinical Small Animal Internal Medicine, Apr 30, 2020

Research paper thumbnail of Management of transitional cell carcinoma of the urinary bladder in dogs: Important challenges to consider

Veterinary Journal, Aug 1, 2015

(D.W. Knapp) Highlights  Transitional cell carcinoma (TCC) affects thousands of dogs yearly worl... more (D.W. Knapp) Highlights  Transitional cell carcinoma (TCC) affects thousands of dogs yearly worldwide.  Although not typically curable, TCC is highly treatable with good quality of life.  New treatment strategies are emerging to improve the outlook for dogs with TCC. Canine invasive TCC provides a model to translate study success from dogs to humans.

Research paper thumbnail of Cardiovascular–renal disorders

There is a complex interaction between the renal and cardiovascular systems, both in health and i... more There is a complex interaction between the renal and cardiovascular systems, both in health and in disease states. In disease states, this complex interaction can present both diagnostic and therapeutic challenges. This chapter discusses definitions, classification, epidemiology and pathophysiology; clinical staging and evaluation; biomarkers, imaging and blood pressure measurement; and management of CvRD.

Research paper thumbnail of Clinical nephrology and urology

Veterinary Clinics of North America-small Animal Practice, Jul 1, 2004

Research paper thumbnail of Management of bilateral idiopathic renal hematuria in a dog with silver nitrate

PubMed, Aug 1, 2013

Renal hematuria has limited treatment options. This report describes management of bilateral idio... more Renal hematuria has limited treatment options. This report describes management of bilateral idiopathic renal hematuria in a dog with surgically assisted installation of 0.5% silver nitrate solution. Initial treatment resulted in freedom from clinical signs or recurrent anemia for 10 months; however, recurrence of bleeding following a nephrectomy resulted in euthanasia.

Research paper thumbnail of Proteinuria in dogs with gallbladder mucocele formation: A retrospective case control study

Journal of Veterinary Internal Medicine, Feb 6, 2021

BackgroundProteinuria is an independent risk factor for morbidity and mortality in dogs. An assoc... more BackgroundProteinuria is an independent risk factor for morbidity and mortality in dogs. An association between proteinuria and gallbladder mucocele formation in dogs is unknown.ObjectiveDetermine if gallbladder mucocele formation or clinicopathologic comorbidities are associated with proteinuria.AnimalsTwenty‐five dogs with mucocele formation and 25 breed and age‐matched control dogs from a prior study.MethodsRetrospective case control study. Proteinuria defined by calculated urine dipstick protein concentration (mg/mL) to urine specific gravity (USG) ratio. Clinicopathologic findings, postcosyntropin cortisol concentration, thyroid function profile, and illness severity score were recorded.ResultsMedian urine dipstick protein concentration to USG ratio and number of dogs having a ratio ≥1.5 were significantly higher for dogs with mucocele formation compared to control dogs. Proteinuria was not significantly associated with CBC or serum biochemistry profile abnormalities but increased in relation to severity of illness.Conclusions and Clinical ImportanceGallbladder mucocele formation is significantly associated with proteinuria in dogs. Diagnosis and treatment of proteinuria in dogs with mucocele formation might minimize long term kidney morbidity in these patients.

Research paper thumbnail of In vitro prediction of canine urolith mineral composition using computed tomographic mean beam attenuation measurements

Veterinary Radiology & Ultrasound, May 1, 2004

Determination of urolith mineral composition is critical for management of urolithiasis in dogs a... more Determination of urolith mineral composition is critical for management of urolithiasis in dogs and cats. Using computed tomography, urolith physical density, and hence chemical composition, can be quantified using mean beam attenuation measurements (Hounsfield units; HU). This study was designed to establish in vitro reference ranges for three types of compositionally pure uroliths retrieved from dogs. Sixty-six canine uroliths (22 uric acid, 21 calcium oxalate, 14 struvite, nine mixed or compound) were placed in a phantom array. Uroliths were scanned at 120 kVp, 200 mA, and 80 kVp, 200 mA. The region of interest (ROI) for mean HU calculation was determined using two techniques, and reference ranges were calculated for each kVp using either ROI technique. HU for urolith types of pure composition were statistically different (Wilcoxon's two-sample test, Po0.0083 [Bonferonni correction with six comparisons for total Po0.05]) using both ROI techniques at either kVp. Struvite uroliths were not statistically different from mixed or compound uroliths. The accuracy for determination of composition of pure uroliths ranged from 86% to 93%; the prediction accuracy for each urolith mineral type and for all uroliths in general was highest when the ROI was hand-drawn just within the visible urolith border at 80 kVp. Technique of ROI determination and kVp that yielded the highest sensitivity, specificity, and positive and negative predictive values varied for each urolith type. Therefore, in this study, HU could be used to differentiate three types of uroliths of pure mineral composition in vitro. Further studies are needed to determine the predictive value of HU in vivo.

