Nasal mucosal mineralization, ulceration and epistaxis in a dog with uremia caused by chronic renal failure / Mineralização, ulceração e epistaxe em um cão com uremia causada por insuficiência renal crônica

ABSTRACT: Soft tissue mineralization and epithelial ulceration are common findings in dogs with uremia, being commonly reported in the gastrointestinal tract, lungs and pleura. This report described a case of nasal mucosal mineralization and ulceration contributing to recurrent epistaxis in a dog with chronic renal failure and uremia. A dog with recurrent epistaxis accompanied by elevated urea and creatinine was hospitalized. Platelet count and coagulation tests were within normal limits. Chronic renal failure was diagnosed, and the dog was euthanized. On necropsy, the kidneys were small, with an irregular capsular surface. The nasal conchae were slightly reddish. Histopathology revealed chronic glomerulonephritis, with gastric mineralization and bilateral parathyroid hyperplasia. Vascular and basal lamina mineralization, epithelial ulceration and hemorrhage were seen in the nasal conchae. The observed findings indicated that nasal mineralization and ulceration were caused by uremia. The severity of histopathological findings suggested that nasal mineralization/ulceration may have caused or at least contributed to epistaxis in this dog. We hope to stimulate further investigations into possible association between uremia, nasal mucosa mineralization/ulceration and epistaxis in dogs.

RESUMO: Mineralização dos tecidos moles e ulceração epitelial são achados comuns em cães com uremia, sendo geralmente observados no trato gastrointestinal, pulmões e pleura. O objetivo desse relato é reportar um caso de mineralização e ulceração da mucosa nasal contribuindo para epistaxe recorrente em um cão com insuficiência renal crônica e uremia. Um cão com epistaxe recorrente e aumento da ureia e creatinina foi hospitalizado. A contagem plaquetária e os testes de coagulação não tinham alterações. Foi diagnosticado insuficiência renal crônica, e o cão foi submetido a eutanásia. Na necropsia, o cão tinha os rins diminuídos, com superfície irregular. As conchas nasais estavam levemente avermelhadas. Histologicamente, foi diagnosticada uma glomerulonefrite crônica com mineralização gástrica e hiperplasia das paratireoides. As conchas nasais tinham mineralização da parede de vasos e membrana basal, úlceras e hemorragia. Os achados histopatológicos indicam que a mineralização e ulceração nasal foram causadas pela uremia. A severidade das lesões histológicas sugere que a mineralização/ulceração nasal pode ter causado, ou pelo menos contribuído, para a epistaxe deste cão. Espera-se, com esse relato, estimular futuros estudos que investiguem uma possível associação entre uremia, mineralização/ulceração nasal e epistaxe em cães.

Nasal mucosal mineralization, ulceration and epistaxis in a dog with uremia caused by chronic renal failure / Mineralização, ulceração e epistaxe em um cão com uremia causada por insuficiência renal crônica

Soft tissue mineralization and epithelial ulceration are common findings in dogs with uremia, being commonly reported in the gastrointestinal tract, lungs and pleura. This report described a case of nasal mucosal mineralization and ulceration contributing to recurrent epistaxis in a dog with chronic renal failure and uremia. A dog with recurrent epistaxis accompanied by elevated urea and creatinine was hospitalized. Platelet count and coagulation tests were within normal limits. Chronic renal failure was diagnosed, and the dog was euthanized. On necropsy, the kidneys were small, with an irregular capsular surface. The nasal conchae were slightly reddish. Histopathology revealed chronic glomerulonephritis, with gastric mineralization and bilateral parathyroid hyperplasia. Vascular and basal lamina mineralization, epithelial ulceration and hemorrhage were seen in the nasal conchae. The observed findings indicated that nasal mineralization and ulceration were caused by uremia. The severity of histopathological findings suggested that nasal mineralization/ulceration may have caused or at least contributed to epistaxis in this dog. We hope to stimulate further investigations into possible association between uremia, nasal mucosa mineralization/ulceration and epistaxis in dogs.

Mineralização dos tecidos moles e ulceração epitelial são achados comuns em cães com uremia, sendo geralmente observados no trato gastrointestinal, pulmões e pleura. O objetivo desse relato é reportar um caso de mineralização e ulceração da mucosa nasal contribuindo para epistaxe recorrente em um cão com insuficiência renal crônica e uremia. Um cão com epistaxe recorrente e aumento da ureia e creatinina foi hospitalizado. A contagem plaquetária e os testes de coagulação não tinham alterações. Foi diagnosticado insuficiência renal crônica, e o cão foi submetido a eutanásia. Na necropsia, o cão tinha os rins diminuídos, com superfície irregular. As conchas nasais estavam levemente avermelhadas. Histologicamente, foi diagnosticada uma glomerulonefrite crônica com mineralização gástrica e hiperplasia das paratireoides. As conchas nasais tinham mineralização da parede de vasos e membrana basal, úlceras e hemorragia. Os achados histopatológicos indicam que a mineralização e ulceração nasal foram causadas pela uremia. A severidade das lesões histológicas sugere que a mineralização/ulceração nasal pode ter causado, ou pelo menos contribuído, para a epistaxe deste cão. Espera-se, com esse relato, estimular futuros estudos que investiguem uma possível associação entre uremia, mineralização/ulceração nasal e epistaxe em cães.

