OBJECTIVE To determine whether urolithiasis is associated with chronic kidney disease (CKD) in cats.
DESIGN Retrospective case-control study.
ANIMALS 126 cats (59 and 67 with and without urolithiasis, respectively).
PROCEDURES Medical records from June 2006 to July 2013 were searched to identify cats that underwent abdominal or focal urinary tract ultrasonography and for which serum creatinine concentration and urine specific gravity data were obtained ≤ 14 days before or after the examination. In cats with (urolithiasis group) and without (control group) urolithiasis, the presence of CKD was determined according to International Renal Interest Society guidelines. Information recorded included signalment, body weight, serum creatinine concentration, and urine specific gravity; when present, the location and number of uroliths were noted. Differences between groups and associations between group and categorical variables were analyzed statistically.
RESULTS Age, weight, sex, and breed did not differ between groups. The prevalence of CKD was significantly higher in cats with urolithiasis than in the control group. Among cats with urolithiasis, there was a negative association between CKD and presence of cystoliths. There was no association between urolithiasis and the stage of CKD or between presence of CKD and location of nephroliths in the kidney.
CONCLUSIONS AND CLINICAL RELEVANCE Results confirmed a positive association between urolithiasis and CKD in the feline population studied and suggested that cats with urolithiasis should be evaluated for CKD. Further research is warranted to assess the nature of the relationship between CKD and urolithiasis in cats.
Objective—To determine the respective associations between ureteral obstruction and renomegaly, urine specific gravity (USG), and serum creatinine concentration and to assess the reliability of abdominal palpation for detection of renomegaly in cats.
Design—Retrospective case series.
Animals—89 client-owned cats with (n = 29) or without ureteral obstruction and with (30) or without (30) kidney disease.
Procedures—Medical records of cats that underwent abdominal ultrasonography at a veterinary teaching hospital from January 2006 through April 2013 were reviewed. Cats were categorized as having ureteral obstruction (obstructed group) or no ureteral obstruction with (KD group) or without kidney disease (NKD group). Renomegaly and renal asymmetry were defined on the basis of mean renal length for NKD cats. Prevalence of renomegaly and renal asymmetry, mean USG and serum creatinine concentration, and abdominal palpation and ultrasonographic findings were compared among the groups.
Results—Renomegaly was identified in 2 obstructed cats and 1 KD cat and was not associated with ureteral obstruction. Renal asymmetry was detected in 18 obstructed cats and 11 KD cats. For obstructed and KD cats, the mean USG was significantly lower and the mean serum creatinine concentration was significantly greater than those for NKD cats. Twenty-eight of 29 cats with ureteral obstruction had hypercreatininemia. Abdominal palpation was not a reliable method for detection of renomegaly.
Conclusions and Clinical Relevance—Results indicated renomegaly was not associated with ureteral obstruction in cats, and abdominal palpation was an unreliable method for detection of renomegaly. The most consistent abnormal finding for cats with ureteral obstruction was hypercreatininemia. (J Am Vet Med Assoc 2015;247:518–524)
Case Description—A 6-year-old spayed female domestic ferret was evaluated because of lethargy, alopecia, pruritus, and an abdominal mass.
Clinical Findings—On initial examination, nonregenerative anemia, mild azotemia, and a large left adrenal gland mass were identified. However, deterioration of the ferret's general condition prevented excision of the mass, and dyspnea, weakness, hypertension, and severe hypokalemia developed. Plasma aldosterone concentration was > 3,329 pmol/L, confirming a provisional diagnosis of hyperaldosteronism. High concentrations of sex hormones were also observed, but baseline cortisol concentration was within reference limits.
Treatment and Outcome—Medical treatment included oral administration of spironolactone, potassium gluconate, leuprolide acetate, amlodipine, and benazepril. Inhalation of albuterol proved effective in reducing the dyspnea. In the following weeks, serum potassium concentration returned to within reference limits and hypertension decreased, but dyspnea persisted. Two months after initial examination, the ferret became anorectic and was euthanized. Histologic examination revealed a large left adrenal gland adenoma, progressive chronic nephropathy, severe pulmonary edema, and focal fibrosis in the left ventricle. Immunohistochemical staining of the adrenal gland mass revealed aldosterone within neoplastic adrenocortical cells.
Clinical Relevance—Findings suggested that primary hyperaldosteronism should be considered as a possible cause in ferrets with hypokalemia, hypertension, and an adrenal gland mass. Early detection of aldosterone-secreting masses might allow for removal of the tumor before irreversible complications occur.
Case Description—A gallbladder mucocele was diagnosed in 2 dogs. In both dogs, the mucocele resolved with medical treatment but without the need for surgical intervention.