Research paper thumbnail of Cobalamin deficiency associated with methylmalonic acidemia in a cat

PubMed, Apr 15, 1992

A 9-month-old sexually intact male longhair cat was examined because of lethargy, anorexia, cold ... more A 9-month-old sexually intact male longhair cat was examined because of lethargy, anorexia, cold intolerance, and failure to thrive since acquisition at an early age. Clinical signs of disease were less pronounced when the cat was fed a low-protein diet. Anemia, hypoglycemia, low total CO2 content, and hyperammonemia were detected. The cat was euthanatized. Urine obtained immediately before euthanasia contained a large amount of methylmalonic acid. Total serum cobalamin concentration was low. Hepatic methylmalonic-CoA mutase activity, with and without the addition of coenzyme adenosylcobalamin, was consistent with a cobalamin deficiency. Methylmalonic acidemia secondary to a putative defect in cobalamin absorption was diagnosed.

Research paper thumbnail of Role of electrolyte concentrations and renin‐angiotensin‐aldosterone activation in the staging of canine heart disease

Journal of Veterinary Internal Medicine, Nov 26, 2019

Background: Refractory congestive heart failure (CHF) and associated diuretic resistance are not ... more Background: Refractory congestive heart failure (CHF) and associated diuretic resistance are not well defined. Objectives: To characterize renal function, electrolyte concentrations, indices of diuretic efficacy, and renin-angiotensin-aldosterone system (RAAS) activation in dogs with naturally occurring heart disease (HD) in American College of Veterinary Internal Medicine stages B1, B2, C, and D and to determine their usefulness in defining HD stages. Animals: Group 1:149 dogs with HD stages B1, B2, C, and D. Group 2:22 dogs with HD stages C and D. Methods: Group 1: Renal parameters, serum and urine electrolyte and diuretic concentrations, and urine aldosterone concentrations were measured. Medication dosages and measured variables were compared among stages. Correlation of furosemide dosages to serum concentrations was explored. Group 2: Angiotensin-converting enzyme activity and RAAS components were measured and compared among CHF stages. Results: Serum chloride concentration was the best differentiator of HD stage. Furosemide PO dosages (≤6 mg/kg/day) were weakly correlated with serum furosemide concentrations, whereas higher dosages were not significantly correlated. Angiotensin-converting enzyme inhibitor dosage and RAAS inhibition were greater in stage D, compared to stage C dogs. Conclusions and Clinical Importance: Hypochloremia is a useful marker for stage D HD in dogs. Poor furosemide dosage correlation to serum concentration may indicate variable and poor absorption, especially at higher dosages, advanced disease, or both. A small number of stage D dogs met proposed criteria for diuretic resistance. Greater RAAS inhibition in stage D versus stage C indicates effectiveness of RAASsuppressive treatments in this group of dogs with refractory CHF.

Research paper thumbnail of Renal biopsy: methods and interpretation

Veterinary Clinics of North America-small Animal Practice, Jul 1, 2004

Renal diseases are common in dogs and cats. Historical information, physical examination, and cli... more Renal diseases are common in dogs and cats. Historical information, physical examination, and clinical laboratory data often allow for the differentiation of renal diseases into the general categories of acute renal failure, chronic renal failure, and glomerular disease. Renal biopsy is often required to establish a definitive diagnosis and determine the severity of the lesion. A precise and accurate histologic diagnosis may also be needed to formulate an optimal treatment plan. Accurate assessment of response to therapy requires knowledge of the type and severity of the disease being treated [1-4]. There is often reluctance on the part of the practitioner to pursue renal biopsy in the clinical evaluation of patients. Many concerns probably contribute to this reluctance, including the potential complications of renal biopsy, the expenses associated with procurement of the renal biopsy specimen and adequate evaluation of the renal biopsy specimen, and the belief that the rendered diagnoses may lack consistency. Studies have shown that the frequency of severe complications from renal biopsy is relatively low and that renal biopsy minimally affects renal function when proper technique is employed [1,2,5-11]. The expense of the renal biopsy procedure can be minimized by correct patient selection and the use of proper technique. Consistent and accurate diagnoses are more likely to be obtained when renal biopsy specimens are appropriately processed and evaluated. The purpose of this article is to discuss patient selection and evaluation, renal biopsy techniques, expected complications of renal biopsy, and appropriate processing and evaluation of the renal biopsy specimen. Patient selection Renal biopsy is indicated only when the results are likely to alter patient management by providing an accurate histologic diagnosis or by facilitating prognostication.

Research paper thumbnail of Fluconazole in cats: Pharmacokinetics following intravenous and oral administration and penetration into cerebrospinal fluid, aqueous humour and pulmonary epithelial lining fluid

Journal of Veterinary Pharmacology and Therapeutics, Jun 1, 1997

in cats: Pharmacokinetics following intravenous and oral administration and penetration into cere... more in cats: Pharmacokinetics following intravenous and oral administration and penetration into cerebrospinal fluid, aqueous humoclr and pulmonary epithelial lining fluid. 1. vet. Pharmacol. Therap. 20, 181-186. The pharmacokinetics of fluconazole following intravenous (i.v.) and oral (p.0.) administration and the penetration of fluconazole into cerebrospinal fluid, aqueous humour and epithelial lining fluid (ELF) of the lungs were evaluated in adult male cats. Pharmacokinetic parameters were calculated from serum concentration-time data obtained following i.v. and p.0. administration of 50 mg per cat using a cross-over study design. Fluconazole concentrations were measured using a high-performance liquid chromatography assay. Mean total body clearance of fluconazole was 3 7.7 mL/h.kg, mean volume of distribution at steady state was 1.14 L/kg, mean residence time was 31.0 h and mean halflife of elimination was 25 h as derived by non-compartmental analysis of data. Absorption was complete. Mean ratios of fluidxerum fluconazole concentrations following administration of 50 mg fluconazole per day for 8 days were as follows: cerebrospinal fluid, 0.88; aqueous humour 0.79; ELF, 1.20. Fluconazole concentrations in cerebrospinal fluid, aqueous humour and ELF exceeded reported minimum inhibitory concentrations of fluconazole for pathogenic fungi. Results of this study suggest fluconazole can effectively be administered to cats at 50 mg per cat per day.