Hemodiálise veterinária: considerações do colégio brasileiro de nefrologia e urologia veterinárias / Veterinary hemodialysis: considerations of the brazilian college of veterinary nephrology and urology / Hemodiálisis veterinaria: consideraciones del colegio brasileño de nefrología y urología veterinaria

Sendo parte integrante do arsenal de opções terapêuticas na nefrologia veterinária, a hemodiálise aplicada aos animais se popularizou e avançou consideravelmente nos últimos anos, não só no mundo como no Brasil. Neste contexto, visando apresentar as características principais da hemodiálise,o Colégio Brasileiro de Nefrologia e Urologia Veterinárias (CBNUV), em nome da sua subcomissão de Técnicas Dialíticas, traz, neste documento, as informações necessárias para embasar os conhecimentos sobre o tema.(AU)

Being an integral part of the arsenal of therapeutic options in veterinary nephrology, hemodialysis applied to animals has become popular and has advanced considerably in recent years, not only in the world but in Brazil. In this context, intending to present the main characteristics of hemodialysis, the Colégio Brasileiro de Nephrologiae Urologia Veterinárias (CBNUV), on behalf of its subcommittee on Dialytic Techniques, brings, in this document, the necessary information to base knowledge on the subject.(AU)

Siendo parte integral del arsenal de opciones terapéuticas en nefrología veterinaria, la hemodiálisis aplicada a animales se popularizó y avanzó considerablemente en los últimos años, no solo en el mundo sino también en Brasil. En ese contexto, con el fin de presentar las principales características de la hemodiálisis, el Colégio Brasileiro de Nephrologia e Urologia Veterinárias (CBNUV), en representación de su subcomité de Técnicas Dialíticas, trae, en este documento, las informaciones necesarias para fundamentar el conocimiento sobre el tema.(AU)

Linfoma renal primário em cão / Primary kidney lymphoma in a dog

Background: Lymphoma is a malignant lymphoid tumor originating in the lymph nodes or other solid organs and comprises90% of all hematopoietic tumors in dogs. However, primary kidney lymphoma is rare and is associated with nonspecificclinical signs. Tumor invasion in both kidneys can cause severe clinical signs due to renal failure, complicating the patient’streatment and prognosis. The aim of this case was to report the case of a dog affected by bilateral primary kidney lymphoma. In addition, to characterize the clinical and histopathological presentation due to the intense morphological changes.Case: A 5-year-old male Poodle dog was admitted showing apathy and emesis for 5 days. On physical examination, thedog showed 10% of dehydration, reddish oral mucous membranes, poor body condition (score 1/5), uremic breath, andpain in the kidney area. Complementary tests revealed severe low white blood cells count, high BUN levels, high levels ofpotassium, calcium, and phosphorus (serum biochemistry). Abdominal ultrasound showed bilateral kidney enlargement.Fine needle aspiration of the mass (guided by ultrasound) revealed round cell tumor. Radiographs showed no alterations.The dog died due to his poor condition and necropsy was performed. On post-mortem examination, the kidneys were bothenlarged, pale, and with an irregular subcapsular surface. The histopathological diagnostic was primary renal lymphoma.Immunohistochemical staining revealed that neoplastic cells were strongly positive for anti CD20 and PAX5, while negative for CD3, supporting the diagnosis of B-cell lymphoma.Discussion: The diagnosis was based on clinical, complementary tests, fine needle aspiration, histopathological andimmunohistochemical findings. In dogs, primary kidney tumors are uncommon and usually malignant. The presence ofvomiting, uremic breath, dehydration, weight loss, and erosive and ulcerative lesions on the tongue (uremic glossitis)...

Linfoma renal primário em cão / Primary kidney lymphoma in a dog

Background: Lymphoma is a malignant lymphoid tumor originating in the lymph nodes or other solid organs and comprises90% of all hematopoietic tumors in dogs. However, primary kidney lymphoma is rare and is associated with nonspecificclinical signs. Tumor invasion in both kidneys can cause severe clinical signs due to renal failure, complicating the patientstreatment and prognosis. The aim of this case was to report the case of a dog affected by bilateral primary kidney lymphoma. In addition, to characterize the clinical and histopathological presentation due to the intense morphological changes.Case: A 5-year-old male Poodle dog was admitted showing apathy and emesis for 5 days. On physical examination, thedog showed 10% of dehydration, reddish oral mucous membranes, poor body condition (score 1/5), uremic breath, andpain in the kidney area. Complementary tests revealed severe low white blood cells count, high BUN levels, high levels ofpotassium, calcium, and phosphorus (serum biochemistry). Abdominal ultrasound showed bilateral kidney enlargement.Fine needle aspiration of the mass (guided by ultrasound) revealed round cell tumor. Radiographs showed no alterations.The dog died due to his poor condition and necropsy was performed. On post-mortem examination, the kidneys were bothenlarged, pale, and with an irregular subcapsular surface. The histopathological diagnostic was primary renal lymphoma.Immunohistochemical staining revealed that neoplastic cells were strongly positive for anti CD20 and PAX5, while negative for CD3, supporting the diagnosis of B-cell lymphoma.Discussion: The diagnosis was based on clinical, complementary tests, fine needle aspiration, histopathological andimmunohistochemical findings. In dogs, primary kidney tumors are uncommon and usually malignant. The presence ofvomiting, uremic breath, dehydration, weight loss, and erosive and ulcerative lesions on the tongue (uremic glossitis)...(AU)

Granulomatous nephritis and uremia associated with Klossiella equi in a horse from Rio Grande do Sul, Brazil / Nefrite granulomatosa e uremia associada a Klossiella equi em um equino no Rio Grande do Sul, Brasil

Klossiella equi is an unusual protozoan of equids. In most cases, it does not cause renal injury. A case of K. equi-associated granulomatous nephritis leading to uremia in a brazilian mare is described. The animal presented colic, and among the complementary exams, increased urea and creatinine was observed. The kidneys were unremarkable on gross exam; however, a multifocal granulomatous nephritis with tubular degeneration associated with intraepithelial and intraluminal protozoa was observed histologically. The large intestines were edematous and hemorrhagic. The importance of including K. equi infection among the differential diagnosis of horses with kidney disease in southern Brazil is highlighted.

