Lit Urinary

Question 1

1. Which urinary & serum biomarkers were a) increased at presentation, and b) predictors of AKI development in hospitalised dogs?
2. What was the overall morbidity rate associated with AKI?

Answer 1

Nivy JVIM 2021
1. a) Biomarkers – uHSP70/uCr, uGGT/uCr, uALKP/uCr, uIL-6/uCr, IL-6, IL-18 were HIGHER in AKI dogs at presentation vs controls.
b) uHSP70/uCr, uGGT/uCr, uIL-6/uCr were higher in dogs that developed AKI. sSDMA was moderately predictive for AKI (discordant with sCr).
2. 18.6% AKI-associated morbidity rate.

Question 2

(2 papers)
What was the association between serum FGF-23 concentration, serum phosphate and CKD progression in dogs?

What variables were negative prognostic indicators based on a 2018 JVIM study?

Answer 2

Miyakawa JVIM 2021
Increased serum [FGF-23] >528 pg/mL was associated with a significantly shorter time to development of hyperphos (>5.0mg/dL), independent of CKD stage, as well as with CKD progression (>1.5x increase in sCr).

Rudinsky JVIM 2018
BCS < 4/9, muscle atrophy, increased crea, hyperphos, increased UPC, increased Ca x P, increased FGF-23.

Question 3

In cats with early (IRIS stage 1-2) CKD, what were the effects of feeding a low-protein, low-phos (LP-LP) diet compared to a moderate-protein, moderate-phos (MP-MP) diet on renal markers?

Answer 3

Schauf JVIM 2021
LP-LP diet - crea decreased to WRI. P did not increase, but tCa and FGF-23 increased long-term.
* Excessive P restriction led to development of hyperCa in early CKD cats.

MP-MP diet: crea, tCa & P remained WRI w/o sig changes, while FGF-23 sig decreased.
* Increasing dietary P and reducing Ca : P ratio maintained renal markers, while improving Ca-P balance. Cats with early CKD could benefit from MP-MP diets.

Question 4

Landmark paper
What was the effect of feeding a moderate phosphate diet (MP 1.5 g/Mcal; Ca:P ratio 1.3) on renal function parameters in cats with azotemic CKD?

Answer 4

Geddes JVIM 2021
Attenuation of dietary phos restriction –> no significant changes in ionized Ca (decreased to <1.4 in some cats), tCa, PTH, FGF-23. P decreased after ~8.8mths. No cats had increased creatinine >25%.

NB: Schauf JVIM 2021 - similar findings
Cats with early CKD developed hyperCa after long-term feeding of a highly P-restricted diet. Increasing dietary P and reducing Ca : P ratio maintained renal markers (crea, tCa, P, decreased FGF-23) while improving Ca-P balance.

Question 5

What was the documented treatment response and adverse effect profile in proteinuric dogs receiving telmisartan?

Answer 5

Lecavalier JVIM 2021
Partial (UPC decr by >/=50%) or complete (UPC <0.5) tx response in 70%, 68%, 80%, and 60% of dogs at 1, 3, 6, & 12 months respectively.
SE: mild self-limiting GI signs occ. Uncommonly azotemia requiring tx cessation.

Question 6

What were the trends in urolith composition & characteristics (location, culture results) in a) dogs and b) cats in a retrospective evaluation?

Answer 6

Kopecny JVIM 2021 (2 papers)
a) Dogs – CaOx (47.0%) > struvite-containing (43.6%) > urate-containing (14.9%) > cystine-containing uroliths (2.7%).
b) Cats – struvite-containing (47.1%) > CaOx-containing (46.2%) > urate (9.2%). Proportion of CaOx-containing uroliths in the upper urinary tract sig higher vs other urolith types. Only 10.9% of struvite-containing uroliths that had bacterial C&S were positive – of which 64.8% yielded urease-producing bacteria.

Question 7

What was the reported outcome of in female dogs with EU that underwent cystoscopic-guided laser ablation?

Answer 7

Hooi JVIM 2021
67.7% dogs became continent after CLA +/- adjunctive medical management. 54.8% (17/31) dogs received adjunctive medical management. Dogs remaining incontinent after CLA may improve with adjunctive medical management.

Question 8

Describe the effects of using telmisartan + ACEI in comparison to either drug alone in the treatment of systemic hypertension & proteinuria in dogs with PLN.

Answer 8

Fowler JVIM 2021
Overall combo more effective than either drug alone.
ACEI + TEL combo significantly reduced SBP by 13mmHg & UPC by 2.5 (vs ACEI alone).
UPC in TEL + ACEI group lower by 3.8 vs ACEI group.
*TEL alone did not sig reduce proteinuria but more effective as combo with ACEI. Similar effects as ACEI+TEL in BP reduction.

NB: retrospective study so TEL group may have been more severe

Question 9

List the following values for a rapid immunoassay (RIA) used to detect bacteriuria in voided urine from dogs when compared to routine urine C&S: a) sensitivity, b) specificity, c) positive predictive value, d) negative PV.

Answer 9

Grant JVIM 2021
a) Sensitivity 89%, specificity 100%, PPV 100%, NPV 92%.

Question 10

What were the patterns of biological variation (BV) in the gut-derived uremic toxins serum indoxyl sulfate (IS), p-cresol sulfate (pCS) & trimethylamine-n-oxide (TMAO) in healthy adult cats, and what was a major factor influencing BV?
What are the clinical utilities of these biomarkers?

Answer 10

Summers JVIM 2021
IS - individual BV was high short-term and low medium term. pCS & TMAO – individual BV were intermediate both short & medium term.
Major influencing factor = feeding. Significantly LOWER [ ] for all toxins at various q2hr intervals (up to 12hr) post prandium –> best to collect samples at same time of day & consistent as fasted/non-fasted state.
Clinical utility - provides info on CKD stage & risk of dz progression. Humans - biomarkers for therapeutic dietary intervention.

Question 11

What was the frequency of renal infarcts in dogs identified on CT and the most common imaging characteristics?

Answer 11

Sutthigran JVIM 2021
Frequency of renal infarcts = 3.15%
Most common - grade 1 (lesions <25% of the kidney),
caudal pole of kidney. Sagittal plane most useful.

Question 12

What 2 risk factors were associated with hypercalcemia after transitioning to a phosphate-restricted diet in IRIS stage 2-3 CKD cats?

Answer 12

Tang JVIM 2021
Lower plasma K+ and/or PO4 concentrations –> increased plasma [tCa] (associated with CKD progression)

Question 13

Which risk factors were associated with Enterococcus spp. bacteriuria in dogs?

Answer 13

Wood JVIM 2020
1) Hx of recurrent bacteriuria (OR 2.07)
2) LUT anatomic abnormalities (OR: 2.94)
3) Urolithiasis
4) LUT neoplasia
(Basically causes for underlying LUT inflammation)

Question 14

Which clinicopathological characteristics were associated with dogs with focal segmental glomerulosclerosis? List 1 common & 4 uncommon characteristics.

Which 2 factors were negatively associated with survival in dogs with FSGS?

Answer 14

Lorbach JVIM 2020

Common - systemic hypertension
Uncommon - azotemia, severe hypoalb (median alb 2.8g/dL), ascites, oedema

Serum crea >2.1mg/dL
Alb <2g/dL

Question 15

a) Which group of disorders (location) were most common in cats with micturition disorders presenting as urinary incontinence?
b) Was there a positive or negative correlation with survival for the answer to a)?
c) Were voiding or storage phase disorders more common?
d) Incidence of UTI in cats with UI?
e) Overall % of cats that regained continence?

Answer 15

Lonc JVIM 2020
a) Spinal cord disorders (>urethral&raquo_space; bladder&raquo_space; ureter)
b) Negative - more guarded prognosis.
c) Both similar frequency. But voiding phase disorders > common in males & younger cats.
d) 39%
e) 42% (spinal cord worse px)

Question 16

a) What is the role of hemojuvelin?

b) How did urine hemojuvelin concentrations (UHJ) & urine-hemojuvenil-to-creatinine ratios (UHCR) in AKI/ACKD/CKD cats compare to healthy cats?
c) Which haemogram & biochemical parameters did UHJ and/or UHCR correlate with in AKI/ACKD/CKD cats? (List 6)

Answer 16

Jing JVIM 2020
a) Membrane protein with key regulatory role in systemic iron homeostasis via the hemojuvelin-hepcidin-ferroportin axis.

b) Sig increased UHJ & UHCR in AKI/ACKD/CKD cats.

c) Both - high BUN, creatinine & phosphate. Low Hct/RBC count, albumin.
UHCR - peripheral WBC count.

Question 17

In non-azotemic dogs being screened for decreased renal function (defined as ≥40% decrease in GFR assessed by iohexol plasma clearance), a cut-off of SDMA >14μg/dL had …..% sens but …. specificity of …..%. In contrast, an SDMA cut-off of 18 μg/dL had similar sensitivity but …. specificity of …..%.

