Perception and usage of short-term prednisone and prednisolone in dogs.

BACKGROUND: Corticosteroids are widely used with low rates of reported side effects and a broad level of comfort in the hands of most veterinarians. With a low side effect reporting level of < 5% and high level of comfort there may be complacency and underestimation of the impact side effects of corticosteroids may have on a pet and pet owner. OBJECTIVE: The objective of this clinical study was to describe the experience and perception of an owner who administered anti-inflammatory doses of oral prednisolone and prednisone to their dog for up to 14 days. We hypothesized dogs receiving anti-inflammatory doses of prednisone and prednisolone would experience much greater rates of side effects by day 14 then reported in current literature. ANIMALS: There were 45 dogs initially enrolled in the study. RESULTS: At each study point, 31 owners provided results. On day 5, 74% (23/31) reported at least 1 change in their dog's behavior including polyuria, polydipsia, polyphagia, polypnea and/or increased vocalization, with 11 individuals (35%) reporting these changes greatly increased. On day 14, 90% of owners (28/31) reported at least 1 change in their dog's behavior including polyuria, polydipsia, polyphagia, and/or polypnea as the most common changes noted. Overall, 61% (19/31) of owners reported an increase in filling of the water bowl over baseline and one-third (11/31) of pet owners reported cleaning up urinary accidents for pets who had been continent prior to the start of the study. Pet owner steroid satisfaction remained high through day 14 at 4.5/5 (1 = very unsatisfied, 5 = very satisfied). CONCLUSION: This study highlights the impact short term anti-inflammatory doses of prednisone or prednisolone have on dog behaviour and confirms our hypothesis that by day 14, 90% of dogs experienced one or more behaviour changes, with polyuria and polydipsia most commonly reported. Adverse events were noted regardless of starting dosage or regimen. Although most pet owners expressed satisfaction with steroid treatment due to its high efficacy, 70% would select a more costly treatment if that treatment had fewer side effects.

Hypodipsic hypernatremia after long-standing polydipsia in a cat with suspect neonatal head trauma.

A 16-month-old neutered male domestic shorthair cat weighing 2.7 kg was referred for further evaluation of acute generalized muscle weakness and paraparesis after a long-standing history of polyuria-polydipsia. The diagnosis of hypodipsic/adipsic hypernatremia relied on the key findings of absent spontaneous drinking despite hypernatremia and a hyperosmolar state (444.8 mOsm/kg, reference interval 280 to 310 mOsm/kg). Brain MRI revealed severe multifocal anatomic anomalies of the rostral calvarium and the forebrain, suggestive of encephaloclastic porencephaly. Involvement of the thalamic and hypothalamic regions could have been responsible for the cat's adipsic hypernatremia. The unique aspects of this case were the rare description of central nervous system disease leading to hypodipsia, and the history of chronic polydipsia before the acute onset of hypodipsia. Key clinical message: Multifocal abnormalities of the forebrain can present with polyuria-polydipsia syndrome, hypodipsia/adipsia, or both, depending on the stage of the disease. This likely happens when the hypothalamic and thalamic regions are affected, since they regulate antidiuretic hormone release and thirst, respectively.