Klossiella equi é um protozoário incomum de rim de equídeos, geralmente considerado de pouca importância clínica. Descreve-se um caso de klosselliose associada a lesão renal e uremia em uma égua. O animal foi atendido com quadro de cólica, e dentre os exames, foi constatado aumento de ureia e creatinina. Na necropsia, os rins não apresentavam lesões macroscópicas, no entanto, na histopatologia, observou-se nefrite granulomatosa com degeneração tubular associada a protozoários intraepiteliais e intraluminais. A parede do intestino grosso estava edemaciada e hemorrágica. Se destaca a importância da inclusão de infecção por K. equi nos diagnósticos diferenciais de equinos com doença renal no sul do Brasil.

C-Fos expression in epileptogenic areas of nephropathic rats undergoing star fruit poisoning

Purpose Studies have demonstrated that star fruit consumption by nephropathic patients triggers severe neurotoxic effects that can lead to convulsions or even death. Brain areas likely susceptible to star fruit poisoning have not been investigated. The objective of the present study was to map possible epileptogenic areas susceptible to star fruit intoxication in nephropathic rats. Methods The study analyzed 25 rats (5 groups). Rats in the experimental group underwent bilateral ureteral obstruction surgery and orogastric gavages with star fruit juice. An electroencephalogram was used to confirm convulsive seizures. Urea and creatinine levels were used to confirm the uremia model. Immunohistochemical analysis was used to map cells with c-Fos protein (c-Fos+ cells) to identify brain areas with increased neuronal activity. Control groups included non-nephropathic and nephropathic rats that did not receive star fruit. Results A statistically significant increase (p 0.01) in c-Fos+ cells was noted in nephropathic animals receiving star fruit juice compared to control groups, in brain areas commonly related to epileptogenic neural circuits including the hippocampus, amygdala, rhinal cortex, anterior cingulate area, piriform area, and medial dorsal thalamus. Conclusion These data corroborate the neurotoxic capacity of star fruit in nephropathic patients.(AU)

Dystrophic mineralization in uremic dogs: an update / Mineralização distrófica em cães urêmicos: uma atualização

Pathological mineralization is the abnormal deposition of minerals in body tissues, previously injured or not. In these lesions, in addition to calcium, other minerals can be found at lower concentrations. Classically, mineralization is divided into two types: dystrophic and metastatic. However, currently, there is no consensus among researchers on the type of mineralization that occurs in uremic dogs. The objective of this study was to elucidate the type of pathological mineralization that occurs in dogs with uremic syndrome through the correlation of biochemical examinations with gross and histopathological changes, given the existence of controversial information on this theme in the specialized literature. The Shapiro-Wilk, D'Agostino and Pearson tests were used to evaluate data normality distribution, and analysis of variance (ANOVA) was applied to compare the data between more than two groups. Additionally, the Dunnett's multiple comparison test was used in the comparison between the Control Group (CG) and the Experimental Groups (G1, G2, and G3). Serum levels of urea, creatinine, total and ionized calcium, phosphorus, calcium-phosphorus product (CPP), parathyroid hormone (PTH), and albumin of 40 azotemic dogs with chronic kidney disease (CKD) were evaluated. Dogs were categorized by degree of azotemia (mild, moderate, and severe). Ionized hypocalcemia was observed in 97.5% (39/40) of the dogs, and no animals presented ionized hypercalcemia. Hyperphosphatemia was frequent (62.5%), especially in dogs with severe azotemia. PTH concentration increased with progression of azotemia, and high PTH levels were verified in 100% of the dogs with severe azotemia. CPP >60mg2/dl2 was observed in 75% (30/40) of the dogs. Of the 29 dogs that died during the study period, 16 were necropsied. Soft tissue mineralization was observed in 93.7% (15/16) of these dogs at gross and histopathological evaluation (HE and Von Kossa), regardless of the degree of azotemia, in nine organs/tissues: kidneys (75%), lungs (50%), stomach (31.2%), heart (25%), larynx (25%), intercostal muscles (25%), aorta (6.2%), intestines (6.2%), and tongue (6.2%). In one animal, the serosa of all segments of the small intestine showed whitish, rough, irregular, multifocal plaques of varying sizes, confirmed by histopathology as dystrophic mineralization of the longitudinal outer muscular layer, which presented necrosis of coagulation and of the intestinal serosa. This intestinal lesion has not been described in dogs with uremic syndrome to date. In conclusion, the laboratory and histopathologic data previously described, especially regarding tissue and vascular mineralization, which occur in association with previous degenerative/necrotic lesions in the absence of hypercalcemia in dogs with CKD, assist with clarifying inconsistencies found in the existing literature. Therefore, conceptually, mineralization that occurs in uremic dogs should be considered dystrophic.(AU)