Research paper thumbnail of Comparative pharmacokinetics of doxycycline in cats and dogs

Journal of Veterinary Pharmacology and Therapeutics, Dec 1, 1990

The disposition of doxycycline hyclate was studied in six adult mixed-breed female cats and six a... more The disposition of doxycycline hyclate was studied in six adult mixed-breed female cats and six adult mid-sized female dogs following a single intravenous administration of 5 mg/kg body weight. Doxycycline volume of the central compartment, area volume of distribution, volume of distribution at steady state, and total body clearance were significantly smaller in cats. The differences were attributed to more extensive binding of doxycycline to plasma protein including albumin in cats. ,The significant differences in the volume of distribution and total body clearance were not reflected in elimination half-lives under the conditions of this study (sample size, inhomogeneous population). Doxycycline elimination half-life was 4.56 5 0.68 (SEM) h for cats and 6.99 k 1.09 h for dogs. Dosage regimens recommended in the veterinary literature were evaluated by the computer program PETDR.

Research paper thumbnail of Consensus Recommendations for Standard Therapy of Glomerular Disease in Dogs

Journal of Veterinary Internal Medicine, Nov 1, 2013

Standard therapy forms the basic foundation for care of dogs with glomerular disease, as it is he... more Standard therapy forms the basic foundation for care of dogs with glomerular disease, as it is herein recommended for use in all affected animals regardless of causation of the disease. Consensus recommendations target the evaluation and management of proteinuria, inhibition of the renin-angiotensin-aldosterone system, modification in dietary intake with special consideration for those nutrients with renal effects, diagnosis and treatment of systemic hypertension, and evaluation and management of body fluid volume status in dogs with glomerular disease.

Research paper thumbnail of Effects of Enalapril versus Placebo as a Treatment for Canine Idiopathic Glomerulonephritis

Journal of Veterinary Internal Medicine, Sep 1, 2000

A blinded, multicenter, prospective clinical trial assessed the effects of enalapril (EN) versus ... more A blinded, multicenter, prospective clinical trial assessed the effects of enalapril (EN) versus standard care in dogs with naturally occurring, idiopathic glomerulonephritis (GN). Twenty-nine adult dogs with membranous (n ϭ 16) and membranoproliferative (n ϭ 13) GN were studied. Dogs were randomly assigned to receive either EN (0.5 mg/kg PO q12-24h; n ϭ 16) or placebo (n ϭ 14) for 6 months (1 dog was treated first with the placebo and then with EN). All dogs were treated with low-dose aspirin (0.5-5 mg/kg PO q12-24h) and fed a commercial diet. At baseline, serum creatinine (SrCr), systolic blood pressure (SBP), and glomerular histologic grade were not different between groups, but the urine protein/creatinine ratio (UP/C) was greater in the EN group compared with the placebo group (8.7 Ϯ 4.4 versus 4.7 Ϯ 2.3). After 6 months of treatment, the change in UP/C from baseline was significantly different between groups (EN ϭ Ϫ4.2 Ϯ 1.4 versus 1.9 Ϯ 0.9 in the placebo group). When data were adjusted for changes in SrCr (SrCr ϫ UP/C) a similar significant reduction was noted (Ϫ2.2 Ϯ 15.2 versus 8.4 Ϯ 10.1). The change in SBP after 6 months of treatment also was significantly different between groups (EN ϭ Ϫ12.8 Ϯ 27.3 versus 5.9 Ϯ 21.5 mm Hg in the placebo group). Response to treatment was categorized as improvement (assigned a value of 2), no progression (assigned a value of 1), and progression (assigned a value of 0). Response was significantly better in the EN group (1.4 Ϯ 0.8) compared with the placebo group (0.3 Ϯ 0.5). These results suggest that EN treatment is beneficial in dogs with naturally occurring idiopathic GN.

Research paper thumbnail of Shear wave elastography evaluation of cats with chronic kidney disease

Veterinary Radiology & Ultrasound, Nov 2, 2022

Chronic kidney disease (CKD) is a major health condition in cats that can lead to poor quality of... more Chronic kidney disease (CKD) is a major health condition in cats that can lead to poor quality of life and financial implications for therapy. Currently staging and identification of CKD is limited by diagnostic testing such as creatinine and urine‐specific gravity, which do not change until late in the disease course. Other methods to evaluate CKD would be valuable in the clinical setting. Shear wave elastography is one novel ultrasound method, which has shown promise in identifying increases in tissue stiffness and identifying CKD in people. As CKD is often histologically characterized by tubulointerstitial fibrosis, shear wave elastography has the potential to identify CKD and differentiate between stages of CKD in cats. This prospective observational case‐control study with 78 cats found no difference in shear wave velocities between groups (P = 0.33), a contradictory finding to one prior publication. There was no effect of weight (P = 0.65), nor the presence of mineralization (P = 0.31) or infarction (P = 0.52) on cortical shear wave velocities. There was a significant effect of age on shear wave velocity (P = 0.018) where velocities increased with age. The intraclass correlation coefficient was only moderate (0.62). Possible reasons for the difference in results between our work and that published prior, include differences in methodology and differences in instrumentation. Variability in measurements in our population may be due to the effects of respiratory motion or limitations in shear wave elastography software. As such, shear wave elastography is not currently recommended as a tool to evaluate CKD in cats and further work is necessary.