Answer 17

McKenna JVIM 2020

90% sens, 50% spec.

93% spec.

Question 18

a) What was the association between vitamin D metabolites & PLN in dogs?

b) Which two clinicopathological parameters did these vitamin D metabolites significantly correlate with?

Answer 18

Miller JVIM 2020
a) PLN dogs had lower concentrations of all vit D metabolites – calcidiol, calcitriol, 24,25[OH]2D (inactive form), serum vitamin D binding protein (VDBP) & urine calcidiol concentrations.

b) Urine calcidiol-to-creatinine ratio – neg correlation with serum albumin, positive correlation with UPC.
Serum 24,25[OH]2D – neg correlation with UPC.

Question 19

What is liver-type fatty acid binding protein (L-FABP)?

Is L-FABP excretion increased or decreased in cats with renal disease?

Is L-FABP index correlated with current renal biomarkers?

Answer 19

Katayama JVIM 2020
Cytotoxic oxidation product secreted from renal proximal tubules under ischemia (or low capillary blood flow) & oxidative stress.
In health, L-FABP secreted from the liver into the blood crosses the glomerular barrier and then is reabsorbed by the PT cells, so hardly appears in urine.

Weak correlation with crea, BUN & SDMA; but stronger when serum crea >1.6mg/dL.

Question 20

(T/F) UPCR measurements in urine samples collected at home were similar between at-home and in-hospital samples in healthy dogs.
(T/F) UPCR did not correlate with UCCR (reflecting patient stress) in paired urine samples of healthy dogs.

Answer 20

Citron JVIM 2020
True for both

Question 21

What optimal cutoff urine Ca to creatinine ratio (UCa/Cr) was identified to differentiate Ca-Ox forming vs control male Mini Schnauzers?
What was the sensitivity & specificity for this cut-off?
Does feeding affect this value?

Answer 21

Carr JVIM 2020
** UCa/Cr >0.06**
Spec 93%, 56% sens (false negs - possibly fluctuating hypercalciuria missed in urolith-formers)
(PPV 83%, NPV 78%)
No (post-prandial sampling up to 8hrs not critical).

Question 22

1) State the:
a) Prevalence of systemic hypertension (SH) in dogs with AKI on admission
b) Proportion of AKI dogs with fluid overload (FO)
c) Proportion of AKI dogs with hypertensive retinopathy
d) Proportion of AKI dogs with significant proteinuria (UPCR >0.5)

2) Which of the above factors were:
a) Risk factor(s) for SH development?
b) Correlated with non-survival?

3) What associations were identified between SH & IRIS AKI grade, oligo/anuria, survival to discharge, duration of hospitalization & proteinuria?

Answer 22

Cole JVIM 2020

1)
a) 75%; of which 56% had severe SH (≥180 mm Hg)
b) 42% (FO on admission/during hosp)
c) 16%
d) 77%

2) a) FO on admission
b) Development of FO

3) No associations identified

Question 23

(T/F, state positive or negative)
In cats with azotemic CKD, bacteriuria (based on positive urine culture) when treated with appropriate antibiotics, was associated with:
a) CKD progression
b) Survival

Answer 23

Hindar JVIM 2020
a) F - no sig association
b) F - no sig association

Question 24

a) What 3 clinicopathological parameters should prompt submission of quantitative urine culture (QUC) for proteinuric dogs?

b) What proportion of proteinuric dogs had:
i) Bacteria growth in urine?
ii) Bacteria growth + active sediment?
iii) Missed/unidentified bacteriuria when QUC was not performed based on an inactive sediment?

Answer 24

Grimes JVIM 2020
a) Active urine sediment (OR 11.1), pyuria (OR 25.1), LUT disease (OR 6.7)

b)
i) 6.7%
ii) 4% (60% of proteinuric dogs with bacteria growth)
iii) 1.8% (low!)

Question 25

What % of dogs with proliferative urethritis (PU) had urinary tract infections? Which clinical and/or therapeutic factors were most likely associated with achieving long-term urethral patency?

Answer 25

Emanuel JVIM 2020 73% Lesion effacement by balloon dilatation or urethral stenting. Duration of urethral patency was longer with BD +stent vs BD tx alone (843d vs 452d).

Question 26

What were the differences between immediate compared to delayed plating of urine samples for bacterial C&S?

Answer 26

Coffey JVIM 2020 No sig diff as long as urine samples are stored (refrigerated) & transported appropriately. More discrepancies in plating methods for midstream samples but most were not clinically significant.

Question 27

What are the 2 types of medullary rom sign (MRS) described on renal US in cats? What was association between each type & presence of kidney disease?

Answer 27

Cordella JVIM 2020 MRS-line (thin hyperechoic line with well-defined margins), MRS-band (thick hyperechoic band with ill-defined margins) MRS-band was more frequently associated with KD (74% cats), whereas MRS-line may occur with/without KD (40% cats had KD).

Question 28

What were the top 3 most common aetiologies for acute-on-chronic kidney disease (ACKD) in dogs? (note differences with cats) What following factors significantly associated with short-term and long-term survival? Mortality rate? MST for dogs surviving to discharge?

Answer 28

Dunaevich JVIM 2020 Unknown (45%) > inflammatory (30%) > pyelonephritis (15%) Short-term - IRIS AKI grade & serum crea at presentation; RR & CK activity. NOT aetiology. Long-term - aetiology & serum crea at discharge NOT predictors (cats opposite) 35% mortality Poor long term px. MST 105d (35 & 8 dogs survived up to 6 & 12mths respectively).

Question 29

What were the top 3 most common aetiologies for acute-on-chronic kidney disease (ACKD) in cats? (note differences with dogs) What following factors significantly associated with short-term and long-term survival? Mortality rate? MST for cats surviving to discharge?

Answer 29

Chen JVIM 2020 Unknown (66%) > UO (11%) > renal ischemia (9%)/pyelonephritis (8%) Short term - serum phos Long term - serum crea & presentation & discharge 42% mortality 66 days

Question 30

The administration of endoscopic-guided cross-linked gelatin (VetFoam) SQ injections was ......(effective/ineffective) in achieving continence in female dogs with USMI refractory/not amenable to medical treatment. Continence was achieved in ......% dogs after 1 injection, and .....% dogs, with a mean duration of continence for ........ after 1 injection. Adverse effects were .....(common/uncommon) and included ......

Answer 30

Chen JVIM 2020 Effective 13/15 (87%) dogs 100% (7/7) 11.1 months Uncommon. Self-limiting stranguria, pollakiuria, tenesmus (1 dog)

Question 31

(T/F) Decompressive cystocentesis is a useful method which can reduce time taken & increase ease of urethral catheterisation in cats with urethral obstruction.

Answer 31

Reineke JAVMA 2021 False. DC did not improve time to place urinary catheter or ease of UC in cats with UO.

Question 32

What was the prevalence of vulvar recession in dogs in a study? What clinical features were associated with a higher risk of vulvar recession? (T/F) Dogs with recessed vulvas were at a higher risk of LUT disease or perivulvar dermatitis.

Answer 32

Palerme JAVMA 2020 14% (36/250) dogs. Dogs with significantly higher BCS & BW, spayed status, spayed ≤1yo (3x as likely for vulvar recession). False.

Question 33

What % of dogs with non-traumatic haemoabdomen due to splenic disease & non-malignant histopath findings suffered an adverse outcome & premature death? MST?

Answer 33

Millar JAVMA 2021 17% (9/53) dogs MST 49 days.

Question 34

What condition should be screened for in young-middle aged Bracchi Italiani when presented with inappetance? What is the MST for this condition, and what 3 histologic findings were identified?

Answer 34

Inman JAVMA 2021 Familial proteinuric nephropathy & renal amyloidosis. 50% azotemic (4/8) Prognosis poor - MST 75d (euthanasia) from time of diagnosis. Histo - glomerular amyloidosis (75%), nephrosclerosis (12.5%), non-amyloidotic fibrillar glomerulopathy (12.5%).

Question 35

What biochemical changes were observed in patients with suspect contrast-induced nephropathy post CT angiography? What was the progression of acute kidney injury & response to treatment in these patients?

Answer 35

Griffin JAVMA 2021 Marked elevation in creatinine (260-720%). Azotemia peaks at 2-3d post CT > improves by 3-4d > resolves by ~7d (up to 13d) post exposure. Excellent short term prognosis with supportive care.

Question 36

What microRNA was upregulated in the urine of cats with pyelonephritis? And which pathogen?

Answer 36

Jessen JVIM 2020 miR16 E. coli

Question 37

What microRNA was upregulated in the urine of cats with pyelonephritis? And which pathogen?

Answer 37

Jessen JVIM 2020 miR16 E. coli

Question 38

In a antimicrobial susceptibility study in the mid-western USA, what was the susceptibility profile of E. coli UTI to amoxicillin/amoxy clav in dogs vs cats? Resistance rates to other abx?