Clinical Findings—A 12-year-old spayed female Miniature Schnauzer had a history of signs of gastrointestinal tract disease and high serum liver enzyme activities. Gallbladder mucocele and hypothyroidism were diagnosed. A 6-year-old neutered mixed-breed dog had chronic intermittent diarrhea and recurrent otitis; gallbladder mucocele and hypothyroidism were diagnosed.
Treatment and Outcome—The first dog was treated with S-adenosyl-methionine, omega-3 fatty acids, famotidine, ursodiol, and levothyroxine. Substantial improvement in the gastrointestinal tract condition and complete resolution of the gallbladder mucocele within 3 months were evident, but the dog was not available for further follow-up monitoring. The second dog was treated with fenbendazole, ursodiol, and levothyroxine and fed a hypoallergenic diet. One month after evaluation, abdominal ultrasonography revealed that the gallbladder mucocele was resolving, and treatment was continued. Ultrasonographic evaluation 2 and 4 months later revealed complete resolution of the mucocele.
Clinical Relevance—Review of the clinical course of 2 dogs in which there was nonsurgical resolution of gallbladder mucocele revealed that surgery is not necessary in all dogs with gallbladder mucocele. Hypothyroidism may have resulted in delayed gallbladder emptying, and its role in the pathogenesis of gallbladder mucocele merits investigation. Despite this information, until further prospective trials with a control group and standardized treatments and follow-up monitoring can be performed, the authors recommend surgical intervention for treatment of dogs with gallbladder mucocele.
OBJECTIVE To determine characteristics of and outcomes for dogs with congenital distal ureteral orifice stenosis (CDUOS) treated by cystoscopic-guided laser ablation (CLA).
DESIGN Retrospective case series.
ANIMALS 16 client-owned dogs with CDUOS treated by CLA at 2 veterinary hospitals between 2010 and 2014.
PROCEDURES Medical records were reviewed and data collected regarding clinical findings, imaging results, surgery characteristics, treatment, and outcome. Follow-up information was collected from dog owners and referring veterinarians via standardized interview.
RESULTS Dogs included 10 males and 6 females; median age was 11.5 months (range, 4 to 112 months). Labrador Retriever (n = 6; 3 males) was the most common breed. Intramural ectopic ureteral openings were identified at the site of stenosis in 15 dogs (18/20 stenotic ureteral openings). Treatment with CLA to enlarge and relocate the stenotic opening was successful in all dogs. Median duration of anesthesia and hospitalization was 105 minutes and 24 hours, respectively. No complications were noted. Fourteen dogs remained alive (2 lost to follow-up) during a median follow-up period of 14.5 months. Owners of 11 of 13 dogs reported improvement in their dog's quality of life after CLA. The treated ureteral orifice remained patent in the 2 dogs that were reimaged.
CONCLUSIONS AND CLINICAL RELEVANCE CDUOS should be considered as a differential diagnosis for dogs with idiopathic distal ureteral obstruction, particularly young male Labrador Retrievers, and was most often associated with an intramural ectopic ureter in this study. Treatment with CLA was safe and effective for opening the ureteral orifice.
CASE DESCRIPTION A 4-year-old spayed female Beagle was evaluated because of a 2-month history of intermittent pollakiuria, stranguria, dysuria, and abdominal pain. A diagnosis of bacterial cystitis was initially made, but clinical signs persisted despite appropriate antimicrobial treatment, so the dog was referred for further evaluation and treatment.
CLINICAL FINDINGS Abdominal ultrasonography revealed a large, thin-walled, cystic structure in the urinary bladder at the level of the expected right ureterovesicular junction that communicated with the uniformly dilated right ureter. Severe right-sided pyelectasia was also detected. A presumptive diagnosis was made of a right-sided orthotopic ureterocele with secondary hydroureter and pyelectasia.
TREATMENT AND OUTCOME Cystoscopy revealed a large cystic structure in the region of the right ureterovesicular junction without obvious communication between the ureter and urinary bladder. Portable C-arm fluoroscopy was used to confirm the presence of an intramural orthotopic tract and to measure the diameter of the ureter and renal pelvis via retrograde contrast ureteropyelography. Complete laser ablation of the ureterocele was performed by incising it circumferentially near its base. Clinical signs resolved immediately following the procedure. Six weeks later, the dog remained free of clinical signs and abdominal ultrasonography revealed resolution of hydroureter with persistence of mild right-sided pyelectasia.