Research paper thumbnail of Evaluation of perinuclear anti-neutrophilic cytoplasmic autoantibodies as an early marker of protein-losing enteropathy and protein-losing nephropathy in Soft Coated Wheaten Terriers

Javma-journal of The American Veterinary Medical Association, Oct 1, 2008

P rotein-losing enteropathy and PLN are chronic and often fatal diseases in SCWTs. Diagnosis typi... more P rotein-losing enteropathy and PLN are chronic and often fatal diseases in SCWTs. Diagnosis typically is made when dogs are at a mean age of 4 to 6 years old. 1 In the United States, the prevalence is estimated to be as high as 10% and median survival time reportedly Evaluation of perinuclear anti-neutrophilic cytoplasmic autoantibodies as an early marker of protein-losing enteropathy and protein-losing nephropathy in Soft Coated Wheaten Terriers

Research paper thumbnail of Pharmacokinetics, inhibition of lymphoblast transformation, and toxicity of cyclosporine in clinically normal pigs

PubMed, Mar 1, 1990

Pharmacokinetic variables were calculated from time-concentration data obtained after IV (10 mg/k... more Pharmacokinetic variables were calculated from time-concentration data obtained after IV (10 mg/kg of body weight; n =9) and oral (12.5 mg/kg to group A [n = 3]; 25 mg/kg to group B [n = 3]; and 50 mg/kg to group C [n = 3] pigs) cyclosporine (formerly, cyclosporine A) administration. Resulting mean (+/- SD) pharmacokinetic variables were as follows: half life of distribution, 0.96 (+/- 0.7) hours; half life of elimination, 7.71 (+/- 2.6) hours; volume of distribution at steady state, 4.47 (+/- 2.22) L/kg; volume of the central compartment, 1.71 (+/- 0.78) L/kg; and systemic clearance, 8.95 (+/- 2.7) ml/kg/min. Oral bioavailability was: overall 57 (+/- 19) %; group A, 44 (+/- 11) %; group B, 78 (+/- 15) %; group C, 48 (+/- 6) %. Time to peak concentration was 3.55 (+/- 0.88) hours. During the 22 days of daily oral cyclosporine administration, blood 24-hour trough concentrations were: group A, 224.3 (+/- 78.4) ng/ml; group B, 640.7 (+/- 174.6) ng/ml; and group C, 2,344 (+/- 1,095) ng/ml. Lymphoblast transformation stimulation index was suppressed in all pigs except 1, which had a corresponding cyclosporine concentration of 92.4 ng/ml. Minimal, although statistically significant, decreases in serum albumin and magnesium concentrations and increases in serum creatinine and urea nitrogen concentrations were evident in pigs of some treatment groups. Histologic examination of necropsy specimens revealed mild hepatic necrosis (n = 1 pig), renal tubular dilatation (n = 5), and pulmonary inflammation (n = 2). Pigs given 25 and 50 mg of cyclosporine/kg failed to gain weight.

Research paper thumbnail of Comparison of urine dipstick, sulfosalicylic acid, urine protein-to-creatinine ratio, and species-specific ELISA methods for detection of albumin in urine samples of cats and dogs

Javma-journal of The American Veterinary Medical Association, Apr 15, 2010

SMALL ANIMALS P ersistent proteinuria with an inactive urine sediment is an established marker of... more SMALL ANIMALS P ersistent proteinuria with an inactive urine sediment is an established marker of CKD. 1 Evidence also suggests an association between renal proteinuria and progression of CKD in dogs and cats; the greater the magnitude of proteinuria, the greater the risk for progression of renal disease and possible death. 2-5 Importantly, treatments that attenuated proteinuria in dogs and cats with CKD also have been associated with slowed progression of CKD, improved survival, or both. 4-8 For these reasons, screening for renal proteinuria and longitudinal assessment of renal proteinuria have received renewed interest. Proteinuria is a general term that describes any type of protein, such as albumin, globulins, Bence-Jones proteins, and others, in the urine. Proteinuria of renal origin results from 2 major mechanisms. The first is a loss of selective filtration that results in an increased Comparison of urine dipstick, sulfosalicylic acid, urine protein-to-creatinine ratio, and species-specific ELISA methods for detection of albumin in urine samples of cats and dogs

Research paper thumbnail of Recommendations for the treatment of glomerular disease without established pathology

Research paper thumbnail of Prevalence of aldosterone breakthrough in dogs receiving renin‐angiotensin system inhibitors for proteinuric chronic kidney disease

