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- Author or Editor: David J. Polzin x
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Abstract
Objective—To determine whether nephrolithiasis was associated with an increase in mortality rate or in the rate of disease progression in cats with naturally occurring stage 2 (mild) or 3 (moderate) chronic kidney disease.
Design—Retrospective case-control study.
Animals—14 cats with stage 2 (mild) or 3 (moderate) chronic kidney disease (7 with nephroliths and 7 without).
Procedures—All cats were evaluated every 3 months for up to 24 months. Possible associations between nephrolithiasis and clinicopathologic abnormalities, incidence of uremic crises, death secondary to renal causes, and death secondary to any cause were evaluated.
Results—There were no clinically important differences in biochemical, hematologic, or urinalysis variables between cats with and without nephroliths at baseline or after 12 and 24 months of monitoring. No associations were detected between nephrolithiasis and rate of disease progression, incidence of uremic crises, or death.
Conclusions and Clinical Relevance—Results suggested that in cats with mild or moderate chronic kidney disease, nephrolithiasis was not associated with an increase in mortality rate or in the rate of disease progression. Findings support recommendations that cats with severe kidney disease and nephrolithiasis be managed without surgery.
Abstract
Objective—To determine whether a renal diet modified in protein, phosphorus, sodium, and lipid content was superior to an adult maintenance diet in minimizing uremic episodes and mortality rate in cats with stage 2 or 3 chronic kidney disease (CKD).
Design—Double-masked, randomized, controlled clinical trial.
Animals—45 client-owned cats with spontaneous stage 2 or 3 CKD.
Procedures—Cats were randomly assigned to an adult maintenance diet (n = 23 cats) or a renal diet (22) and evaluated trimonthly for up to 24 months. Efficacy of the renal diet, compared with the maintenance diet, in minimizing uremia, renal-related deaths, and all causes of death was evaluated.
Results—Serum urea nitrogen concentrations were significantly lower and blood bicarbonate concentrations were significantly higher in the renal diet group at baseline and during the 12- and 24-month intervals. Significant differences were not detected in body weight; Hct; urine protein-to-creatinine ratio; and serum creatinine, potassium, calcium, and parathyroid hormone concentrations. A significantly greater percentage of cats fed the maintenance diet had uremic episodes (26%), compared with cats fed the renal diet (0%). A significant reduction in renal-related deaths but not all causes of death was detected in cats fed the renal diet.
Conclusions and Clinical Relevance—The renal diet evaluated in this study was superior to an adult maintenance diet in minimizing uremic episodes and renalrelated deaths in cats with spontaneous stage 2 or 3 CKD.
Abstract
Objective—To identify risk factors associated with diagnosis of chronic kidney disease (CKD) in cats.
Design—Retrospective case-control study.
Animals—1,230 cats with a clinical diagnosis of CKD, serum creatinine concentration > 1.6 mg/dL, and urine specific gravity < 1.035 and 1,230 age-matched control cats.
Procedures—Data on putative risk factors for CKD were extracted for multivariate logistic regression analysis from the medical records of cats brought to 755 primary care veterinary hospitals. For a subset of cats evaluated 6 to 12 months prior to the date of CKD diagnosis or control group inclusion, the percentage change in body weight between those dates as well as clinical signs at the earlier date were analyzed for associations with CKD development.
Results—Risk factors for CKD in cats included thin body condition, prior periodontal disease or cystitis, anesthesia or documented dehydration in the preceding year, being a neutered male (vs spayed female), and living anywhere in the United States other than the northeast. The probability of CKD decreased with increasing body weight in nondehydrated cats, domestic shorthair breed, and prior diagnosis of diabetes mellitus and increased when vomiting, polyuria or polydipsia, appetite or energy loss, or halitosis was present at the time of diagnosis or control group inclusion but not when those signs were reported 6 to 12 months earlier. Median weight loss during the preceding 6 to 12 months was 10.8% and 2.1% in cats with and without CKD, respectively.
Conclusions and Clinical Relevance—The probability of CKD diagnosis in cats was influenced by several variables; recent weight loss, particularly in combination with the other factors, warrants assessment of cats for CKD.
Abstract
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. (J Am Vet Med Assoc 2002;220: 1163–1170)
Abstract
Objective—To determine frequency of urinary tract infection (UTI) among dogs with pruritic disorders that were or were not receiving long-term glucocorticoid treatment.
Design—Observational study.