Mineralização patológica é a deposição anormal de minerais em tecidos previamente lesados ou não. Nessas lesões, além do cálcio, outros minerais podem ser encontrados em concentrações inferiores. Classicamente, as mineralizações são divididas em dois tipos: distrófica e metastática. Contudo, atualmente, ainda não há consenso entre os pesquisadores sobre o tipo de mineralização que ocorre em cães urêmicos. Objetivou-se com esse estudo elucidar o tipo de mineralização patológica que ocorre em cães com síndrome urêmica através da correlação de exames bioquímicos com alterações macroscópicas e histopatológicas, visto a existência de informações controversas na literatura especializada. Os dados obtidos foram submetidos ao teste de Shapiro-Wilk e teste de D'Agostino e Pearson para avaliação da normalidade da distribuição e para comparação de dados em mais de dois grupos foi utilizado o teste ANOVA. Adicionalmente, o teste de comparações múltiplas de Dunnett permitiu a comparação entre o grupo controle (GC) com os demais grupos (G1, G2 e G3). Foram avaliados os níveis séricos de ureia, creatinina, cálcio total e ionizado, fósforo, produto cálcio-fósforo (PCF), PTH e albumina de 40 cães azotêmicos com doença renal crônica (DRC). Os cães foram classificados quanto ao grau de azotemia (leve, moderada e severa). Verificou-se hipocalcemia ionizada em 97,5% (39/40) dos cães e, em nenhum animal houve hipercalcemia ionizada. Hiperfosfatemia foi frequente (62,5%), principalmente em cães com azotemia severa. A concentração do PTH aumentou conforme a progressão da azotemia, encontrando-se elevada em 100% dos cães com azotemia severa. Em 75% (30/40) dos cães o PCF foi superior a 60mg2/dl2. Durante o estudo, 29 cães morreram, sendo 16 desses necropsiados. Em 93,7% (15/16) desses cães observou-se mineralização de tecidos moles, durante a avaliação macroscópica e histopatológica (HE e Von Kossa), independentemente do grau de azotemia, em nove órgãos/tecidos: rins (75%), pulmões (50%), estômago (31,2%), coração (25%), laringe (25%), músculos intercostais (25%), aorta (6,2%), intestino (6,2%) e língua (6,2%). Adicionalmente, em um animal verificou-se na serosa de todos os segmentos do intestino delgado placas multifocais brancacentas, rugosas, irregulares de tamanhos variados, cuja histopatologia confirmou tratar-se de mineralização distrófica da camada longitudinal muscular externa que apresentava necrose de coagulação e da serosa intestinal. Essa lesão intestinal nunca havia sido descrita em cães com síndrome urêmica. Em suma, os dados laboratoriais e histopatológicos aqui descritos, sobretudo, no que se refere à mineralização tecidual e vascular, que ocorrem relacionadas a lesões degenerativo-necróticas prévias, na ausência de hipercalcemia, em cães com DRC, ajudam a esclarecer as incongruências existentes na literatura. Por conseguinte, conceitualmente, as mineralizações que ocorrem em cães urêmicos devem ser consideradas distróficas.(AU)

Dystrophic mineralization in uremic dogs: an update / Mineralização distrófica em cães urêmicos: uma atualização

Pathological mineralization is the abnormal deposition of minerals in body tissues, previously injured or not. In these lesions, in addition to calcium, other minerals can be found at lower concentrations. Classically, mineralization is divided into two types: dystrophic and metastatic. However, currently, there is no consensus among researchers on the type of mineralization that occurs in uremic dogs. The objective of this study was to elucidate the type of pathological mineralization that occurs in dogs with uremic syndrome through the correlation of biochemical examinations with gross and histopathological changes, given the existence of controversial information on this theme in the specialized literature. The Shapiro-Wilk, D'Agostino and Pearson tests were used to evaluate data normality distribution, and analysis of variance (ANOVA) was applied to compare the data between more than two groups. Additionally, the Dunnett's multiple comparison test was used in the comparison between the Control Group (CG) and the Experimental Groups (G1, G2, and G3). Serum levels of urea, creatinine, total and ionized calcium, phosphorus, calcium-phosphorus product (CPP), parathyroid hormone (PTH), and albumin of 40 azotemic dogs with chronic kidney disease (CKD) were evaluated. Dogs were categorized by degree of azotemia (mild, moderate, and severe). Ionized hypocalcemia was observed in 97.5% (39/40) of the dogs, and no animals presented ionized hypercalcemia. Hyperphosphatemia was frequent (62.5%), especially in dogs with severe azotemia. PTH concentration increased with progression of azotemia, and high PTH levels were verified in 100% of the dogs with severe azotemia. CPP >60mg2/dl2 was observed in 75% (30/40) of the dogs. Of the 29 dogs that died during the study period, 16 were necropsied. Soft tissue mineralization was observed in 93.7% (15/16) of these dogs at gross and histopathological evaluation (HE and Von Kossa), regardless of the degree of azotemia, in nine organs/tissues: kidneys (75%), lungs (50%), stomach (31.2%), heart (25%), larynx (25%), intercostal muscles (25%), aorta (6.2%), intestines (6.2%), and tongue (6.2%). In one animal, the serosa of all segments of the small intestine showed whitish, rough, irregular, multifocal plaques of varying sizes, confirmed by histopathology as dystrophic mineralization of the longitudinal outer muscular layer, which presented necrosis of coagulation and of the intestinal serosa. This intestinal lesion has not been described in dogs with uremic syndrome to date. In conclusion, the laboratory and histopathologic data previously described, especially regarding tissue and vascular mineralization, which occur in association with previous degenerative/necrotic lesions in the absence of hypercalcemia in dogs with CKD, assist with clarifying inconsistencies found in the existing literature. Therefore, conceptually, mineralization that occurs in uremic dogs should be considered dystrophic.(AU)

Mineralização patológica é a deposição anormal de minerais em tecidos previamente lesados ou não. Nessas lesões, além do cálcio, outros minerais podem ser encontrados em concentrações inferiores. Classicamente, as mineralizações são divididas em dois tipos: distrófica e metastática. Contudo, atualmente, ainda não há consenso entre os pesquisadores sobre o tipo de mineralização que ocorre em cães urêmicos. Objetivou-se com esse estudo elucidar o tipo de mineralização patológica que ocorre em cães com síndrome urêmica através da correlação de exames bioquímicos com alterações macroscópicas e histopatológicas, visto a existência de informações controversas na literatura especializada. Os dados obtidos foram submetidos ao teste de Shapiro-Wilk e teste de D'Agostino e Pearson para avaliação da normalidade da distribuição e para comparação de dados em mais de dois grupos foi utilizado o teste ANOVA. Adicionalmente, o teste de comparações múltiplas de Dunnett permitiu a comparação entre o grupo controle (GC) com os demais grupos (G1, G2 e G3). Foram avaliados os níveis séricos de ureia, creatinina, cálcio total e ionizado, fósforo, produto cálcio-fósforo (PCF), PTH e albumina de 40 cães azotêmicos com doença renal crônica (DRC). Os cães foram classificados quanto ao grau de azotemia (leve, moderada e severa). Verificou-se hipocalcemia ionizada em 97,5% (39/40) dos cães e, em nenhum animal houve hipercalcemia ionizada. Hiperfosfatemia foi frequente (62,5%), principalmente em cães com azotemia severa. A concentração do PTH aumentou conforme a progressão da azotemia, encontrando-se elevada em 100% dos cães com azotemia severa. Em 75% (30/40) dos cães o PCF foi superior a 60mg2/dl2. Durante o estudo, 29 cães morreram, sendo 16 desses necropsiados. Em 93,7% (15/16) desses cães observou-se mineralização de tecidos moles, durante a avaliação macroscópica e histopatológica (HE e Von Kossa), independentemente do grau de azotemia, em nove órgãos/tecidos: rins (75%), pulmões (50%), estômago (31,2%), coração (25%), laringe (25%), músculos intercostais (25%), aorta (6,2%), intestino (6,2%) e língua (6,2%). Adicionalmente, em um animal verificou-se na serosa de todos os segmentos do intestino delgado placas multifocais brancacentas, rugosas, irregulares de tamanhos variados, cuja histopatologia confirmou tratar-se de mineralização distrófica da camada longitudinal muscular externa que apresentava necrose de coagulação e da serosa intestinal. Essa lesão intestinal nunca havia sido descrita em cães com síndrome urêmica. Em suma, os dados laboratoriais e histopatológicos aqui descritos, sobretudo, no que se refere à mineralização tecidual e vascular, que ocorrem relacionadas a lesões degenerativo-necróticas prévias, na ausência de hipercalcemia, em cães com DRC, ajudam a esclarecer as incongruências existentes na literatura. Por conseguinte, conceitualmente, as mineralizações que ocorrem em cães urêmicos devem ser consideradas distróficas.(AU)