Answer 38

KuKanich JVIM 2020 Dogs - E. coli mostly susceptible to clav in dogs (92%), much lower for amoxicillin (53%). Amoxy clav may be a better empirical choice in this region. Cats - not susceptible, attributed to a different breakpoint between species. Higher breakpoints for dog vs cats. Low resistance rates to other abx (

Question 39

What changes in faecal straight & branched short-chain fatty acids (SCFAs) are seen in cats with IRIS Stage 3 or 4 CKD?

Answer 39

Summers JVIM 2019 Higher isovaleric acid concentrations in CKD cats (esp in late stage disease). Branched SCFA [ ] correlated weakly with p-cresol-sulfate [ ] & were higher in cats with muscle wasting (reflecting malassimilation of protein in CKD).

Question 40

What were the effects of IVFT and/or intermittent hemodalysis on SDMA in dogs with IRIS Stage 4 CKD? (Hint: is SDMA dialyzable?)

Answer 40

Le Sueur JVIM 2019 SDMA is a dialyzable biomarker. For every 10% increase in urea reduction ratio = 6.2μg/dL decrease in SDMA. Its clearance is still dependent on renal function & had less post-dialysis rebound effect (cf urea & sCr), so may still be used to monitor renal function in CKD dogs undergoing IH/IVFT.

Question 41

What is the Idexx SediVue highly, moderately vs poorly sensitive for in detecting pathology in cat/dog urine samples?

Answer 41

Hernandez JVIM 2019 Sensitive for RBC, WBC & struvite (sens 85-90%), moderate for CaOx (75%). Moderate-poorly sensitive for epithelial cells (33% for sqEPI, 71% for nsEPI). Highly specific for CaOx & EPI (99%), moderate for struvite (84%), 87-90% for remaining elements.

Question 42

What is the intra-individual variability in a first AM USG in dogs (mean difference between min & max)?

Answer 42

Rudinsky JVIM 2019 0.015

Question 43

What (primary/secondary) hemostatic disorder can be observed in dogs with >/= IRIS grade III AKI? What hemostatic abnormalities identified support this?

Answer 43

McBride JVIM 2019 Primary Type II vwD-like phenotype (low [ ] + abnormal structure) Higher platelet count but decreased collagen-activated platelet aggregation High vWF:Ag:vWF:CBA (von Willebrand factor antigen : collagen binding activity ratio) - *i.e. vWF present but reduced binding/functional activity.* Strongly correlated with sCr. *NB: collagen-binding assay is a useful test for measuring the functional activity of VWF. Assay measures the binding of VWF to collagen and preferentially the HMW VWF multimers - therefore reflects reduction/ absence of larger VWF multimers*

Question 44

What is indoxyl sulfate? What other biomarker is it associated with and what can it predict?

Answer 44

Liao JVIM 2019 Derived from breakdown metabolite of dietary L-tryptophan by colonic bacteria. Protein-bound. Associated with phosphate metabolism & CKD progression in cats. Significantly associated with FGF-23 - both increase concurrently in line with decreasing renal function. Uremic toxin in excess.

Question 45

What are the faecal microbiome changes that occur in cats with CKD? Which metabolic biomarker(s) may change?

Answer 45

Summers JVIM 2019 Reduced diversity & richness of faecal microbiome in CKD cats. Increased indoxyl sulfate (not p-cresol sulfate). No significant differences between stages 2 & 3/4 CKD.

Question 46

What is the optimal needle size to maximize diagnostic yield with renal biopsies? What other patient & procedural factors influence diagnostic yield?

Answer 46

Crivellenti JAVMA 2018 16G, similar yield with 14G but greater than 18G Other factors influencing no. of glomeruli per core specimen - dog age, sCr, degree of proteinuria.

Question 47

What percentage of ureterocoeles are ectopic? How effective is laser ablation? What condition may be associated with stenotic or imperforate ureters Recommended treatment for this condition? Which breed(s) is/are overrepresented with stenotic ureters?

Answer 47

Rogatko JVIM 2019 71% ectopic. JVIM 2018. 71% ectopic. 84% (11/13) had resolution of pollakiuria or incontinence after ablation. Ectopic ureterocele. Cystoscopic-guided laser ablation (surgical conversion needed if cannot extend opening of ureteral orifice). Labrador Retrievers (54% study population, 7/13 dogs) *NB: also predisposed to congenital UVJ stenosis but usually w/o ureterocele *

Question 48

1. What is the incidence of positive urine cultures post-SUB placement/ureteral stenting in cats, and 2. the most common bacterial isolate? 3. Why is this a concern? 4. Describe factors that reduce the risk of post-SUB UTI.

Answer 48

Kopecny JVIM 2019 1. 25% (5/20) of SUBS had positive urine cultures post-SUB/ureteral stenting pre-discharge. 2. Enterococcus spp. (50%; as mono or polymicrobial infections). 3. Most cats with positive urine C&S had signs of pyelonephritis and/or LUT signs. (rather than subclinical) 4. Post-op antibiotics significantly reduced likelihood of positive urine culture. *Positive cultures NOT associated with CKD, renal implant type, post-op urinary catheterization.*

Question 49

When is the recommended age to start screening for CaOx urolithiasis in at-risk canine breeds, based on onset of clinical urolithiasis? What high risk breeds were identified?

Answer 49

Hunprasit JVIM 2019 Median age was 8.4 +/- 2.8 years for onset of clinical CaOx urolithiasis. Screening recommended from 5-6 yo. High-risk: all small dog breeds, total 12. Mini Pin, Pom, Cairn Terrier, Brussels Griffon (OR >3) > Maltese, Lhasa Apso, Chihuhua, JRT, Mini Schnauzer, Yorkie (OR 2-3) > Bichon Frise, Jap Chin (OR 1-2) *(Low-risk: medium-large dog breeds)*

Question 50

What abnormalities in vitamin D metabolism can be seen in a subset of CaOx stone forming dogs?

Answer 50

Groth JVIM 2019 Decreased conversion of 25(OH)D to 24,25(OH)2D --> increased 25(OH)D:24,25(OH)2D ratio - moderate positive correlation with urinary Ca:Cr. *Recap: 25(OH)D = calcidiol. 1,25OH2D = calcitriol. 24,25(OH)2D = less active metabolite of calcidiol & calcitriol.*

Question 51

What % of cats with FIC will have recurrent urethral obstruction within 6 months after discharge? Is this incidence improved by meloxicam administration?

Answer 51

Nivy JVIM 2019 24%. No (not in this study) - NB: meloxicam dose used was low dose @0.025mg/kg PO SID for 2 wks post discharge, in addition to phenoxybenzamine & alprazolam.

Question 52

Which cytokines/chemokines were increased in cats with acute idiopathic cystitis compared to healthy controls?

Answer 52

Parys JVIM 2019 All pro-inflammatory: **CXCL12, IL-12, IL-18, Flt3L** (fms-related tyrosine kinase 3 ligand) *May be potentially useful non-invasive biomarkers for diagnosis, staging & tx outcome monitoring of FIC cats - but more studies needed.*

Question 53

What is an alternative to cross-linked collagen injections for USMI in dogs? What is the reported success rate?

Answer 53

Lüttmann JSAP 2019 Dextranomer/hyaluronic acid copolymer injection (another urethral bulking agent). 58% success rate at 6mths (71% for X-linked collagen) Median duration of continence ~20mths (vs 48mths for X-linked collagen)

Question 54

What factors are associated with duration and severity of post-obstructive diuresis (POD) in cats with ureteral obstruction undergoing stenting or SUB placement? Overall survival rate?

Answer 54

Balsa JAVMA 2019 - Pre-sx renal values (sCr, BUN), K+ & PO4 - associated with POD intensity & duration. - Absolute change pre & post-op of BUN/crea & K - associated with POD duration. - Anuria pre-sx associated with longer period of POD. - (No diff in POD duration/severity with uni vs bilateral UO) 92% survived to discharge (50% of this had resolved azotemia by then)

Question 55

What are the clinical consequences of high dietary phosphate intake in cats?

Answer 55

Laflamme JVIM 2020 (Review) High amt of soluble P (in particular inorganic P) & low Ca:P ratio (<1:1) in diet have been associated with progressive renal damage in cats.

Question 56

What is the impact of a) HCM & b) diabetes mellitus on SDMA in cats? Was there an association between DM & CKD in cats?

Answer 56

Langhorn JVIM 2018 a) No changes for HCM compared to healthy controls. b) DM cats significantly lower SDMA - caution when interpreting renal function in this population of cats. Pérez-López JVIM 2019 Yes. CKD cats had increased assocation with DM (OR 4.47)

Question 57

What differences in RAAS are there between greyhounds & non-greyhound breeds?

Answer 57

Martinez JVIM 2017 Greyhounds had no difference in basal RAAS activation (plasma renin, ACE activity) vs other breeds. BUT did have lower aldosterone concentration, likely an appropriate response to higher BP & Na concentration (where ATII effects in the renal tubules predominate over aldosterone). Also have higher creatinine & SDMA vs other breeds.