Journal of Veterinary Internal Medicine, Nov 1, 2022

BackgroundThe influence of aldosterone breakthrough (ABT) on proteinuria reduction during renin‐a... more BackgroundThe influence of aldosterone breakthrough (ABT) on proteinuria reduction during renin‐angiotensin system (RAS) inhibition for spontaneous proteinuric chronic kidney disease (CKDP) has not been determined in dogs.ObjectivesDetermine whether ABT occurs in dogs with CKDP and if it is associated with decreased efficacy in proteinuria reduction during RAS inhibitor treatment.AnimalsFifty‐six client‐owned dogs with CKDP and 31 healthy client‐owned dogs.MethodsProspective, multicenter, open‐label clinical trial. Dogs were treated with an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker alone or in combination at the attending clinician's discretion and evaluated at 5 time points over 6 months. Healthy dogs were used to determine the urine aldosterone‐to‐creatinine ratio cutoff that defined ABT. The relationship of ABT (present at ≥50% of visits) and proteinuria outcome (≥50% reduction in urine protein‐to‐creatinine ratio from baseline at ≥50% of subsequent visits) was evaluated. Mixed effects logistic regression was used to evaluate the relationship between clinical variables and outcomes (either successful proteinuria reduction or ABT).ResultsThirty‐six percent (20/56) of dogs had successful proteinuria reduction. Between 34% and 59% of dogs had ABT, depending on the definition used. Aldosterone breakthrough was not associated with proteinuria outcome. Longer duration in the study was associated with greater likelihood of successful proteinuria reduction (P = .002; odds ratio, 1.6; 95% confidence interval [CI], 1.2‐2.2).Conclusions and Clinical ImportanceAldosterone breakthrough was common in dogs receiving RAS inhibitors for CKDp but was not associated with proteinuria outcome.

Research paper thumbnail of Glomerular Disease

Clinical Small Animal Internal Medicine, Apr 30, 2020

Research paper thumbnail of Management of transitional cell carcinoma of the urinary bladder in dogs: Important challenges to consider

Veterinary Journal, Aug 1, 2015

(D.W. Knapp) Highlights  Transitional cell carcinoma (TCC) affects thousands of dogs yearly worl... more (D.W. Knapp) Highlights  Transitional cell carcinoma (TCC) affects thousands of dogs yearly worldwide.  Although not typically curable, TCC is highly treatable with good quality of life.  New treatment strategies are emerging to improve the outlook for dogs with TCC. Canine invasive TCC provides a model to translate study success from dogs to humans.

Research paper thumbnail of Cardiovascular–renal disorders

There is a complex interaction between the renal and cardiovascular systems, both in health and i... more There is a complex interaction between the renal and cardiovascular systems, both in health and in disease states. In disease states, this complex interaction can present both diagnostic and therapeutic challenges. This chapter discusses definitions, classification, epidemiology and pathophysiology; clinical staging and evaluation; biomarkers, imaging and blood pressure measurement; and management of CvRD.

Research paper thumbnail of Clinical nephrology and urology

Veterinary Clinics of North America-small Animal Practice, Jul 1, 2004

Research paper thumbnail of Management of bilateral idiopathic renal hematuria in a dog with silver nitrate

PubMed, Aug 1, 2013

Renal hematuria has limited treatment options. This report describes management of bilateral idio... more Renal hematuria has limited treatment options. This report describes management of bilateral idiopathic renal hematuria in a dog with surgically assisted installation of 0.5% silver nitrate solution. Initial treatment resulted in freedom from clinical signs or recurrent anemia for 10 months; however, recurrence of bleeding following a nephrectomy resulted in euthanasia.

Research paper thumbnail of Proteinuria in dogs with gallbladder mucocele formation: A retrospective case control study

Journal of Veterinary Internal Medicine, Feb 6, 2021

BackgroundProteinuria is an independent risk factor for morbidity and mortality in dogs. An assoc... more BackgroundProteinuria is an independent risk factor for morbidity and mortality in dogs. An association between proteinuria and gallbladder mucocele formation in dogs is unknown.ObjectiveDetermine if gallbladder mucocele formation or clinicopathologic comorbidities are associated with proteinuria.AnimalsTwenty‐five dogs with mucocele formation and 25 breed and age‐matched control dogs from a prior study.MethodsRetrospective case control study. Proteinuria defined by calculated urine dipstick protein concentration (mg/mL) to urine specific gravity (USG) ratio. Clinicopathologic findings, postcosyntropin cortisol concentration, thyroid function profile, and illness severity score were recorded.ResultsMedian urine dipstick protein concentration to USG ratio and number of dogs having a ratio ≥1.5 were significantly higher for dogs with mucocele formation compared to control dogs. Proteinuria was not significantly associated with CBC or serum biochemistry profile abnormalities but increased in relation to severity of illness.Conclusions and Clinical ImportanceGallbladder mucocele formation is significantly associated with proteinuria in dogs. Diagnosis and treatment of proteinuria in dogs with mucocele formation might minimize long term kidney morbidity in these patients.