Hypernatrémie hypodipsique après polydipsie ancienne chez un chat suspect de traumatisme crânien néonatal. Un chat domestique à poil court mâle castré âgé de 16 mois et pesant 2,7 kg a été référé pour une évaluation plus approfondie de faiblesse musculaire aiguë généralisée et de paraparésie après une longue histoire de polyurie-polydipsie. Le diagnostic d'hypernatrémie hypodipsique/adipsique reposait sur les principales conclusions de l'absence d'abreuvement spontané malgré l'hypernatrémie et un état hyperosmolaire (444,8 mOsm/kg, intervalle de référence de 280 à 310 mOsm/kg). L'IRM du cerveau a révélé des anomalies anatomiques multifocales sévères de la calotte crânienne rostrale et du prosencéphale évoquant une porencéphalie encéphaloclastique. L'atteinte des régions thalamique et hypothalamique pourrait être responsable de l'hypernatrémie adipsique du chat. Les aspects uniques de ce cas étaient la description rare d'une maladie du système nerveux central conduisant à l'hypodipsie, et l'histoire de la polydipsie chronique avant l'apparition aiguë de l'hypodipsie.Message clinique clé :Les anomalies multifocales du cerveau antérieur peuvent présenter un syndrome de polyurie-polydipsie, une hypodipsie/adipsie, ou les deux, selon le stade de la maladie. Cela se produit probablement lorsque les régions hypothalamique et thalamique sont affectées, car elles régulent respectivement la libération d'hormone antidiurétique et la soif.(Traduit par Dr Serge Messier).

Polyuria and Polydipsia in Horses.

Polyuria and polydipsia are rare, but significant, manifestations of several different diseases of horses. Causes can be endocrine, iatrogenic, psychogenic, infectious, or toxic in nature and can also be due to primary renal disease or diseases of other organs, such as the liver. Although numerous causes of polyuria and polydipsia in horses exist, the most common conditions include chronic kidney disease, pituitary pars intermedia dysfunction, and psychogenic polydipsia with secondary polyuria. Additional testing is dictated by history, other clinical signs, and the results of blood work and/or urinalysis. Prognosis for horses with polyuria and/or polydipsia varies significantly based on the underlying cause.

Transient Fanconi syndrome with severe polyuria and polydipsia in a 4-year old Shih Tzu fed chicken jerky treats.

Acquired Fanconi syndrome is characterized by inappropriate urinary loss of amino acids, bicarbonate, electrolytes, and water. It has recently been described in dogs fed chicken jerky treats from China, a new differential diagnosis to the classical inciting infectious diseases (e.g. leptospirosis, pyelonephritis) and toxins. A dog fed exclusively chicken jerky treats purchased in Switzerland was presented to our clinic with severe polyuria, polydipsia and profound electrolyte and acid base disturbances. Other inciting causes of Fanconi syndrome were ruled out. The requirement of a very intensive supportive treatment in this dog stands in contrast to treatment of chronic forms of Fanconi syndrome as described in the Basenji. This intensive therapy and the associated monitoring can be a real challenge and a limiting factor for the prognosis of acquired Fanconi syndrome. Veterinarians should be aware of the risk of excessive feeding of chicken jerky treats.

Metastatic malignant pilomatrixoma, acanthomatous ameloblastoma, and liver tumor in a dog with polyphagia, polyuria, polydipsia, and weight loss.

A 12-year-old, spayed female, Labrador dog was presented for evaluation of polyphagia, polyuria, polydipsia, weight loss of 2 months duration, and multiple cutaneous and subcutaneous masses. The dog was diagnosed with malignant pilomatrixoma with renal, lung, and lumbar metastases. This report describes an atypical presentation of malignant pilomatrixoma.

Pilomatrixoma malin avec métastases, améloblastome acanthomateux et tumeur hépatique chez une chienne avec polyphagie, polyurie, polydipsie et amaigrissement. Une chienne Labrador, âgée de 12 ans, était présentée pour l'évaluation d'une polyphagie, polyurie, polydipsie et d'un amaigrissement durant depuis 2 mois, ainsi que de multiples masses cutanées et sous-cutanées. Elle présentait un pilomatrixoma avec métastases aux reins, aux poumons et à une vertèbre lombaire. Ce rapport de cas décrit une présentation atypique de pilomatrixoma malin.(Traduit par les auteurs).

Transient distal renal tubular acidosis with nephrogenic diabetes insipidus after general anaesthesia in a dog.