Question 58

SDMA & creatinine: - Which is more reliable for sequential patient monitoring? - What about use of population RI?

Answer 58

Kopke JVIM 2018 Creatinine was recommended to be used with sequential measurements. SDMA better suited to population based RI. *(False-negatives could occur when comparing a single test result from an individual to such RIs). An individual’s homeostatic set point is derived from the mean & CI of the test variable with repeat measurements.*

Question 59

What is the association between cTnI & BNP with GFR in dogs? How does this affect clinical interpretation in healthy vs stable CKD dogs?

Answer 59

Pelander JVIM 2017 No independent associations between either parameter with GFR. Increased circulating cTnI & NT-proBNP [ ] can be interpreted similarly in stable CKD vs non-CKD dogs.

Question 60

How is plasma FGF-23 concentration associated with CKD severity? What are the strongest predictors of FGF-23 concentration in dogs?

Answer 60

Harjes JVIM 2017 FGF-23 increases with CKD severity (sig higher in stages 3/4 vs 1/2). Creatinine & phosphorus.

Question 61

Can SDMA differentiate between CKD & AKI in dogs?

Answer 61

Dahlem JVIM 2017 No, but SDMA/creatinine ratio is higher in CKD cf AKI dogs.

Question 62

Is urine/serum Cystatin C a useful biomarker in cats with CKD? What is it trying to predict? Is serum cystatin C reliable in assessing renal function in hyperT cats?

Answer 62

Ghys JVIM 2016 Proteinase inhibitor, produced in all nucleated cells at a constant rate (responsible for intracellular protein catabolism). Biomarker for tubular damage in people & dogs. To predict GFR. Not useful as insensitive - could not reliably distinguish healthy from CKD cats or reduced GFR. Also uCysC not detectable in 100% CKD cats in this study. Williams JVIM 2016 No. *sCysC did not change significantly pre & post hyperT tx. Also not sig diff between non-hyperT CKD cats & healthy older cats, or hyperT cats that rmained non-azotemic vs developed azotemia 4mths post tx.*

Question 63

How did the diagnostic performance of serum cystatin C compare to sCr & SDMA to detect GFR reductions in clinically stable dogs?

Answer 63

Pelander JVIM 2019 Overall diagnostic performance of sCr (Sp 90%) & SDMA (Sp 87%) were similar (Sn 90% for both), but cystatin C was inferior to both (lower Sp 72% for similar Sn 90%).

Question 64

Are UPCs on single, averaged, or pooled measurements (over 3 days) comparable in PLN dogs?

Answer 64

Shropshire JVIM 2018 Overall methods are comparable. More variability at UPC 4+ but clinical relevance unknown. At UPC <4, there was variability but according to authors, was not considered a true difference (change must >80% to be clinically relevant).

Question 65

Are there significant differences in renal pelvis widths amongst cats with CKD, pyelonephritis & ureteral obstruction on US?

Answer 65

Quimby JFMS 2017 Between CKD & pyelo: no significant differences in renal pelvis widths, but sig diff proximal ureteral widths. Between UO & CKD: UO had greater renal pelvic & proximal ureteral widths. Between UO & pyelo: no sig diff in renal pelvis & proximal ureteral widths.

Question 66

How reliable is the presence of ureteral dilation on US for detection of ureteral obstruction (UO) in cats? Did Sn/Sp differ with different aetiologies for UO? How does US compare with antegrade pyelography for the diagnosis of UO in cats?

Answer 66

Lemieux JVIM 2021 Feline UO may be associated with minimal RP dilation (8% cats had RP dilation

Question 67

What is the effect of AKI on cPLI, TLI & lipase in dogs?

Answer 67

Hulseboch JVIM 2016 AKI did not consistently change these parameters (did not correlate with sCr elevations); though in some dogs there were variable increases.

Question 68

What are the diagnostic & prognostic utilities of FE of Na in dogs with volume-responsive vs intrinsic AKI?

Answer 68

Troia JVIM 2018 FE (Na) was: - Higher in I-AKI cf VR-AKI - good for early differentiation. *(in this study FE(Na) was actually not sig diff between VR-AKI & contorl non-AKI dogs*) - Higher in non-survivors (along with other risk factors: AKI IRIS grade, UOP) - In another paper, was predictive of renal recovery (as it reduces)

Question 69

What was the effect of fenoldopam on HEALTHY dogs?

Answer 69

Kelly JVIM 2016 Significantly increased GFR & FeNa (cf D5W). No AE recorded in this study.

Question 70

Fenoldopam - MOA? Did a CRI have effect on a) renal parameters, and b) improving survival in dogs with AKI associated with heatstroke?

Answer 70

Segev JVIM 2018 Dopamine 1 receptor agonist. Theoretically increases GFR & renal blood flow via direct vasodilation. No to both a) and b). No sig diff in UOP, GFR & NaFE between tx & placebo groups. No sig diff in mortality rates between tx & placebo groups (30-40%).

Question 71

Is a CPLI >/= 400ug/L prognostic in dogs undergoing intermittent hemodialysis (IHD) for AKI?

Answer 71

Takada JVIM 2018 High prevalence (62%), but no sig associations with survival or IHD-dependency at 30 days (though study could be underpowered).

Question 72

Vitamin D metabolites are decreased in which stages of CKD in dogs? Which renal parameters were negatively correlated with vit D metabolite concentrations?

Answer 72

Parker JVIM 2017 Sig lower in stages 3 & 4 (no sig diff in 1 vs 2). PTH, FGF-23 & phosphorus concentrations.

Question 73

Calcitonin - roles & what stimulates its release? Do blood calcitonin levels impact iCa levels in CKD cats?

Answer 73

Van den Broek JVIM 2018 Calcitonin is released by C-cells of the thyroid gland response to increased serum iCa. Role in preventing hyperCa by inhibiting bone turnover (Ca release) & renal reabsorption. No. *(no apparent impt role in Ca metabolism in CKD cats)*

Question 74

What acute phase proteins (APPs) & iron status derangements may be seen in cats with CKD? Did these changes correlate with survival?

Answer 74

Javard JVIM 2017 Overall CKD results in functional iron deficiency (altered metabolism due to systemic inflammation). CKD cats had: - Increased hepcidin & SAA (positive correlation with sCr) - Decreased TIBC & total iron. - CKD cats that were anemic (37%) had sig lower TIBC. No association between survival time & APP, iron status, or EPO concentrations.

Question 75

What ultrasonographic index may help distinguish healthy cat kidneys from kidneys with CKD?

Answer 75

Matos JFMS 2017 Resistive index (only need evaluation of 1 kidney). Increased, cut off 0.639 for preliminary diagnosis of CKD. Tipisca JFMS 2016 Found in contrast that RI can differ between 2kidneys, but did not change with age. Found increased RI with CKD, AKI, PCKD, renal neoplasia.

Question 76

What was the effect of feeding a moderate protein & phos-restricted diet on phos homeostasis in healthy older cats?

Answer 76

Geddes JVIM 2016 - Sig effect of diet on plasma PTH, FE(PO4) & iCa (not crea, plasma PO4 or FGF-23). - Stable PTH levels (PTH levels increased over time in control diet). - No treatment effect on the onset of azotemic CKD in this study.

Question 77

Are there differences in effects between 6% tetrastarch vs LRS on AKI markers (NGAL & sCr) or extravascular lung water in experimentally haemorrhaged dogs?

Answer 77

Diniz JVIM 2018 No difference in AKI markers between groups. Tetrastarch dogs had less extravascular lung water but no difference in ppO2 between both groups.

Question 78

Which urinary markers are associated with immune-mediated glomerulonephritis? Which 3 biomarkers were significantly associated with survival in these dogs?

Answer 78

Hokamp JVIM 2016 **Urine IgM:Cr & urine NAG:Cr (Sn 75%, Sp 78% within population of proteinuric dogs). ** *Neutrophil gelatinase-associated lipocalin (NGAL) & urine N-acetyl-b-D-glucosaminidase (uNAG) are markers of renal tubular damage* *FE (IgG) & FE (IgM) correlated best with glomerular damage based on LM. sCr correlated best with tubular injury.* **SCr, FE (IgM) & glomerular damage based on transmission electron microscopy (TEM)**.

Question 79

What is hydroxyethyl starch (HES) & its main indications? Is there an association between HES and AKI in dogs vs cats?

Answer 79

Sigrist JVIM 2017 (dogs) Colloid - increases colloid osmotic P, SBP, blood volume. Indications - hypovolemia, hypotension, peri-op IVFT, low colloid osmotic P, hypoalbuminemia. HES treated dogs were not significantly more likely to develop AKI or have a different AKI grade. But** no. of days HES treatment was given was associated with increase in AKI grade within 10 days.** So duration of HES tx should be kept short. Sigrist JVIM 2017 (cats) Non-azotemic critically ill cats. HES treated cats not more likely to develop AKI or have development of more severe serum creatinine increases. **HES dose & duration (# days) did not appear to be risk factors for AKI development in this study.**

Question 80

Feline morbillivirus (FMBV) is an enveloped/non-enveloped, single/double-stranded, ....virus (which family). What renal pathology can feline morbillivirus (FMBV) cause in cats? Was an association between FMBV & CKD identified in a UK population of cats?