Research paper thumbnail of In vitro prediction of canine urolith mineral composition using computed tomographic mean beam attenuation measurements

Veterinary Radiology & Ultrasound, May 1, 2004

Determination of urolith mineral composition is critical for management of urolithiasis in dogs a... more Determination of urolith mineral composition is critical for management of urolithiasis in dogs and cats. Using computed tomography, urolith physical density, and hence chemical composition, can be quantified using mean beam attenuation measurements (Hounsfield units; HU). This study was designed to establish in vitro reference ranges for three types of compositionally pure uroliths retrieved from dogs. Sixty-six canine uroliths (22 uric acid, 21 calcium oxalate, 14 struvite, nine mixed or compound) were placed in a phantom array. Uroliths were scanned at 120 kVp, 200 mA, and 80 kVp, 200 mA. The region of interest (ROI) for mean HU calculation was determined using two techniques, and reference ranges were calculated for each kVp using either ROI technique. HU for urolith types of pure composition were statistically different (Wilcoxon's two-sample test, Po0.0083 [Bonferonni correction with six comparisons for total Po0.05]) using both ROI techniques at either kVp. Struvite uroliths were not statistically different from mixed or compound uroliths. The accuracy for determination of composition of pure uroliths ranged from 86% to 93%; the prediction accuracy for each urolith mineral type and for all uroliths in general was highest when the ROI was hand-drawn just within the visible urolith border at 80 kVp. Technique of ROI determination and kVp that yielded the highest sensitivity, specificity, and positive and negative predictive values varied for each urolith type. Therefore, in this study, HU could be used to differentiate three types of uroliths of pure mineral composition in vitro. Further studies are needed to determine the predictive value of HU in vivo.

Research paper thumbnail of Cobalamin deficiency associated with methylmalonic acidemia in a cat

PubMed, Apr 15, 1992

A 9-month-old sexually intact male longhair cat was examined because of lethargy, anorexia, cold ... more A 9-month-old sexually intact male longhair cat was examined because of lethargy, anorexia, cold intolerance, and failure to thrive since acquisition at an early age. Clinical signs of disease were less pronounced when the cat was fed a low-protein diet. Anemia, hypoglycemia, low total CO2 content, and hyperammonemia were detected. The cat was euthanatized. Urine obtained immediately before euthanasia contained a large amount of methylmalonic acid. Total serum cobalamin concentration was low. Hepatic methylmalonic-CoA mutase activity, with and without the addition of coenzyme adenosylcobalamin, was consistent with a cobalamin deficiency. Methylmalonic acidemia secondary to a putative defect in cobalamin absorption was diagnosed.

Research paper thumbnail of Role of electrolyte concentrations and renin‐angiotensin‐aldosterone activation in the staging of canine heart disease

Journal of Veterinary Internal Medicine, Nov 26, 2019

Background: Refractory congestive heart failure (CHF) and associated diuretic resistance are not ... more Background: Refractory congestive heart failure (CHF) and associated diuretic resistance are not well defined. Objectives: To characterize renal function, electrolyte concentrations, indices of diuretic efficacy, and renin-angiotensin-aldosterone system (RAAS) activation in dogs with naturally occurring heart disease (HD) in American College of Veterinary Internal Medicine stages B1, B2, C, and D and to determine their usefulness in defining HD stages. Animals: Group 1:149 dogs with HD stages B1, B2, C, and D. Group 2:22 dogs with HD stages C and D. Methods: Group 1: Renal parameters, serum and urine electrolyte and diuretic concentrations, and urine aldosterone concentrations were measured. Medication dosages and measured variables were compared among stages. Correlation of furosemide dosages to serum concentrations was explored. Group 2: Angiotensin-converting enzyme activity and RAAS components were measured and compared among CHF stages. Results: Serum chloride concentration was the best differentiator of HD stage. Furosemide PO dosages (≤6 mg/kg/day) were weakly correlated with serum furosemide concentrations, whereas higher dosages were not significantly correlated. Angiotensin-converting enzyme inhibitor dosage and RAAS inhibition were greater in stage D, compared to stage C dogs. Conclusions and Clinical Importance: Hypochloremia is a useful marker for stage D HD in dogs. Poor furosemide dosage correlation to serum concentration may indicate variable and poor absorption, especially at higher dosages, advanced disease, or both. A small number of stage D dogs met proposed criteria for diuretic resistance. Greater RAAS inhibition in stage D versus stage C indicates effectiveness of RAASsuppressive treatments in this group of dogs with refractory CHF.

Research paper thumbnail of Renal biopsy: methods and interpretation

Veterinary Clinics of North America-small Animal Practice, Jul 1, 2004

Renal diseases are common in dogs and cats. Historical information, physical examination, and cli... more Renal diseases are common in dogs and cats. Historical information, physical examination, and clinical laboratory data often allow for the differentiation of renal diseases into the general categories of acute renal failure, chronic renal failure, and glomerular disease. Renal biopsy is often required to establish a definitive diagnosis and determine the severity of the lesion. A precise and accurate histologic diagnosis may also be needed to formulate an optimal treatment plan. Accurate assessment of response to therapy requires knowledge of the type and severity of the disease being treated [1-4]. There is often reluctance on the part of the practitioner to pursue renal biopsy in the clinical evaluation of patients. Many concerns probably contribute to this reluctance, including the potential complications of renal biopsy, the expenses associated with procurement of the renal biopsy specimen and adequate evaluation of the renal biopsy specimen, and the belief that the rendered diagnoses may lack consistency. Studies have shown that the frequency of severe complications from renal biopsy is relatively low and that renal biopsy minimally affects renal function when proper technique is employed [1,2,5-11]. The expense of the renal biopsy procedure can be minimized by correct patient selection and the use of proper technique. Consistent and accurate diagnoses are more likely to be obtained when renal biopsy specimens are appropriately processed and evaluated. The purpose of this article is to discuss patient selection and evaluation, renal biopsy techniques, expected complications of renal biopsy, and appropriate processing and evaluation of the renal biopsy specimen. Patient selection Renal biopsy is indicated only when the results are likely to alter patient management by providing an accurate histologic diagnosis or by facilitating prognostication.