Lily poisoning in domestic cats

Background: Cases of plant intoxication in small animals are observed frequently in the domestic environment, mainlybecause most dogs and cats live in households and occasionally have access to streets and rural areas. Among such toxicagents, ornamental plants of the genus Lilium and Hemerocallis, which are potentially nephrotoxic to the feline species,are highlighted. Affected cats start presenting clinical signs 1-6 h after plant ingestion. Renal failure takes place in 12-72h, and death may occur in an interval ranging from three to seven days. The objective of this article is to describe theepidemiological, clinical and pathological findings of lily (Lilium sp.) poisoning in two cats.Case: The aspects of lily poisoning in two cats are described (cat #1 and cat #2). Cat #1 was a 3-year-old, mixed breedfemale cat, which presented a clinical history of anorexia, apathy, drooling, vomiting and polydipsia. Serum biochemicalanalysis revealed creatinine elevation (21.2 mg/dL), as well as hyperphosphatemia (19 mg/dL). Seventy-two h after theonset of clinical signs, renal failure progressed to anuria, followed by death. The second animal of this report (cat #2) wasa 2-year-old, mixed-breed male cat. The animal was found dead by the owner without displaying any previous clinicalsigns. Cats #1 and #2 ingested leaves of lily, which were present in their households as ornamental plants. At necropsy, thekidneys of both cats presented mild enlargement. Moderate perirenal edema was also noted. Cat #1 showed morphologicextrarenal uremic lesions, characterized by ulcers in the oral mucosa and in the margin of the tongue ventral surface. Microscopic lesions observed in both cases were similar and compatible with acute toxic nephropathy. Histologically, severeepithelial cell degeneration and necrosis of proximal and distal convoluted tubules were noted. Other renal microscopicfindings included hyaline...

Lily poisoning in domestic cats

Background: Cases of plant intoxication in small animals are observed frequently in the domestic environment, mainlybecause most dogs and cats live in households and occasionally have access to streets and rural areas. Among such toxicagents, ornamental plants of the genus Lilium and Hemerocallis, which are potentially nephrotoxic to the feline species,are highlighted. Affected cats start presenting clinical signs 1-6 h after plant ingestion. Renal failure takes place in 12-72h, and death may occur in an interval ranging from three to seven days. The objective of this article is to describe theepidemiological, clinical and pathological findings of lily (Lilium sp.) poisoning in two cats.Case: The aspects of lily poisoning in two cats are described (cat #1 and cat #2). Cat #1 was a 3-year-old, mixed breedfemale cat, which presented a clinical history of anorexia, apathy, drooling, vomiting and polydipsia. Serum biochemicalanalysis revealed creatinine elevation (21.2 mg/dL), as well as hyperphosphatemia (19 mg/dL). Seventy-two h after theonset of clinical signs, renal failure progressed to anuria, followed by death. The second animal of this report (cat #2) wasa 2-year-old, mixed-breed male cat. The animal was found dead by the owner without displaying any previous clinicalsigns. Cats #1 and #2 ingested leaves of lily, which were present in their households as ornamental plants. At necropsy, thekidneys of both cats presented mild enlargement. Moderate perirenal edema was also noted. Cat #1 showed morphologicextrarenal uremic lesions, characterized by ulcers in the oral mucosa and in the margin of the tongue ventral surface. Microscopic lesions observed in both cases were similar and compatible with acute toxic nephropathy. Histologically, severeepithelial cell degeneration and necrosis of proximal and distal convoluted tubules were noted. Other renal microscopicfindings included hyaline... (AU)

