Journal of Veterinary Internal Medicine最新文献

Background

The prevalence of immune complex-mediated glomerulonephropathy (ICGN) in dogs with proteinuric kidney disease is approximately 50% in the United States and Europe but is unknown in other locations such as Australia and New Zealand.

Objectives

Determine the prevalence of ICGN in dogs biopsied for proteinuric kidney disease in Australia and New Zealand and compare clinicopathologic variables in dogs with specific pathologic lesions.

Animals

Fifty client-owned dogs.

Methods

Retrospective case series. Reports from renal biopsy samples submitted to the Texas and International Veterinary Renal Pathology Services from dogs with proteinuric kidney disease (urine protein-to-creatinine ratio ≥ 0.5) between 2007 and 2023 were reviewed. Clinical data were retrieved and compared.

Results

Among 50 dogs with proteinuric renal disease, 15 dogs (30%) had ICGN and 35 (70%) had non-ICGN. The most common category of ICGN was membranous glomerulonephropathy (6/15; 40%). Glomerulosclerosis was the most common category of non-ICGN (17/35; 49%). Dogs with glomerulosclerosis (median, 10 years) were older than dogs with other types of lesions (membranoproliferative, mesangioproliferative or mixed pattern; median, 6 years; p = 0.04) and those with membranous glomerulonephropathy (median, 4 years; p = 0.005). Dogs with membranous glomerulonephropathy had lower serum albumin concentrations (median, 2.1 g/dL) than dogs with glomerulosclerosis (median, 3.0 g/dL; p = 0.01) or other nephropathies (median, 3.0 g/dL; p = 0.04).

Conclusions and Clinical Importance

The prevalence of ICGN is lower in dogs in Australia and New Zealand biopsied for proteinuric kidney disease, potentially because of a lower prevalence of infectious disease, particularly vector-borne disease. The lower prevalence of ICGN emphasizes the importance of renal biopsy to optimize treatment.

Background

Prophylactic fenestration (PF) has been reported to protect against recurrent intervertebral disc extrusion (IVDE), but recurrence is not always confirmed. No published studies address the cost–benefit of PF.

Objectives

Observe the association between PF and intervertebral disc (IVD) survival and conduct cost–benefit analysis.

Animals

Eighty chondrodystrophic dogs with recurrent IVDE.

Methods

Longitudinal assessment with follow-up magnetic resonance imaging (MRI) was performed to retrospectively observe the survival of in situ IVDs. The association between PF and IVD survival was analyzed using a multivariable survival model, which included Pfirrmann grade as a covariate. Worst-case, base-case, and best-case cost–benefit simulations were conducted, corresponding to the lower 95% confidence interval (CI), point estimate, and upper 95% CI of the effect size of PF.

Results

For IVDs treated with PF, 4/31 (12.9%) IVDs were documented to subsequently extrude on follow-up MRI. For IVDs not treated with PF, 76/602 (12.6%) were documented to subsequently extrude on follow-up MRI. There was no association between the use of PF and IVD survival (time ratio: 1.17; 95% CI: 0.49–2.76; p = 0.72). An increase in Pfirrmann grade was associated with a decrease in IVD survival (time ratio: 0.34; 95% CI: 0.26–0.46; p < 0.001). Prophylactic fenestration was only cost-effective under a limited range of conditions.

Conclusions and Clinical Importance

There was no evidence that PF prevented IVDE under study conditions. Pfirrmann grade was the strongest predictor of IVD survival. Universal use of PF was not cost-effective in multiple simulations. Targeted PF of high-risk IVDs may be considered the most cost-effective approach.

Background

Accessory pathways (APs) are muscular bundles directly connecting the atria and ventricles, bypassing the atrioventricular (AV) node-His-Purkinje system. Anterograde conduction along the AP results in ventricular preexcitation. A retrograde conducting AP allows ventriculo-atrial (VA) conduction, creating a reentry circuit that mediates orthodromic atrioventricular reentry tachycardia (OAVRT). This condition is well described in humans and small animals, but has not been reported previously in horses.

Objectives

Describe clinical and electrocardiographic findings of horses with retrograde AP conduction and reporte mapping and radiofrequency ablation results in one horse.

Animals

Six horses with retrograde AP conduction.

Methods

Records from six horses with retrograde AP conduction were reviewed.

Results

Resting ECGs showed P′ waves in the ST segment with fixed coupling intervals to the preceding QRS complexes. In five of six horses, P′ waves were conducted back to the ventricles along the AV node, resulting in OAVRT. All horses had episodes where P′ waves were blocked at the AV node, which resulted in orthodromic atrioventricular reentry bradycardia (OAVRB). In one horse, the AP conducted bidirectionally resulting in ventricular preexcitation. An electrophysiological study in one horse identified a left-atrial AP insertion by the shortest VA interval. Radiofrequency ablation using an impedance-based mapping system could not eliminate the AP.

Conclusions

Retrograde conducting APs in horses caused OAVRT and OAVRB. APs in horses behaved differently compared to those in humans and dogs. Further research is necessary to elucidate AP behavior, evaluate risk and effect on performance, and assess treatment by ablation.

Background

Adverse events (AEs) are under-reported in veterinary medicine. The ability to report AEs directly from the practice management system (PMS) has been suggested to facilitate reporting. The Small Animal Veterinary Surveillance Network (SAVSNET) informatics system provides an opportunity to integrate reporting into the workflow such that reports can be submitted directly to the National Competent Authority, the Veterinary Medicines Directorate (VMD).

Objectives

Animals

Animals attending United Kingdom (UK) first-opinion veterinary practices participating in SAVSNET.

Methods

An AE “reporting button” was developed and available in the normal clinical workflow for SAVSNET enrolled practices using the Robovet PMS. The button facilitated capture of pertinent information relating to AEs, including the ability to append clinical notes from the associated EHR. After submission, reports were automatically submitted daily to the VMD. Report quality was assessed using an adapted version of the vigiGrade scoring system, which was used to compare the quality of reports submitted to the VMD via standard routes to those submitted via SAVSNET. Assessment of reports submitted via SAVSNET, was conducted twice. First, considering only information contained in the report and second, considering information contained in both the report and associated clinical notes.

Results

Sixty reports were submitted during the first 18 months by 42 different veterinary practices. The quality of SAVSNET reports was significantly improved by information contained within the clinical notes. These reports were more likely to be well-documented than those submitted via standard routes.

Conclusions and Clinical Importance

Adverse event reports populated using