Animals—127 dogs receiving glucocorticoids for > 6 months and 94 dogs not receiving glucocorticoids.
Procedure—Bacterial culture of urine samples was performed in dogs receiving long-term glucocorticoid treatment, and information was collected on drug administered, dosage, frequency of administration, duration of glucocorticoid treatment, and clinical signs of UTI. For dogs not receiving glucocorticoids, a single urine sample was submitted for bacterial culture.
Results—Multiple (2 to 6) urine samples were submitted for 70 of the 127 (55%) dogs receiving glucocorticoids; thus, 240 urine samples were analyzed. For 23 of the 127 (18.1%) dogs, results of bacterial culture were positive at least once, but none of the dogs had clinical signs of UTI. Pyuria and bacteriuria (present vs absent) were found to correctly predict results of bacterial culture for 89.9% and 95.8% of the samples, respectively. Type of glycocorticoid, dosage, frequency of administration, and duration of treatment were not associated with frequency of UTI. None of the urine samples from dogs not receiving glucocorticoids yielded bacterial growth. The frequency of UTI was significantly higher for dogs treated with glucocorticoids than for dogs that had not received glucocorticoids.
Conclusions and Clinical Relevance—Results suggest that dogs receiving long-term glucocorticoid treatment have an increased risk of developing a UTI. On this basis, we recommend that urine samples be submitted for bacterial culture at least yearly for such dogs. (J Am Vet Med Assoc 2005;227:239–243)
Abstract
Objective—To determine whether urine protein-to-creatinine ratio (UP:C) ≥ 1.0 at initial diagnosis of chronic renal failure (CRF) is associated with greater risk of development of uremic crises, death, and progression of renal failure in dogs.
Design—Prospective cohort study.
Animals—45 dogs with CRF.
Procedure—Dogs were prospectively assigned to 2 groups on the basis of initial UP:C < 1.0 or ≥ 1.0. The association between magnitude of proteinuria and development of uremic crises and death was determined before and after dogs with initial UP:C ≥ 1.0 were assigned to 3 subgroups and compared with dogs with initial UP:C < 1.0. Changes in reciprocal serum creatinine concentration were used to estimate decrease in renal function.
Results—Initially, dogs had similar clinical characteristics with the exception of systolic blood pressure and UP:C. Relative risks of development of uremic crises and death were approximately 3 times higher in dogs with UP:C ≥ 1.0, compared with dogs with UP:C < 1.0. Relative risk of adverse outcome was approximately 1.5 times higher for every 1-unit increment in UP:C. The decrease in renal function was of greater magnitude in dogs with UP:C ≥ 1.0, compared with dogs with UP:C < 1.0.
Conclusions and Clinical Relevance—Initial UP:C ≥ 1.0 in dogs with CRF was associated with greater risk of development of uremic crises and death, compared with dogs with UP:C < 1.0. Initial determinations of UP:C in dogs with naturally occurring CRF may be of value in refining prognoses. (J Am Vet Med Assoc 2005;226:393–400)
Abstract
Objective—To determine whether high systolic blood pressure (SBP) at the time of initial diagnosis of chronic renal failure in dogs was associated with increased risk of uremic crisis, risk of dying, or rate of decline in renal function.
Design—Prospective cohort study.
Animals—45 dogs with spontaneous chronic renal failure.
Procedure—Dogs were assigned to 1 of 3 groups on the basis of initial SBP (high, intermediate, low); Kaplan-Meier and Cox proportional hazards methods were used to estimate the association between SBP and development of a uremic crisis and death. The reciprocal of serum creatinine concentration was used as an estimate of renal function.
Results—Dogs in the high SBP group were more likely to develop a uremic crisis and to die than were dogs in the other groups, and the risks of developing a uremic crisis and of dying increased significantly as SBP increased. A greater decrease in renal function was observed in dogs in the high SBP group. Retinopathy and hypertensive encephalopathy were detected in 3 of 14 dogs with SBP ≥ 180 mm Hg. Systolic blood pressure remained high in 10 of 11 dogs treated with antihypertensive drugs.
Conclusions and Clinical Relevance—Results suggested that initial high SBP in dogs with chronic renal failure was associated with increased risk of developing a uremic crisis and of dying. Further studies are required to determine whether there is a cause-and-effect relationship between high SBP and progressive renal injury and to identify the risks and benefits of antihypertensive drug treatment. (J Am Vet Med Assoc 2003;222:322–329)