Research paper thumbnail of Fluconazole in cats: Pharmacokinetics following intravenous and oral administration and penetration into cerebrospinal fluid, aqueous humour and pulmonary epithelial lining fluid

Journal of Veterinary Pharmacology and Therapeutics, Jun 1, 1997

in cats: Pharmacokinetics following intravenous and oral administration and penetration into cere... more in cats: Pharmacokinetics following intravenous and oral administration and penetration into cerebrospinal fluid, aqueous humoclr and pulmonary epithelial lining fluid. 1. vet. Pharmacol. Therap. 20, 181-186. The pharmacokinetics of fluconazole following intravenous (i.v.) and oral (p.0.) administration and the penetration of fluconazole into cerebrospinal fluid, aqueous humour and epithelial lining fluid (ELF) of the lungs were evaluated in adult male cats. Pharmacokinetic parameters were calculated from serum concentration-time data obtained following i.v. and p.0. administration of 50 mg per cat using a cross-over study design. Fluconazole concentrations were measured using a high-performance liquid chromatography assay. Mean total body clearance of fluconazole was 3 7.7 mL/h.kg, mean volume of distribution at steady state was 1.14 L/kg, mean residence time was 31.0 h and mean halflife of elimination was 25 h as derived by non-compartmental analysis of data. Absorption was complete. Mean ratios of fluidxerum fluconazole concentrations following administration of 50 mg fluconazole per day for 8 days were as follows: cerebrospinal fluid, 0.88; aqueous humour 0.79; ELF, 1.20. Fluconazole concentrations in cerebrospinal fluid, aqueous humour and ELF exceeded reported minimum inhibitory concentrations of fluconazole for pathogenic fungi. Results of this study suggest fluconazole can effectively be administered to cats at 50 mg per cat per day.

Research paper thumbnail of Comparative pharmacokinetics of doxycycline in cats and dogs

Journal of Veterinary Pharmacology and Therapeutics, Dec 1, 1990

The disposition of doxycycline hyclate was studied in six adult mixed-breed female cats and six a... more The disposition of doxycycline hyclate was studied in six adult mixed-breed female cats and six adult mid-sized female dogs following a single intravenous administration of 5 mg/kg body weight. Doxycycline volume of the central compartment, area volume of distribution, volume of distribution at steady state, and total body clearance were significantly smaller in cats. The differences were attributed to more extensive binding of doxycycline to plasma protein including albumin in cats. ,The significant differences in the volume of distribution and total body clearance were not reflected in elimination half-lives under the conditions of this study (sample size, inhomogeneous population). Doxycycline elimination half-life was 4.56 5 0.68 (SEM) h for cats and 6.99 k 1.09 h for dogs. Dosage regimens recommended in the veterinary literature were evaluated by the computer program PETDR.

Research paper thumbnail of Consensus Recommendations for Standard Therapy of Glomerular Disease in Dogs

Journal of Veterinary Internal Medicine, Nov 1, 2013

Standard therapy forms the basic foundation for care of dogs with glomerular disease, as it is he... more Standard therapy forms the basic foundation for care of dogs with glomerular disease, as it is herein recommended for use in all affected animals regardless of causation of the disease. Consensus recommendations target the evaluation and management of proteinuria, inhibition of the renin-angiotensin-aldosterone system, modification in dietary intake with special consideration for those nutrients with renal effects, diagnosis and treatment of systemic hypertension, and evaluation and management of body fluid volume status in dogs with glomerular disease.

Research paper thumbnail of Effects of Enalapril versus Placebo as a Treatment for Canine Idiopathic Glomerulonephritis

Journal of Veterinary Internal Medicine, Sep 1, 2000

A blinded, multicenter, prospective clinical trial assessed the effects of enalapril (EN) versus ... more A blinded, multicenter, prospective clinical trial assessed the effects of enalapril (EN) versus standard care in dogs with naturally occurring, idiopathic glomerulonephritis (GN). Twenty-nine adult dogs with membranous (n ϭ 16) and membranoproliferative (n ϭ 13) GN were studied. Dogs were randomly assigned to receive either EN (0.5 mg/kg PO q12-24h; n ϭ 16) or placebo (n ϭ 14) for 6 months (1 dog was treated first with the placebo and then with EN). All dogs were treated with low-dose aspirin (0.5-5 mg/kg PO q12-24h) and fed a commercial diet. At baseline, serum creatinine (SrCr), systolic blood pressure (SBP), and glomerular histologic grade were not different between groups, but the urine protein/creatinine ratio (UP/C) was greater in the EN group compared with the placebo group (8.7 Ϯ 4.4 versus 4.7 Ϯ 2.3). After 6 months of treatment, the change in UP/C from baseline was significantly different between groups (EN ϭ Ϫ4.2 Ϯ 1.4 versus 1.9 Ϯ 0.9 in the placebo group). When data were adjusted for changes in SrCr (SrCr ϫ UP/C) a similar significant reduction was noted (Ϫ2.2 Ϯ 15.2 versus 8.4 Ϯ 10.1). The change in SBP after 6 months of treatment also was significantly different between groups (EN ϭ Ϫ12.8 Ϯ 27.3 versus 5.9 Ϯ 21.5 mm Hg in the placebo group). Response to treatment was categorized as improvement (assigned a value of 2), no progression (assigned a value of 1), and progression (assigned a value of 0). Response was significantly better in the EN group (1.4 Ϯ 0.8) compared with the placebo group (0.3 Ϯ 0.5). These results suggest that EN treatment is beneficial in dogs with naturally occurring idiopathic GN.