Dystrophic mineralization in uremic dogs: an update

ABSTRACT: Pathological mineralization is the abnormal deposition of minerals in body tissues, previously injured or not. In these lesions, in addition to calcium, other minerals can be found at lower concentrations. Classically, mineralization is divided into two types: dystrophic and metastatic. However, currently, there is no consensus among researchers on the type of mineralization that occurs in uremic dogs. The objective of this study was to elucidate the type of pathological mineralization that occurs in dogs with uremic syndrome through the correlation of biochemical examinations with gross and histopathological changes, given the existence of controversial information on this theme in the specialized literature. The Shapiro-Wilk, DAgostino and Pearson tests were used to evaluate data normality distribution, and analysis of variance (ANOVA) was applied to compare the data between more than two groups. Additionally, the Dunnetts multiple comparison test was used in the comparison between the Control Group (CG) and the Experimental Groups (G1, G2, and G3). Serum levels of urea, creatinine, total and ionized calcium, phosphorus, calcium-phosphorus product (CPP), parathyroid hormone (PTH), and albumin of 40 azotemic dogs with chronic kidney disease (CKD) were evaluated. Dogs were categorized by degree of azotemia (mild, moderate, and severe). Ionized hypocalcemia was observed in 97.5% (39/40) of the dogs, and no animals presented ionized hypercalcemia. Hyperphosphatemia was frequent (62.5%), especially in dogs with severe azotemia. PTH concentration increased with progression of azotemia, and high PTH levels were verified in 100% of the dogs with severe azotemia. CPP >60mg2/dl2 was observed in 75% (30/40) of the dogs. Of the 29 dogs that died during the study period, 16 were necropsied. Soft tissue mineralization was observed in 93.7% (15/16) of these dogs at gross and histopathological evaluation (HE and Von Kossa), regardless of the degree of azotemia, in nine organs/tissues: kidneys (75%), lungs (50%), stomach (31.2%), heart (25%), larynx (25%), intercostal muscles (25%), aorta (6.2%), intestines (6.2%), and tongue (6.2%). In one animal, the serosa of all segments of the small intestine showed whitish, rough, irregular, multifocal plaques of varying sizes, confirmed by histopathology as dystrophic mineralization of the longitudinal outer muscular layer, which presented necrosis of coagulation and of the intestinal serosa. This intestinal lesion has not been described in dogs with uremic syndrome to date. In conclusion, the laboratory and histopathologic data previously described, especially regarding tissue and vascular mineralization, which occur in association with previous degenerative/necrotic lesions in the absence of hypercalcemia in dogs with CKD, assist with clarifying inconsistencies found in the existing literature. Therefore, conceptually, mineralization that occurs in uremic dogs should be considered dystrophic.

RESUMO: Mineralização patológica é a deposição anormal de minerais em tecidos previamente lesados ou não. Nessas lesões, além do cálcio, outros minerais podem ser encontrados em concentrações inferiores. Classicamente, as mineralizações são divididas em dois tipos: distrófica e metastática. Contudo, atualmente, ainda não há consenso entre os pesquisadores sobre o tipo de mineralização que ocorre em cães urêmicos. Objetivou-se com esse estudo elucidar o tipo de mineralização patológica que ocorre em cães com síndrome urêmica através da correlação de exames bioquímicos com alterações macroscópicas e histopatológicas, visto a existência de informações controversas na literatura especializada. Os dados obtidos foram submetidos ao teste de Shapiro-Wilk e teste de DAgostino e Pearson para avaliação da normalidade da distribuição e para comparação de dados em mais de dois grupos foi utilizado o teste ANOVA. Adicionalmente, o teste de comparações múltiplas de Dunnett permitiu a comparação entre o grupo controle (GC) com os demais grupos (G1, G2 e G3). Foram avaliados os níveis séricos de ureia, creatinina, cálcio total e ionizado, fósforo, produto cálcio-fósforo (PCF), PTH e albumina de 40 cães azotêmicos com doença renal crônica (DRC). Os cães foram classificados quanto ao grau de azotemia (leve, moderada e severa). Verificou-se hipocalcemia ionizada em 97,5% (39/40) dos cães e, em nenhum animal houve hipercalcemia ionizada. Hiperfosfatemia foi frequente (62,5%), principalmente em cães com azotemia severa. A concentração do PTH aumentou conforme a progressão da azotemia, encontrando-se elevada em 100% dos cães com azotemia severa. Em 75% (30/40) dos cães o PCF foi superior a 60mg2/dl2. Durante o estudo, 29 cães morreram, sendo 16 desses necropsiados. Em 93,7% (15/16) desses cães observou-se mineralização de tecidos moles, durante a avaliação macroscópica e histopatológica (HE e Von Kossa), independentemente do grau de azotemia, em nove órgãos/tecidos: rins (75%), pulmões (50%), estômago (31,2%), coração (25%), laringe (25%), músculos intercostais (25%), aorta (6,2%), intestino (6,2%) e língua (6,2%). Adicionalmente, em um animal verificou-se na serosa de todos os segmentos do intestino delgado placas multifocais brancacentas, rugosas, irregulares de tamanhos variados, cuja histopatologia confirmou tratar-se de mineralização distrófica da camada longitudinal muscular externa que apresentava necrose de coagulação e da serosa intestinal. Essa lesão intestinal nunca havia sido descrita em cães com síndrome urêmica. Em suma, os dados laboratoriais e histopatológicos aqui descritos, sobretudo, no que se refere à mineralização tecidual e vascular, que ocorrem relacionadas a lesões degenerativo-necróticas prévias, na ausência de hipercalcemia, em cães com DRC, ajudam a esclarecer as incongruências existentes na literatura. Por conseguinte, conceitualmente, as mineralizações que ocorrem em cães urêmicos devem ser consideradas distróficas.

Renal myxoma in a feline

Background: Renal neoplasms are a rare condition in felines, with metastatic lymphoma presenting the highest incidencerate. Secondary renal neoplasms are more frequent (88%) than primary renal tumors, with primary mesenquimal renalneoplasms accounting for 22% of the cases and the incidence of benign tumors not exceeding 5%. Myxomas are neoplasmsin undifferentiated mesenchymal cells with abundant reproduction of the myxoid matrix, with few few case reports aboutthis type of neoplasm in the veterinary literature. This study reports the first case of renal myxoma in a young feline afflicted by granulomatous nephritis and diagnosed with FIP (Feline Infectious Peritonitis).Case: A 9-month-old, male, mixed breed feline, was admitted into the Veterinary Hospital maintained by the Schoolof Veterinary Medicine and Animal Science, Botucatu, Brazil, presenting symptoms such progressive weight loss andoccasional episodes of emesis for one week, progressing to anorexia, hematochezia, vocalization, lack of coordination,spasms, anuria and inability to defecate. A physical examination revealed moderate dehydration, low temperatures (<33ºC), dyspnea (36 mpm), slight hyperglycemia (187 mg/dL) and distension of the abdomen and of the urinary bladder.The hematological assay and the serum biochemistry assay revealed neutrophilic leukocytosis, thrombocytopenia, anemiaand slight uremia. In view of the severity of the neurologic signs and lack of response to the clinical treatment, the owneropted to euthanize the animal. The necropsy revealed diffused jaundice, with kidney injuries observed through the palecoloration of the tissue and irregular surface with multiple off-white small nodules distributed in a marked and diffuseway. The same injury pattern was observed markedly in the lungs and discretely in the spleen and liver. The material collected was fixed in a 10% formalin solution, and processed according to the routine technique (Hematoxylin & Eosin)...