Answer 80

McCallum JVIM 2018 Enveloped, single-stranded, negative RNA, paramyxovirus. Tubulointerstitial nephritis. In this study, seropositivity was not different between azotemic vs non-azotemic cats.

Question 81

What is the association between Mg and FGF 23 in cats with CKD? Prevalence of hypoMg in CKD cats?

Answer 81

Van Den Broek JVIM 2018 Inverse association. Hypomagnesemia was associated with higher plasma FGF-23 & increased risk of death. OR 2.74. 12% *NB: study measured tMg not iMg*

Question 82

What is the MOA of Beraprost? Effects of this drug on cats with CKD based on a placebo controlled trial?

Answer 82

Takenaka JVIM 2018 Beraprost = prostacyclin analogue (vasodilator & platelet aggregation inhibitor). *(Prostacyclin is primarily produced by vascular endothelial cells. Impt role in maintaining cardiovascular & renal vascular homeostasis. Used to treat PAH in humans.)* Theoretical benefit is renoprotection, inhibition of inflammatory mediators & renal endothelial & tubular apoptosis (addresses renal hypoxia in the pathogenesis of CKD development). BPS treated cats: - Didn’t experience increased sCr over 180d (whereas placebo cats did) - indicating inhibition of reduced GFR. - Did not have increased PO4/Ca ratio (whereas placebo cats did).

Question 83

What is the association between plasma FGF23 & SDMA in non-azotemic geriatric cats?

Answer 83

Sargent JVIM 2019 More cats with increased SDMA had higher FGF23 cf cats with normal SDMA --> suggests alteration in phosphate homeostasis. Potential utility of FGF23 in influencing management of cats with early CKD.

Question 84

What was the efficacy (% of CKD dogs) achieving a PCV of 30%+ with darbopeitin? What’s the minimum frequency of administration? What was the incidence of adverse effects (name 5)?

Answer 84

Fiocchi JVIM 2017 85% dogs achieved 30%+ PCV (~29 days to reach target PCV). Minimum q21 days to maintain response to tx. Systemic hypertension (36%), seizures (15%), V+ (9%), D+ (9%), suspected PRCA (6%).

Question 85

What can happen to the appearance of the bladder wall on ultrasound after cystotomy?

Answer 85

Mariano JAVMA 2018 50% of dogs in this study had persistent thickening of the cystotomy site up to 12wks post-sx (but were subclinical). 61% had reoccurrence of hyperechoic foci within the bladder (~17d post sx).

Question 86

Rate of survival to discharge for dogs with uroabdomen undergoing either sx or medical management? What peri-operative factors were associated with non-survival?

Answer 86

Grimes JAVMA 2018 79%. Development of intra/post-op complications (hypotension most common intra-op, 53% post op complications) No pre-op factors (esp sCr at admission)

Question 87

Are acidic urine & presence of CaOx crystalluria reliable predictors of CaOx uroliths in dogs? What two UA abnormalities were commonly observed in CaOx dogs?

Answer 87

Kennedy JAVMA 2016 No; CaOx urolith cases infrequently had either of these two variables present. Hematuria & proteinuria.

Question 88

1. What were the rates of a) peri-operative complications & b) mortality in cats undergoing ureteral surgery (ureterotomy or neoureterocystostomy) & ureteral stenting? 2. Which group of cats were more likely to experience LUT signs and/or recurrent obstruction long term? 3. Any risk factors for post-operative mortality identified?

Answer 88

Wormser JAVMA 2016 1. a) 14% (stent) vs 3% (sx) b) Similar (8-9%); also similar MST 2. Chronic LUT signs & LUTI significantly more common in stent cats. Neither for reobstruction; similar incidence in both groups (22%). Culp JAVMA 2016 Benign UO cats undergoing stenting more likely to have sig decreases in sCr & BUN at 1days post op; and resolution of azotemia before discharge (vs ureterotomy alone). 3. Cats more likely to develop abdominal effusion post-ureterotomy (vs stent) - associated with non-survival in this study.

Question 89

Why is placement of ureteral bypass devices preferred to double pigtail ureteral stents to treat cats with UO? Most common long term complication in SUB cats? What was 1 risk factor associated with SUB device occlusion (in a separate study)?

Answer 89

Deroy JAVMA 2017 UB device placement was associated with - Shorter duration of sx & hospitalisation - Lower complication rate - LUT signs (hematuria, pollakiuria, stranguria), risk of device occlusion (4% UB vs 26% stent) - Lower risk of requiring additional procedures to treat complications (9% in UB - UB occlusion & urethral obstruction; vs 44% in stents - uroabdomen, stent occlusion, refractory cystitis). - Longer survival time Similar peri-op mortality rates (18% stent, 13% UB). Berent JAVMA 2018 (concluded SUB device placement is a viable option for cats with benign UO, with 94% survival to discharge. **Catheter mineralisation** most common long-term complications (24%) at ~460days post SUB placement. **High post-op iCa** significantly associated with SUB device occlusion. NB: Cray JAVMA 2018 Case series (4 cats). Renal pelvis lavage with SUB device placement successful to treat cats with obstructive pyonephrosis. Borchert JAVMA 2018 Bilateral SUB placement + mass resection successful for treating bilateral UO secondary to retroperitoneal paraganglioma in a cat.

Question 90

What interventional renal-sparing technique could be considered for removal of complicated nephroliths in dogs & cats? What complications were observed?

Answer 90

Petrovsky JAVMA 2019 Endoscopic nephrolithotomy (ENL). 93% (15/16) were nephrolith free post procedure. Renal puncture-associated hemorrhage (required transfusion), renal capsule tear, ureteral puncture - all managed without complications/deaths.

Question 91

What intrathoracic pathology may be (uncommonly) associated with urinary tract obstruction in cats?

Answer 91

Duffy JAVMA 2017 Pleural effusion (transudate, non-chylous lymphatic effusion documented in a cat). Resolved after removal of hydronephrotic kidney.

Question 92

Is presence of urolithiasis associated with presence & severity of CKD in cats?

Answer 92

Cléroux JAVMA 2017 Positive association with CKD presence - should evaluate for CKD in cats with urolithiasis. But no associations between urolithiasis & CKD stage; or between CKD presence & location of nephroliths.

Question 93

What are some risk factors for USMI in female dogs?

Answer 93

Byron JVIM 2017 Heavier BW (25kg+) Neutering For dogs >25kg - age at neutering (decrease in hazard for every month of delay in neutering) Median time from neuter to incontinence = 3.7yrs.

Question 94

What is the incidence of 30-day recurrence of obstructed FLUTD in cats that received an indwelling U-cath vs those that were treated as outpatients? What factor was associated with recurrence in the indwelling group?

Answer 94

Seitz JAVMA 2018 LOWER recurrence with indwelling U-cath (11%) cf outpatient (31%). Increasingly abnormal urine colour at time of U cath removal was associated with recurrence.

Question 95

Is ureteral stenting a viable option for DOGS with benign UO? What major complication should be monitored for post-stenting?

Answer 95

Pavia JAVMA 2018 Yes (either endoscopic or surgical). Success rates: endoscopic 82% (45/55), surgical 100% (10/10) UTI (pre-stent 59%, post stent 26%)

Question 96

What is the reported incidence of bacteriuria pre & post catheterisation in obstructed male cats? Is empirical antibiotic administration warranted?

Answer 96

Cooper JVECC 2018 0% pre & 13% post (at 24hrs). Streps > Pasteurella. No.

Question 97

What is Tavocept? Indications?

Answer 97

JVIM 2018 Water soluble form of mesna. Converted to mesna in the kidneys, then inactivates toxic platinum species. May be given with cisplatin to reduce to diuresis time required from 6 hours to 90 minutes while also reducing occurrence of azotemia.

Question 98

How is US monitoring of the renal pelvis in SUB cats useful?

Answer 98

Fages JFMS 2017 Renal pelvic distension is at least partially reversible after SUB placement. Pelvic width 3.5mm+ may indicate post-SUB obstructive complications.

Question 99

What is the proper disease name for 'Alabama Rot'? - Classic histo findings & main ddx? - Pathogenesis? Risk factors? - Clinical manifestations? - Diagnostic methods?