A 3-year-old, 3.5 kg, female spayed Pomeranian was referred due to persistent vomiting, anorexia, polyuria and polydipsia, 7 days after receiving general anaesthetic for a medial patellar luxation correction. Physical examination revealed lethargy, tachypnoea and 7% dehydration. Complete blood count and serum chemistry results were unremarkable, and venous blood gas analysis revealed hypokalaemia and hyperchloraemic metabolic acidosis with a normal anion gap. Urinalysis revealed a urine specific gravity (USG) of 1.005, pH of 7.0 and proteinuria, and the bacterial culture was negative. Based on these results, the dog was diagnosed with distal renal tubular acidosis, and potassium citrate was prescribed to correct metabolic acidosis. In addition, concurrent diabetes insipidus (DI) was suspected because the dog showed persistent polyuria, polydipsia and a USG below 1.006 despite dehydration. After 3 days of initial treatment, acidosis was corrected, and vomiting resolved. Desmopressin acetate and hydrochlorothiazide were also prescribed for DI, but the USG was not normalized. Based on the insignificant therapeutic response, nephrogenic DI was highly suspected. DI was resolved after 24 days. This case report describes the concomitant presence of RTA and DI in a dog after general anaesthesia.

Long-term follow-up of a juvenile simple renal cyst in a dog treated by laparoscopic deroofing, fulguration, and omentalization.

CASE DESCRIPTION: A 10-month-old male crossbred dog presented with a 4-week history of polyuria and polydipsia and a 6-month history of vomiting. CLINICAL FINDINGS: Clinical examination revealed abdominal pain and right-sided nephromegaly. Biochemistry was within normal limits. Diagnostic imaging showed a well-defined, unilateral renal mass containing anechoic fluid consistent with a simple renal cyst (SRC). TREATMENT AND OUTCOME: The cyst was drained under ultrasonographic guidance but recurred 3 months later, concomitant with recurrence of the previously reported clinical signs. The cyst was then deroofed, fulgurated, and omentalized under laparoscopy by use of a 3-port technique. The resected cystic wall was histopathologically consistent with an SRC, presumptively congenital. The dog showed a good recovery with resolution of clinical signs. Renal function was normal at last follow-up, conducted 2 years postoperatively, without evidence of recurrent disease. CLINICAL RELEVANCE: To our knowledge, this was the first report of a symptomatic juvenile SRC of presumptively congenital origin in a dog treated successfully by laparoscopic deroofing, fulguration, and omentalization. The polyuria, polydipsia, chronic vomiting, and abdominal pain may all have been related to space-occupying effects of the cyst, as these symptoms resolved post-treatment. Results of long-term follow-up advocate for this durable cure of SRC by use of laparoscopic procedures, especially when compared to simple drainage of the cyst, as the latter initially failed in the present case.

Effects of desmopressin acetate administration in healthy dogs receiving prednisolone.

BACKGROUND: Glucocorticoids are used for a variety of purposes in veterinary medicine but often are associated with clinically important adverse effects. Polyuria and polydipsia are the most frustrating adverse effects noted by owners. OBJECTIVE: To determine whether administration of desmopressin ameliorates polyuria and polydipsia associated with prednisolone administration. ANIMALS: Seven healthy adult Walker Hounds. METHODS: Prospective hypothesis testing study. Daily water intake and urine specific gravity (USG) were measured in dogs under 4 separate sequential conditions: no medications (C), prednisolone only (P), prednisolone and desmopressin (PD), and prednisolone after discontinuation of desmopressin (PAD). RESULTS: When compared to baseline, 6 of 7 dogs became polydipsic after administration of prednisolone (0.5 mg/kg PO q12h). When desmopressin (5 µg/dog SC q12h) was administered to dogs receiving prednisolone, significant decreases in water intake and serum sodium concentration occurred, and USG increased significantly. CONCLUSIONS AND CLINICAL IMPORTANCE: Administration of desmopressin to dogs receiving prednisolone significantly decreased water intake and serum sodium concentration, and increased USG. Our results suggest that, in some dogs, desmopressin ameliorates the most important adverse effect of prednisolone noted by owners, but that hyponatremia is an important complication associated with desmopressin use.