Research paper thumbnail of Shear wave elastography evaluation of cats with chronic kidney disease

Veterinary Radiology & Ultrasound, Nov 2, 2022

Chronic kidney disease (CKD) is a major health condition in cats that can lead to poor quality of... more Chronic kidney disease (CKD) is a major health condition in cats that can lead to poor quality of life and financial implications for therapy. Currently staging and identification of CKD is limited by diagnostic testing such as creatinine and urine‐specific gravity, which do not change until late in the disease course. Other methods to evaluate CKD would be valuable in the clinical setting. Shear wave elastography is one novel ultrasound method, which has shown promise in identifying increases in tissue stiffness and identifying CKD in people. As CKD is often histologically characterized by tubulointerstitial fibrosis, shear wave elastography has the potential to identify CKD and differentiate between stages of CKD in cats. This prospective observational case‐control study with 78 cats found no difference in shear wave velocities between groups (P = 0.33), a contradictory finding to one prior publication. There was no effect of weight (P = 0.65), nor the presence of mineralization (P = 0.31) or infarction (P = 0.52) on cortical shear wave velocities. There was a significant effect of age on shear wave velocity (P = 0.018) where velocities increased with age. The intraclass correlation coefficient was only moderate (0.62). Possible reasons for the difference in results between our work and that published prior, include differences in methodology and differences in instrumentation. Variability in measurements in our population may be due to the effects of respiratory motion or limitations in shear wave elastography software. As such, shear wave elastography is not currently recommended as a tool to evaluate CKD in cats and further work is necessary.

Research paper thumbnail of Evaluation of perinuclear anti-neutrophilic cytoplasmic autoantibodies as an early marker of protein-losing enteropathy and protein-losing nephropathy in Soft Coated Wheaten Terriers

Javma-journal of The American Veterinary Medical Association, Oct 1, 2008

P rotein-losing enteropathy and PLN are chronic and often fatal diseases in SCWTs. Diagnosis typi... more P rotein-losing enteropathy and PLN are chronic and often fatal diseases in SCWTs. Diagnosis typically is made when dogs are at a mean age of 4 to 6 years old. 1 In the United States, the prevalence is estimated to be as high as 10% and median survival time reportedly Evaluation of perinuclear anti-neutrophilic cytoplasmic autoantibodies as an early marker of protein-losing enteropathy and protein-losing nephropathy in Soft Coated Wheaten Terriers

Research paper thumbnail of Pharmacokinetics, inhibition of lymphoblast transformation, and toxicity of cyclosporine in clinically normal pigs

PubMed, Mar 1, 1990

Pharmacokinetic variables were calculated from time-concentration data obtained after IV (10 mg/k... more Pharmacokinetic variables were calculated from time-concentration data obtained after IV (10 mg/kg of body weight; n =9) and oral (12.5 mg/kg to group A [n = 3]; 25 mg/kg to group B [n = 3]; and 50 mg/kg to group C [n = 3] pigs) cyclosporine (formerly, cyclosporine A) administration. Resulting mean (+/- SD) pharmacokinetic variables were as follows: half life of distribution, 0.96 (+/- 0.7) hours; half life of elimination, 7.71 (+/- 2.6) hours; volume of distribution at steady state, 4.47 (+/- 2.22) L/kg; volume of the central compartment, 1.71 (+/- 0.78) L/kg; and systemic clearance, 8.95 (+/- 2.7) ml/kg/min. Oral bioavailability was: overall 57 (+/- 19) %; group A, 44 (+/- 11) %; group B, 78 (+/- 15) %; group C, 48 (+/- 6) %. Time to peak concentration was 3.55 (+/- 0.88) hours. During the 22 days of daily oral cyclosporine administration, blood 24-hour trough concentrations were: group A, 224.3 (+/- 78.4) ng/ml; group B, 640.7 (+/- 174.6) ng/ml; and group C, 2,344 (+/- 1,095) ng/ml. Lymphoblast transformation stimulation index was suppressed in all pigs except 1, which had a corresponding cyclosporine concentration of 92.4 ng/ml. Minimal, although statistically significant, decreases in serum albumin and magnesium concentrations and increases in serum creatinine and urea nitrogen concentrations were evident in pigs of some treatment groups. Histologic examination of necropsy specimens revealed mild hepatic necrosis (n = 1 pig), renal tubular dilatation (n = 5), and pulmonary inflammation (n = 2). Pigs given 25 and 50 mg of cyclosporine/kg failed to gain weight.