Answer 99

Jepson VCNA 2019 Cutaneous & renal glomerular vasculopathy (CRGV) Form of **thrombotic microangiopathy (TMA)** on histo. Initial vascular lesions that include endothelial cell swelling, detachment, and microthrombosis --> microangiopathic hemolytic anemia. **Ddx for TMA = hemolytic uremic syndrome (but no skin lesions). Other ddx = thrombotic thrombocytopenic purpura (TTP), neoplasia, drug-induced (chemo vs others), renal transplant, sepsis, DIC.** Pathogenesis: - Unknown! No infectious cause identified to date. Risk factors: - Seasonal outbreaks (UK) - Nov-May in the UK. - Woodlands/lowland areas? - Hounds (esp Greyhounds), gun dogs, pastoral dogs. - Flat-coated retriever, Hungarian Vizsla, Manchester terrier, Saluki, Whippet, English springer spaniel, Bearded collie - Females, neutered CSx: - Typically **ulcerated skin lesions affecting distal limb (77%) **esp interdigital spaces, body (20%), face/muzzle (7%), tongue (4%). - Skin lesions usually apparent before systemic signs. - Range from small superficial abrasions (0.5 cm) to large full-thickness ulcerated & necrotic lesions (>30 cm), with surrounding bruising & oedema. - Progression to oligoanuric AKI within ~4 days. Subclinical possible. - Classified into 4 groups a) Skin lesions w/o systemic signs, non-azotemic (?%) b) Skin lesions + pyrexia, followed rapidly by azotemic AKI (19% cases) c) Skin lesions + azotemic AKI within 10 days (60% cases) d) Azotemia before skin lesions (1%) Dx - Histo of renal bx gold standard - TMA (usually PM diagnosis) - Routine bloodwork + UA - Blood smear may show microangiopathic hemolysis (Burr cells, acanthocytes, schistocytes) - Biochem: +/- azotemia, elevated LE, TBIL, CK - Elevated spec CPL (79%) - UA: usually NSF; +/- proteinuria, Hb/RBC, glucosuria, granular/hyaline casts - Oligoanuria (70% cases) - AUS: usually non specific (may reflect AKI), peritoneal effusion (if vol overloaded or bleeding) - Skin bx histo: may be helpful, but usually non-specific ischemia/ ulceration, may see evidence of TMA.

Question 100

'Alabama rot' - Treatment? - Prognosis?

Answer 100

Jepson VCNA 2019 Tx - Manage as per AKI - limit further damage, enhance cell recovery (correct fluid/electrolyte/AB disorders, maintain normotension (**hypertension common**, maintaining UOP). - Immunosuppressive tx - successful in 1 dog but needs more research; used in people. - Anti-platelet tx - not if clinical bleeding, severe thrombocytopenia - Wound management - avoid sedation/GA. Sterile dressing. Debridement rarely needed. Analgesia. Sample skin for cytology & culture - however systemic abx is contraindicated if no clincial signs indicating infection even if cyto/culture positive. - Renal replacement therapy - may extend tx for several weeks but not shown to improve survival w/o other specific tx. - Eculizumab (monoclonal antibody) - no evidence in dogs, successful as immunomodulator in atypical HUS in humans but $$$$. Binds to C5 to impair hydrolysis & subsequent complement activation. - TPE: Successful in improving survival rates in people with TTP & anti-ADAMTS13 autoantibodies, best in EARLY disease. Trialled in dogs with severe CRGV (case series) but lack of controlled study design so unknown if truly beneficial (2/6 dogs did survive though). Prognosis - Excellent for NON-AZOTEMIC CRGV - Fair with intensive management (83% survival in USA study), 100% survival in dogs with development of azotemia BEFORE skin lesions. - Poor - 100% mortality in dogs with dvpt of azotemia AFTER skin lesions (multiple studies; US & UK). - High mortality once develop oliganuric AKI, but survival possible with intensive care.

Question 101

What did contrast-enhanced US identify in the kidneys of cats with CKD, and what does it reflect?

Answer 101

Stock JVIM 2018 Longer time to peak & shorter mean transit times for the renal cortex --> indicate decreased blood velocity & shorter total duration of enhancement, likely due to increased vascular resistance. Contrasting findings for renal medulla - a shorter time to peak. In theory indicates increased blood velocity; unclear cause but authors propose different regulatory factors in medulla vs cortex.

Question 102

What is ASB E coli 2-12 and what are its clinicial benefits?

Answer 102

Segev JVIM 2018 ASB = asymptomatic bacteriuria (E coli). Live biotherapeutic product. Reported to have anti-infective & visceral analgesic effects in rodent models & people. Administered as infusion via U cath into the bladder (10^10 CFU/mL). Did not cause LUT signs in research dogs. In dogs with recurrent UTI, 4/9 had complete clinical cures, of which 3 had microbiological cure at D14. No major AE, 2 dogs had mild self-limiting hyporexia.

Question 103

What is the incidence and risk factors for subclinical bacteriuria in older, non-azotemic cats? What is the impact on survival?

Answer 103

White JVIM 2016 Prevalence 10-13% in cats 7yo +. Being female was a risk factor (OR 21.2). No association with survival.

Question 104

What is the incidence for bacteriuria in chronically paralyzed dogs? Did this impact survival?

Answer 104

Rafatpanah Baigi JVIM 2017 74% 1+ positive urine culture, 27% recurrent bacteriuria. Uncommonly caused pyrexia. Positive cultures associated with pyuria, but not cloudiness. No association with survival.

Question 105

What is the proposed mechanism of action for cranberry extract for E coli UTI? What is the benefit of cranberry extract for reducing the risk of bacteriuria in dogs with IVDD?

Answer 105

Olby JVIM 2017 Contains PACs (proanthocyanidins), which inhibit adhesion of type I & P-fimbriated uropathogenic bacteria (esp E coli) to uroepithelium. No benefit of oral cranberry in preventing bacteriuria. Did not impact urine anti-adhesion activity, BUT UAAA was associated with lower risk of E coli UTI in these dogs.

Question 106

What is the incidence of antimicrobial resistance (AMR) in E coli-associated UTI in dogs based on a surveillance study in Saskatchewan, Canada? What mechanisms of AMR were identified?

Answer 106

Courtice JVIM 2021 20%. Resistance to ampicillin most common (14.9%). Mechanisms: - β-lactamases (12 isolates) - Extended spectrum beta-lactamase (ESBLs) (7 isolates) - 3rd gen cephalosporin resistance - Plasmid-mediated quinolone resistance (PMQR) gene (1 isolate) - ST131 strain (1 isolate) - commonly associated with MDR

Question 107

What is the incidence of antimicrobial resistance (AMR) in E coli-associated UTI in dogs based on a surveillance study in Saskatchewan, Canada? What mechanisms of AMR were identified?

Answer 107

Courtice JVIM 2021 20%. Resistance to ampicillin most common (14.9%). Mechanisms: - β-lactamases (12 isolates) - Extended spectrum beta-lactamase (ESBLs) (7 isolates) - 3rd gen cephalosporin resistance - Plasmid-mediated quinolone resistance (PMQR) gene (1 isolate) - ST131 strain (1 isolate) - commonly associated with MDR

Question 108

What assay can be used to detect biofilm in E coli UTI? What % of E coli isolates causing UTIs can form biofilms? Do these biofilm forming E coli have any distinct clinical features?

Answer 108

Kern JVIM 2018 Crystal violet assay. 52.6%. None identified in this study. Impt to consider potential biofilm formation in all E coli UTI cases. Biofilm-forming E. coli had a lower likelihood of MDR.

Question 109

What were the characteristics of dogs with pyelonephritis in Canada?

Answer 109

Bouillon JVIM 2018 0.4-1.3% prevalence (PM exams). CSx inappetence (57%), lethargy (51%), vomiting (36%), dehydration (25%). 75% had co-morbidities. Could be acute (26%), subacute (19%) or chronic (55%). Mild (15%) to severe (61%). Fever was associated with subacute pyelonephritis. E coli most common isolate. **38% had no UTI signs.**

Question 110

What urine conditions favour E coli growth?

Answer 110

Thornton JVIM 2018 Favours neutral to acidic & dilute urine. Lowest growth in concentrated, alkaline urine. Need to assess impact of non-alkalizing diluting diets on incidence of E coli LUTI.

Question 111

What are the clinical features of Corynebacterium urealyticum UTI? What disease can it cause? What is an important lab consideration when submitting urine in patients with suspected disease? *Bonus question* What oral medication can be considered to alter urine pH in these animals?

Answer 111

Maurey JSAP 2019 Alkaline urine, urease-producing so struvite crystalluria. Risk factors: pre-existing urinary disorders (previous urologic sx, LUT or prostatic disease, neurogenic UI), urethral catheterisation. Can be associated with **encrusted cystitis**. MDR resistance common. Negative routine urine culture (fastidious bacteria) - need overnight incubation with blood agar + culture 72hrs+ to improve yield. PO L-methionine for urine acidification.

Question 112

What is the microbiome composition of urine in healthy dogs? What findin was associated with bacterial communities in urine?

Answer 112

Melgarejo JVIM 2021 Low presence of bacteria and/or fungi, identified on next-generation sequencing molecular diagnostics but not routine culture. Struvite crystals.

Question 113

(2 papers) What is the impact on processing delay and transport on quantitative bacterial culture? What about the impact of refrigeration?