CLINICAL RELEVANCE Cystoscopic-guided laser ablation of an orthotopic ureterocele secondary to ureterovesicular stenosis was a safe and effective minimally invasive treatment for the dog of this report, resulting in immediate and continued improvement of clinical signs and ultrasonographic changes. Laser ablation should be considered as an alternative to surgery for the treatment of orthotopic ureteroceles in dogs.
Case Description—An 11-year-old spayed female Collie was evaluated because of regurgitation, dysphagia, severe ptyalism, coughing, and weight loss of approximately 12 weeks’ duration. Esophageal squamous cell carcinoma had been diagnosed prior to referral on the basis of results of radiographic and endoscopic examination and histologic evaluation of biopsy samples. A percutaneous endoscopically placed gastrostomy (PEG) tube had been inserted 2 weeks prior to referral, and the dog was being treated for infection at the gastrostomy site.
Clinical Findings—Physical examination findings included marked ptyalism, stertor, and inflammation and discharge at the gastrostomy site.
Treatment and Outcome—Surgical options were declined by the owner, and palliative treatment was chosen to alleviate clinical signs and facilitate PEG tube removal. With fluoroscopic guidance, a self-expanding metallic stent was placed in the esophageal lumen at the site of obstruction. Botulinum toxin A was injected into the mandibular salivary glands under ultrasonographic guidance as treatment for severe ptyalism. Following discharge, clinical improvement was reported until euthanasia for unrelated disease 12 weeks after stent placement. Necropsy revealed that the stent had not migrated and had remained patent with some tumor ingrowth but no evidence of stricture or obstruction.
Clinical Relevance—Esophageal stenting effectively treated obstruction and improved clinical signs and may be beneficial for palliative treatment in other animals with malignant esophageal tumors. Although the degree to which botulinum toxin A injection into salivary glands improved clinical signs could not be determined, it may potentially be useful as adjunctive treatment to reduce severe ptyalism.
Objective—To determine tracheal mucociliary clearance
rate (TMCCR) by use of a standard protocol in
healthy anesthetized cats and to determine the effect
of theophylline on TMCCR in healthy anesthetized
Animals—6 healthy cats.
Procedure—Cats were anesthetized with propofol,
and a droplet of the radiopharmaceutical technetium
Tc 99m macroaggregated albumin was placed endoscopically
at the carina. Dynamic acquisition scintigraphic
imaging was performed, using the larynx as
the end point. The TMCCR was determined by measuring
the distance the droplet traveled by frame rate.
Each cat was imaged 6 times as follows: 3 times following
placebo administration and 3 times following
the administration of sustained release theophylline
(25 mg/kg, PO). Serum theophylline concentrations
were assessed during imaging to ensure therapeutic
Results—The TMCCR in healthy adult cats anesthetized
with propofol was 22.2 ± 2.8 mm/min.
Tracheal mucociliary clearance rate in cats receiving
theophylline was 21.8 ± 3.5 mm/min. Theophylline
administration did not significantly alter TMCCR.
Conclusion and Clinical Relevance—Theophylline
has been shown to increase TMCCR in humans and
dogs. In our study, we determined TMCCR in healthy
anesthetized cats and found that it was not accelerated
by the administration of theophylline. (Am J Vet
Objective—To determine prevalence of various radiographic signs in cats with feline bronchial disease (FBD) and evaluate intra- and interobserver variability in radiographic interpretation for examiners with variable degrees of experience in radiographic interpretation.
Design—Retrospective case series.
Animals—40 cats with FBD and 40 control cats without thoracic disease.
Procedures—Radiographic abnormalities in cats with FBD were scored by consensus of 2 radiologists. Radiographs of control cats and cats with FBD were examined twice by 5 other individuals, and diagnostic accuracy and observer agreement were assessed.
Results—In cats with FBD, the most common radiographic signs were bronchial (n = 37) and unstructured interstitial (30) lung patterns, lung hyperinflation (31) and hyperlucency (21), aerophagia (19), and lung soft tissue opacities (11). Ratios of lung inflation on ventrodorsal views were significantly higher in cats with FBD. For the 5 examiners, sensitivity ranged from 71% to 89% and specificity ranged from 43% to 74%. Intraobserver agreement was good (N = 0.47 to 0.60), but the agreement between examiners was only poor to good (N = 0.22 to 0.70). For most examiners, significant associations were found between examiner diagnosis (correct vs incorrect), level of examiner certainty, and bronchial pattern severity.
Conclusions and Clinical Relevance—Findings suggested that several radiographic abnormalities can commonly be seen in cats with FBD but highlighted the limitations of thoracic radiography. Examiner diagnosis and level of confidence were significantly associated with severity of a bronchial pattern.