Renal myxoma in a feline

Background: Renal neoplasms are a rare condition in felines, with metastatic lymphoma presenting the highest incidencerate. Secondary renal neoplasms are more frequent (88%) than primary renal tumors, with primary mesenquimal renalneoplasms accounting for 22% of the cases and the incidence of benign tumors not exceeding 5%. Myxomas are neoplasmsin undifferentiated mesenchymal cells with abundant reproduction of the myxoid matrix, with few few case reports aboutthis type of neoplasm in the veterinary literature. This study reports the first case of renal myxoma in a young feline afflicted by granulomatous nephritis and diagnosed with FIP (Feline Infectious Peritonitis).Case: A 9-month-old, male, mixed breed feline, was admitted into the Veterinary Hospital maintained by the Schoolof Veterinary Medicine and Animal Science, Botucatu, Brazil, presenting symptoms such progressive weight loss andoccasional episodes of emesis for one week, progressing to anorexia, hematochezia, vocalization, lack of coordination,spasms, anuria and inability to defecate. A physical examination revealed moderate dehydration, low temperatures (<33ºC), dyspnea (36 mpm), slight hyperglycemia (187 mg/dL) and distension of the abdomen and of the urinary bladder.The hematological assay and the serum biochemistry assay revealed neutrophilic leukocytosis, thrombocytopenia, anemiaand slight uremia. In view of the severity of the neurologic signs and lack of response to the clinical treatment, the owneropted to euthanize the animal. The necropsy revealed diffused jaundice, with kidney injuries observed through the palecoloration of the tissue and irregular surface with multiple off-white small nodules distributed in a marked and diffuseway. The same injury pattern was observed markedly in the lungs and discretely in the spleen and liver. The material collected was fixed in a 10% formalin solution, and processed according to the routine technique (Hematoxylin & Eosin)...(AU)

Maxillomandibular deformity in a canine with fibrous osteodystrophy secondary to chronic kidney disease

Background: Cases of renal fibrous osteodystrophy are usually associated with nutritional causes, which of renal causesare considered uncommon in dogs. This disorder is characterized by the intense proliferation of fibrous connective tissue inbones, impairing bone stiffness. The aim of this study was to report a case of fibrous osteodystrophy secondary to chronickidney disease in a canine with a “rubber jaw” facial deformity.Case: A 4-year-old male unneutered mongrel dog weighing 5.2 kg had a history of apathy, progressive weight loss andvomiting for one month, and polyuria and polydipsia for more than three months. In addition, the owner complained aboutthe deformed appearance in the muzzle region of the animal, which was evidenced flexibility of the same, with a displacement of the mandible and maxilla on physical examination, similar to the “rubber jaw”. Blood tests revealed macrocyticanemia, elevated total plasma proteins, and lymphopenia-associated neutrophilia, as well as hyperphosphatemia (24 mg/dL), uremia (283.6 mg/dL) and increased creatinine (8.6 mg/dL), ALT (143.2 UI/L) and alkaline phosphatase (3222.2UI/L), while calcium (8.8 mg/dL) and albumin (1.9 g/dL) were decreased. A serological test for visceral leishmaniasis wasalso performed, which was negative. Abdominal ultrasound imaging revealed kidneys with alterations in tissue architecture, increased thickness and complete loss of cortico-medullary relationship, while the parathyroid gland was enlargedand spindle-shaped. Cranial radiography showed marked radiopacity of the bilateral maxillary bones, with destructionof the nasal, turbinate and frontal bones, as well as loosening of the teeth and destruction of the mandibular bone matrix,characterizing an aspect of “rubber jaw”. Based on the history, history and evidence of azotemia, hyperphosphatemia andloss of facial bone density, the diagnosis of fibrous osteodystrophy secondary to chronic kidney...

Maxillomandibular deformity in a canine with fibrous osteodystrophy secondary to chronic kidney disease

Background: Cases of renal fibrous osteodystrophy are usually associated with nutritional causes, which of renal causesare considered uncommon in dogs. This disorder is characterized by the intense proliferation of fibrous connective tissue inbones, impairing bone stiffness. The aim of this study was to report a case of fibrous osteodystrophy secondary to chronickidney disease in a canine with a “rubber jaw” facial deformity.Case: A 4-year-old male unneutered mongrel dog weighing 5.2 kg had a history of apathy, progressive weight loss andvomiting for one month, and polyuria and polydipsia for more than three months. In addition, the owner complained aboutthe deformed appearance in the muzzle region of the animal, which was evidenced flexibility of the same, with a displacement of the mandible and maxilla on physical examination, similar to the “rubber jaw”. Blood tests revealed macrocyticanemia, elevated total plasma proteins, and lymphopenia-associated neutrophilia, as well as hyperphosphatemia (24 mg/dL), uremia (283.6 mg/dL) and increased creatinine (8.6 mg/dL), ALT (143.2 UI/L) and alkaline phosphatase (3222.2UI/L), while calcium (8.8 mg/dL) and albumin (1.9 g/dL) were decreased. A serological test for visceral leishmaniasis wasalso performed, which was negative. Abdominal ultrasound imaging revealed kidneys with alterations in tissue architecture, increased thickness and complete loss of cortico-medullary relationship, while the parathyroid gland was enlargedand spindle-shaped. Cranial radiography showed marked radiopacity of the bilateral maxillary bones, with destructionof the nasal, turbinate and frontal bones, as well as loosening of the teeth and destruction of the mandibular bone matrix,characterizing an aspect of “rubber jaw”. Based on the history, history and evidence of azotemia, hyperphosphatemia andloss of facial bone density, the diagnosis of fibrous osteodystrophy secondary to chronic kidney...(AU)