Paraneoplastic hypercalcemia in a dog with benign renal angiomyxoma.

An 11-year-old, male, neutered crossbred Collie dog was presented for a history of polydipsia and polyuria. Diagnostic investigations revealed total and ionized hypercalcemia and an increased concentration of parathyroid hormone-related peptide. Abdominal ultrasonography and contrast-enhanced computed tomography of the abdomen revealed a right-sided, cystic-appearing renal mass. Cytological examination of ultrasound-guided aspirates of the mass revealed high numbers of spindle cells. The mass was removed en bloc via an ureteronephrectomy. Histopathological examination of the mass revealed neoplastic spindle cells in loosely packed and interlacing streams within a myxomatous stroma. Immunohistochemical examination with vimentin, von Willebrand Factor, and alpha-smooth muscle actin confirmed the mass to be a renal angiomyxoma. A minority of the neoplastic spindle cells showed positive cytoplasmic parathyroid hormone-related peptide immunostaining. The hypercalcemia resolved following surgery, and the parathyroid hormone-related peptide concentration returned to within the reference interval. The dog was no longer polydipsic or polyuric 1 year following surgery. The present report describes a previously unreported renal neoplasm causing paraneoplastic hypercalcemia and highlights the possibility of paraneoplastic hypercalcemia being caused by a benign neoplasm.

Abnormal water balance in a mutant strain of chickens.

Polydipsia and polyuria are pronounced in chickens of a selected strain and this diabetes insipidus is inherited. The kidneys of such birds are capable of an antidiuretic response when lysine vasopressin or arginine vasotocin is injected. Osmotic pressure and sodium concentration of the plasmas of normal and mutant chickens are identical. Chicks predicted to have diabetes insipidus on the basis of parental pedigree are polydipsic.

Bilateral juvenile renal dysplasia in a Norwegian Forest Cat.

Renal dysplasia is defined as a condition of disorganised development of renal parenchyma due to abnormal differentiation. The case of a 5-month-old intact male Norwegian Forest Cat with a history of polyuria and polydipsia is reported. Ultrasonographic examination showed a slight enlargement of kidneys. Biochemical parameters, haematological examinations and clinical signs were compatible with chronic renal failure (CRF). Histological examination was correlated with a primary tubular disorganisation and modification of glomerular compartment. The clinical history together with the histological lesions is consistent with bilateral juvenile renal dysplasia in this cat. To our knowledge, feline renal dysplasia has been reported in fetal infections with panleukopenia virus; no reports indicate the idiopathic origin in feline dysplastic lesions.

Luteinizing hormone-dependent Cushing's syndrome in a pet ferret (Mustela putorius furo).

Hyperadrenocorticism in ferrets is associated with increased circulating concentrations of adrenal androgens, whereas plasma concentrations of cortisol and ACTH are usually not affected. Here, we report on a 5-year-old castrated male pet ferret (Mustela putorius furo) in which the major presenting signs were polyuria and polyphagia. Routine biochemistry values were within their reference ranges. The urinary corticoid:creatinine ratio (UCCR) was increased and the plasma ACTH concentration was suppressed. Abdominal ultrasonography revealed an enlarged right adrenal gland and atrophy of the left adrenal gland. Administration of hCG resulted in an increase of plasma cortisol and androstenedione concentrations. Based on these findings LH/hCG-dependent hypercortisolism and hyperandrogenism were suspected and treatment was started with a depot GnRH-agonist implant containing 9.4mg deslorelin. Within 3 weeks after placement of the implant all clinical signs had disappeared. Three months later the endocrine parameters had normalized, while abdominal ultrasonography revealed that the right adrenal gland had diminished in size and the left adrenal gland was considered of normal size. No recurrences of clinical signs were seen within 2 years after placement of the deslorelin implant. At that time urinary corticoid and plasma hormone concentrations were within their reference ranges, and no further change in the size of the adrenal glands was seen. In conclusion, this is the first confirmed case of LH-dependent hypercortisolism in a ferret that was treated successfully with a depot GnRH-agonist.