Answer 113

Patterson JAVMA 2016 When stored at 4degC for 24hrs, urine samples from silicon coated tubes (STT) had higher bacterial yield. When stored at room temp for 24hrs, urine transport tubes (UTT) were superior. STT at room temp for 24hrs reduced to less than the cutoff for significant infection (>1000CFU/mL for cysto samples). Thus when prolonged storage 24hrs+ is anticipated at room temp, UTTs should be used. Acierno JAVMA 2018 Recc immediate submission of urine samples for bacterial culture. CFU counts for refrigerated and immediately processed samples were stat similar in this study, but sample refrigeration in enrichment broth resulted in imperfect sensitivity for UTI detection (sig lower CFU counts & lower Sn of 89% vs 95% without broth), thus not recommended.

Question 114

What was the Sn/Sp of a commercially available POC compartmentalized urine culture and antimicrobial susceptibility test plate (CCSP) to detect UTI in dogs?

Answer 114

Uhl JAVMA 2017 Sn 93%, Sp 100%. Limitations of the CCSP method included inaccuracy of some abx susceptibility test results (matched with reference cultures for only 39% isolates) & failure to correctly identify bacteriuria in 7% dogs.

Question 115

What is XX sex reversal? What developmental anomalies & clinical signs have been associated with XX sex reversal in dogs?

Answer 115

Yoon JVIM 2018 Discordance between the XX karyotype, gonad & genital phenotypes. Urogenital anomaly (in this case hypoplastic testes without spermatozoa, a uterus & ambiguous external genitalia). Urinary incontinence.

Question 116

(2 papers) What are F2-isoprostanes (IsoPs)? What sample is best for measurement? Were urinary IsoPs associated with CKD stage in cats? What about its utility in differentiating urinary carcinoma from other LUT disease in dogs?

Answer 116

Biomarker of oxidative stress/injury. Formed by non-enzymatic, free radical-catalyzed lipid peroxidation of arachidonic acid. Measure in urine - more stable cf plasma. Whitehouse JVIM 2017 Yes, urinary IsoPs are significantly higher in EARLY CKD (stage 1) cats, and decreased with advancement of each stage. Inverse correlation with sCr. Studies needed to determine whether early antioxidant treatments have a protective effect on CKD progression. Woolcock JVIM 2020 Urinary IsoPs not useful in differentiating UC from other LUTD, but were higher in dogs with all causes of urinary dz cf healthy dogs.

Question 117

What is urine neutrophil gelatinase-associated lipocalin (NGAL)? What is its association with CKD progression in cats?

Answer 117

Wang JVIM 2017 Glycoprotein expressed by neutrophils (usually found within granules), many epithelial cells & tubular cells of PT, LOH & CDs. Primary function possibly binding of extracellular iron. Yes, both urinary NGAL & urinary NGAL to creatinine ratio (UNCR) are useful markers to predict CKD progression in cats. Both sig higher in CKD cats (cf healthy) & highly correlated with sCr. UNGAL cut-off of 2.06ng/mL had 76% Sn & 75% Sp. UNCR cut-off of 4.08 x10^(-6) had 76% Sn & 79% Sp. Cats with UNCR > cut-off had faster deterioration (median 19d),

Question 118

Is urine neutrophil gelatinase-associated lipocalin (NGAL) associated with CKD progression in dogs?

Answer 118

Kim JVIM 2019 Yes, UNGAL higher in progressive CKD vs stable CKD dogs. No sig diff between pre-renal azotemia & stable CKD dogs.

Question 119

Urine NGAL to creatinine ratio (UNCR) is a useful biomarker in acute nephrotoxicosis caused by what in dogs? How was it useful?

Answer 119

Palm JVIM 2016 UNCR = early marker of gentamicin-induced AKI (based on 7x increase by D16) vs >50% incr in sCr. uNGAL incr earlier than UNCR (D11 vs D19) but changes overall paralleled UNCR. UNCR also decreased 2d earlier cf sCr at onset of renal recovery.

Question 120

What is the Sn/Sp for increased total Ca in CKD cats for predicting ionized hyperCa? What bloodwork parameter may cause underestimation of tCa, and why?

Answer 120

Van den Broek JVIM 2017 Sp 100%, low Sn (9.1% non-azotemic, 27% azotemic) CKD cats had 4.29 HR for total hyperCa vs non-azotemia cats. Lower venous HCO3- associated with underestimation. - Higher HCO3 expected to increase tCa by stimulating tubular Ca reabsorption & increased protein binding.

Question 121

How did serum gastrin/gastric pH concentrations compare between CKD cats & healthy controls? What therapeutic implication does this finding have?

Answer 121

Tolbert JVIM 2017 No sig diff in both. CKD cats may not need acid suppression - need more studies to determine if there is clinical benefit.

Question 122

What is the proposed benefit of mesenchymal stem cell therapy in stage III CKD cats? How is this delivered & what was the short term outcome for these cats?

Answer 122

Thomson JVIM 2019 MSCs have a 'homing' ability - travel via circulation to sites of inflammation, attracted by cytokines and chemokines released from injured tissue --> create anti-inflammatory, pro-angiogenic, anti-fibrotic, and anti-apoptotic effects within the local tissue environment by releasing growth factors, cytokines, and chemokines --> provide trophic support for damaged tissue, helps regeneration and differentiation of injured cells --> tissue recovery. Adipose tissue harvested from individual cats to grow MSCs. Delivered into renal artery via femoral/carotid a. under fluoroscopic guidance. Study is in phase I clinical trial, only had FU of 3 months. Variable changes in renal parameters at D90 (but small sample no & short FU). No AE noted.

Question 123

What 4 parameters are included in an advanced machine learning model for predicting CKD in cats? How sensitive/specific was the model and were this influenced by timeframe before onset of disease?

Answer 123

Bradley JVIM 2019 Crea, BUN, USG, age. Higher Sn near point of diagnosis (90%), decreased to 63% 1 yr before & 44% 2 yrs before dx. Sp remained simlar 98-99% throughout different timepoints.

Question 124

What is thymidine kinase 1 (sTK1)? What is its utility in identifying or monitoring dogs with naive/relapsed LSA?

Answer 124

Boyé JVIM 2019 Marker of cellular proliferation; increases markedly after G1-S transition of cell cycle > declines rapidly in G2. sTK1 activity >20Du/L in 88% dogs with LSA; sig lower in dogs with CR vs PR. Also useful to detect relapse/dz progression (5x increase in sTK1 when monitored q4wks had Sp 94% but Sn 50%)

Question 125

What procedure/technique can be attempted to salvage mineralised SUB devices prior to SUB device replacement?

Answer 125

Chik JVIM 2019 Infusion of 1-2mL 2% tetrasodium ethylenediaminetetraacetic acid (tEDTA) solution into SUB after drainage & irrigation using sterile saline. 100% (8/8) had resolution of mineralisation with 1st flush. 2/8 cats reobstructed but resolved after additional tEDTA, 1 cat needed SUB replacement.

Question 126

Based on a questionnaire study, what risk factors for development of azotemic CKD in cats were identified?

Answer 126

Finch JVIM 2016 Annual/frequent vax, moderate-severe dental disease (more studies needed to explore pathophys)

Question 127

Which 2 measurements predicted GFR during development of an estimated GFR formula in cats? Was this formula comparable or more reliable than serum creatinine?

Answer 127

Finch JVIM 2018 Pelvic circumference, reciprocal of creatinine. No, not reliable.

Question 128

How long before diagnosis of CKD can weight loss be detected in cats? Is this prognostic?

Answer 128

Freeman JVIM 2018 Weight loss noted up to 3 years before CKD diagnosis, accelerated within 1 yr before CKD dx. Yes, shorter survival.

Question 129

Describe the MOA, indications, AE for the following drugs: - Carbachol - Alfuzosin - Baclofen

Answer 129

Hu JVIM 2016 Review Carbachol - similar to bethanechol. Parasympathomimetic drug (Pelvic n.). Tx bladder atony --> promote detrusor contraction & urine voiding. Alfuzosin - similar to prazosin - bind to alpha receptors in bladder wall s.m. (alpha-sympatholytic drug). Tx bladder atony, promote relaxation of IUS, assist urine voiding. AE - Baclofen - GABA-derived striated muscle relaxant. Tx bladder atony, promote relaxation of EUS. Narrow therapeutic index. GI signs, salivation, pruritus, weakness; seizures & hallucinations (reported with abrupt withdrawal)

Question 130

What is a potential surgical tx option for dogs with neurogenic LUT dysfunction following spinal cord injury? What % of dogs had improved voiding efficiency?

Answer 130

Hu JVIM 2016 Sacral neuromodulation (ventral root stimulation). Involves surgical isolation and placement of silicon-insulated platinum electrodes around S2 spinal nerves bilaterally. Electrodes are attached to a SQ receiver coil, which can be activated transcutaneously with an external stimulator that triggers S2 firing and subsequent detrusor contraction & bladder emptying “on demand". 8/9 dogs had voiding efficiency of >90%; dogs still using the system 5 years after implantation.