Morfina epidural contínua no controle da dor pós-operatória em ovino / Postoperative pain management in a sheep using continuous epidural morphine

Background: Although ruminants experience pain like other species, diagnosis and treatment may be imprecise and challenging, especially because of lack of recognition and restraint of therapeutic resources. In addition to the restrictions inherent in the species, organic dysfunctions may further restrict the analgesic arsenal, making it necessary to find viable and effective alternative for pain control. The continuous administration of opioids in the epidural space has been highlighted as an analgesic resource in several species. However, until this moment, there are few information on this practice in ruminants. Therefore, the aim of this study was to describe the use of continuous epidural infusion of morphine in a sheep undergoing to urethrostomy with a history of chronic pain and urolithiasis.Case: A 3-year-old Santa Ines sheep, weighting 110 kg, was presented to the Veterinary Hospital of Federal University of Bahia with history of recurrent urolithiasis, lameness, severe pain and continuous use of nonsteroidal anti-inflammatory drug (NSAID). The findings of the physical examination, imaging and laboratory tests revealed possible abomasum inflammation, chronic laminitis, left humerus-radioulnar osteoarthritis and urethral urolithiasis with uremia. A clinical stabilization of the animal was performed, including an interruption of the use of the NSAID and the administration of fluid, urinary acidifier (ammonium chloride), histamine H2 receptor antagonist (ranitidine), cytoprotectant (sucralfate), antibiotic (norfloxacin) and dipyrone. After 3 days, urethrostomy was performed followed by the implantation of an epidural catheter (19G) in the lumbosacral space (L7 - S1) by means of a Tuohy needle (18G), after the surgical procedure. Administration of morphine (0.1 mg kg-1) through the catheter at 24-h intervals, associated with dipyrone (25 mg kg-1) intravenously (IV), every 8 h, over a 5-day period, was the postoperative analgesic protocol chosen.[...]

Morfina epidural contínua no controle da dor pós-operatória em ovino / Postoperative pain management in a sheep using continuous epidural morphine

Background: Although ruminants experience pain like other species, diagnosis and treatment may be imprecise and challenging, especially because of lack of recognition and restraint of therapeutic resources. In addition to the restrictions inherent in the species, organic dysfunctions may further restrict the analgesic arsenal, making it necessary to find viable and effective alternative for pain control. The continuous administration of opioids in the epidural space has been highlighted as an analgesic resource in several species. However, until this moment, there are few information on this practice in ruminants. Therefore, the aim of this study was to describe the use of continuous epidural infusion of morphine in a sheep undergoing to urethrostomy with a history of chronic pain and urolithiasis.Case: A 3-year-old Santa Ines sheep, weighting 110 kg, was presented to the Veterinary Hospital of Federal University of Bahia with history of recurrent urolithiasis, lameness, severe pain and continuous use of nonsteroidal anti-inflammatory drug (NSAID). The findings of the physical examination, imaging and laboratory tests revealed possible abomasum inflammation, chronic laminitis, left humerus-radioulnar osteoarthritis and urethral urolithiasis with uremia. A clinical stabilization of the animal was performed, including an interruption of the use of the NSAID and the administration of fluid, urinary acidifier (ammonium chloride), histamine H2 receptor antagonist (ranitidine), cytoprotectant (sucralfate), antibiotic (norfloxacin) and dipyrone. After 3 days, urethrostomy was performed followed by the implantation of an epidural catheter (19G) in the lumbosacral space (L7 - S1) by means of a Tuohy needle (18G), after the surgical procedure. Administration of morphine (0.1 mg kg-1) through the catheter at 24-h intervals, associated with dipyrone (25 mg kg-1) intravenously (IV), every 8 h, over a 5-day period, was the postoperative analgesic protocol chosen.[...](AU)

Nefrolitíase bilateral associada a uma encefalopatia urêmica em cão / Bilateral nephrolithiasis associated with uremic encephalopathy in dogs

Urolithiasis is the formation of stones in the urinary system. Depending on its locationmay lead to a set of systemic changes, called uremic syndrome. At PATHOVET inFortaleza, a dog named Mel, of the breed Poodle, 13 years, castrated and cardiopathicwas attended. The owner reported that the animal had about 9 months had photos ofpolyuria, polydipsia and syncope. Blood count, creatinine and urea, abdominalultrasonography and urinalysis were requested. The results of the tests showed thepresence of bilateral nephrolithiasis and uremia that justified the onset of uremicsyndrome. In view of the above, it is possible to perceive the importance of earlydiagnosis and adequate therapy in cases of kidney problems.

Nefrolitíase bilateral associada a uma encefalopatia urêmica em cão / Bilateral nephrolithiasis associated with uremic encephalopathy in dogs

Urolithiasis is the formation of stones in the urinary system. Depending on its locationmay lead to a set of systemic changes, called uremic syndrome. At PATHOVET inFortaleza, a dog named Mel, of the breed Poodle, 13 years, castrated and cardiopathicwas attended. The owner reported that the animal had about 9 months had photos ofpolyuria, polydipsia and syncope. Blood count, creatinine and urea, abdominalultrasonography and urinalysis were requested. The results of the tests showed thepresence of bilateral nephrolithiasis and uremia that justified the onset of uremicsyndrome. In view of the above, it is possible to perceive the importance of earlydiagnosis and adequate therapy in cases of kidney problems.(AU)