Question 131

What % of uremic dogs vs cats undergoing are hypothermic? Does thermoregulation improve with intermittent hemodialysis? What factors are predictive of low temperature?

Answer 131

Kabatchnick JVIM 2016 38% cats, 20.5% dogs. Temp sig lower vs non-uremic patients. Yes. Lower BW (cats <5kg), timing (pre-dialysis vs post).

Question 132

What impact does benazepril have on the outcome/survival of CKD dogs based on a JVIM 2017 study?

Answer 132

King JVIM 2017 BZP sig reduced proteinuria, but insufficient sample no. to draw conclusions on survival time.

Question 133

What % of CKD dogs have positive urine cultures, and how many of these are symptomatic? What factors are associated with a positive PUC?

Answer 133

Lamoureux JVIM 2019 32% prevalence overall (common even in IRIS stage 1 CKD 28%). Only 8% symptomatic. Risk factors - female (OR 3.2), isosthenuria (OR 2.48), positive leukocyte esterase test & microorganisms on urine sediment.

Question 134

Based on a UK study, what % of dogs with renal biopsy evaluation had ICGN; and was this the most common cause? Most common immunosuppressant therapy used? Survival rates?

Answer 134

Vessieres JSAP 2019 27% (glomerulosclerosis most common; 35%) Mycophenolate, myco + chlorambucil. 53% IMGN dogs were alive at study end point (652d). All dogs treated with myco were alive at 712d, successful tx in 4/6.

Question 135

What is the most common cause of ICGN in dogs? What are the aetiologies?

Answer 135

Vessieres JSAP 2019 Membranoproliferative GN (26-60%). Mainly 2' to infectious dz with immune complex accumulation on sub-endothelial side of glomerular BM. Agents - D. immits, L. infantum, Babesia spp, tick borne dz, systemic mycosis (coccidiodes), Bb (controversial)

Question 136

What is an uncommon risk factor (arising from the urothelium) for formation of CaOx urolithiasis based on a 2017 case report?

Answer 136

Lulich JVIM 2017 Dystrophic mineralisation > ectopic bone arising from the urothelium.

Question 137

What is a limitation in the interpretation of urinary biomarkers (CysC, uNGAL & uLgG) for early detection of CKD in dogs?

Answer 137

Liu JVIM 2018 All these biomarkers have a wide range of long-term intra-dog variability (8% for sCysC, up to 87-88% for uNGAL & uLgG). Ideally need to establish RIs for healthy vs CKD dogs.

Question 138

Is the accuracy of UPC measurements affected by storage in different temperatures (-20, 4 vs 24) and/or container type (HP, PC vs glass)?

Answer 138

Moyle JVIM 2018 Not in this study. Urine samples kept in 24C for 4hrs, 4C for 12hrs, or −20C for 72hrs.

Question 139

Is USG helpful to predict UPC in dogs?

Answer 139

Meindl JVIM 2018 No

Question 140

What % of healthy geriatric dogs had overt or borderline proteinuria? What % of these dogs had persistent proteinuria? Did the method of urine collection (cysto vs free catch) affect UPC results?

Answer 140

Marynissen JVIM 2017 11% overt (UPC >0.5), 14% borderline (0.2-0.5). 19% persistent proteinuria. Not in this study.

Question 141

Was the use of simplified GFR protocol based on iohexol plasma clearance useful in the diagnosis of CKD in dogs? Inclusion of which timepoint was most useful?

Answer 141

Pocar JVIM 2019 Yes. Plasma iohexol was measured 5, 15, 60, 90 & 180 minutes after injection. Simplified GFR protocols were based on 1-3 samples (vs 5) - all gave reliable GFR measurements, with **best GFR measures including the 180-min sampling.** Gray zone may corerspond to early kidney dysfunction.

Question 142

What was the overall Sn/Sp for 3 models of a clinical scoring system validated for predicting outcome in dogs with AKI managed by hemodialysis?

Answer 142

Segev JVIM 2016 Higher scores > decreased 30d survival probability. Overall Sn 71-75%, Sp 75-86%.

Question 143

What is the influence of CKD on bone quality in dogs, and how common are dogs clinical for it?

Answer 143

Shipov JVIM 2018 Reduces bone quality (smaller lacunae size), but changes noted were mild & not likely to cause CSx. Authors commented short duration of CKD for dogs in this study (6mths+) likely accounting for subtle changes.

Question 144

Based on a Danish study, what was the % of dogs with UTI that were appropriately treated with antimicrobials? What was the main cause (relating to diagnostic workup) of inappropriate tx?

Answer 144

Sørensen JVIM 2018 62%. Performing in-house urine microscopy (accuracy 64.5%) but not culture (accuracy 77%; only done in 56% cases).

Question 145

What are 2 options for anticoagulation in AKI dogs undergoing intermittent hemodialysis? Any signifiicant differences in safety & efficacy?

Answer 145

Francey JVIM 2018 Heparin most commonly used. Regional citrate anti-coagulation in thist study showed to be safe, adv: doesn't systemically anti-coagulate the patient, good for patients at risk of bleeding. Cause hypoCa (mild in this study).

Question 146

What % of dogs & cats receiving hemodialysis require blood transfusions? What were risk factors for transfusion dependency? Did transfusion dependency affect survival?

Answer 146

Langston JVIM 2017 87% cats, 32% dogs. No of dialysis treatments (cats only) Dogs needing transfusion had higher likelihood of death (OR 3.1) but not cats.

Question 147

What was the survival & complication rate for dogs with NSAID overdose that received TPE? What % of dogs developed AKI?

Answer 147

Rosenthal JVIM 2019 27% dogs developed AKI, severity of sCr increase was dose dependent. TPE = effective tx, 100% (11 dogs) survived to discharge. 54% complication rate, did not affect patient outcome.

Question 148

What metabolic & physiological complications or changes can occur with TPE treatment using regional citrate anticoagulation? What maximal tolerable citrate rate(s) were established?

Answer 148

Francey JVIM 2019 24% decrease in TP, 53% decr in fibrinogen, 36% decr in TBIL, 9% in urea, 4.5% in urea. 34% complication rate, fatal in 2/22 dogs. 100% dogs (34) had citrate accumulation (worse with renal dz but not liver dz). Max tolerable citrate rate 5.5 umol/kg/min for dogs with renal dz, 9.0 without.

Question 149

Were there differences in remission & survival outcome when TPE was used as an adjunctive treatment for dogs with IMHD (IMTP/IMHA) vs not?

Answer 149

Francey JVIM 2021 No sig diff, even with bias towards refractory cases in the TPE group. TPE had good response rate (83% in IMHA vs 65% med), 80% in IMTP (vs 70% med). 82% TPE dogs survived to discharge (controls 69%). 71% TPE achieved CR, 14% PR, 18% died/euthanised.

Question 150

List 2 medications & 1 interventional procedure as treatment options for idiopathic renal hematuria in dogs? What is the response rate for dogs receiving the medications listed above? Overall survival?

Answer 150

Adelman JAVMA 2017 Povidone iodine sclerotherapy (5% solution instilled via ureteral stent). Kortum JSAP 2021 ACE-Is or ARBs. Px good; MST 1482d regardless or tx/clinical response. With ACEI/ARB, complete response 42%, partial 26%, no improvement 31%.

Question 151

What % of CKD dogs had positive urine cultures? What were positive urine cultures most associated with (subclinical bacteriuria, cystiits or pyelonephritis)?

Answer 151

Foster JAVMA 2018 18% dogs. Subclinical bacteriuria.

Question 152

What was the diagnostic yield for bacterial culture of urine obtained via pyelocentesis in dogs & cats? Was this higher than that of cystocentesis samples? What was the major/minor complication rate of pyelocentesis?

Answer 152

Etedali JAVMA 2019 94% diagnostic rate. No. 24% minor, 2% major

Question 153

Did use of silver coated urinary catheters reduce risk of catheter-associated UTI or bacteriuria in hospitalised dogs?

Answer 153

Ogilvie JAVMA 2018 Not in this study, ass with earlier development of CAB but not CAUTI, but larger prospective studies needed to assess benefits.

Question 154

What urinary complication following renal transplantation may occur in dogs, that is associated with recurrent UTIs, pyelonephritis, graft damage & potential renal failure? What treatment was successful in addresising this complication in a dog based on a case report?

Answer 154

Park JAVMA 2016 Vesicoureteral reflux (common in people). Sx intervention involving ureteral reimplantation with an extravesicular technique incorporating a long submucosal tunnel resolved hydronephrosis & recurrent UTI episodes in the case report.

Question 155

What structural anomaly may cause distal ureteral obstruction in young dogs (esp male Labs) and how can this be treated? What concurrent condition is commonly asociated with this anomaly in these dogs?

Answer 155

Meler JAVMA 2018 CDUOS (congenital distal ureteral orifice stenosis). Tx with cystoscopic laser ablation (CLA) to open the ureteral orifice. Intramural EU.