Pituitary-dependent hyperadrenocorticism in a cockatoo.

CASE DESCRIPTION: A 13-year-old female intact Moluccan cockatoo (Cacatua moluccensis) was evaluated because of coelomic distention, presumed to be secondary to an abdominal hernia. The patient also had a history of rapid weight gain and polyuria and polydipsia. CLINICAL FINDINGS: Ultrasonography was used to confirm the existence of a pseudohernia that appeared to contain the small intestines, pancreas, and reproductive tract. Results of plasma biochemical analysis revealed hyperglycemia, hypophosphatemia, and high nonfasting bile acid concentrations and aspartate aminotransferase activity. A CBC revealed a relative heterophilia with a concomitant lymphopenia and mild monocytosis. Histologic evaluation of a liver biopsy specimen indicated chronic hepatic lipidosis. Despite a strong clinical suspicion of hyperadrenocorticism, ACTH stimulation test results were equivocal. TREATMENT AND OUTCOME: The pseudohernia was strengthened with a prolene mesh. Despite ongoing medical and surgical care, the patient developed complications associated with the herniorrhaphy and was euthanatized. The clinical suspicion of hyperadrenocorticism was confirmed on the basis of histologic evaluation of the pituitary gland by use of special stains. CLINICAL RELEVANCE: To our knowledge, pituitary-dependent hyperadrenocorticism has not been previously confirmed in Psittaciformes. The condition should be considered in birds with clinical signs consistent with those observed in mammals. For the cockatoo of this report, ACTH stimulation test results were equivocal and additional diagnostic tests should be developed for avian patients.

Pollakisuria in a dwarf goat due to pathologic enlargement of the uterus.

Pollakisuria in adult goats can be caused by diseases of the urinary tract and by distension of parts of the genital tract leading to irritation of the bladder. Hydrometra is the most common cause of uterine distension in goats and usually can be resolved by prostaglandin injections. But other pathologies of the uterus can generate a similar syndrome. A dwarf goat was presented at the clinic with a history of chronic pollakisuria and tenesm. An initial ultrasonographic examination of the abdomen led to the suspicion of hydrometra, but treatment with injections of prostaglandin were not successful. Blood samples revealed low progesterone and high oestrogen values. A laparotomy was performed and an enlarged uterus with 1.5 L of mucous content and cystic ovaries were found and partially removed. A single solid leiomyoma was diagnosed histologically in the uterine wall. Two months later the goat's condition had deteriorated and therefore she was euthanized. Necropsy and pathohistological examination revealed the presence of a metastasized adenocarcinoma of the uterus. In this case, the pollakisuria provoqued by distension of the uterus was not caused by hydrometra, but by neoplasia. The syndrome and the pathogenesis of the adenocarcinoma in consideration of the hormonal status of the patient is discussed.

Polyuria and polydipsia in horses.

Polyuria and polydipsia provide a diagnostic challenge for the equine clinician. This article describes the various known causes of polyuria and polydipsia in horses and provides a description of a systematic diagnostic approach for assessing horses with polyuria and polydipsia to delineate the underlying cause. Treatment and management strategies for addressing polyuria and polydipsia in horses are also described.

Primary hyperparathyroidism in 29 dogs: diagnosis, treatment, outcome and associated renal failure.

OBJECTIVES: To review the records of 29 dogs diagnosed with primary hyperparathyroidism and see if any factors correlate with renal failure. METHODS: Dogs were selected retrospectively from case files from the QVSH and the QMH. RESULTS: The majority of dogs were middle-aged and four were keeshonds. The primary presenting complaints were polyuria and polydipsia. All dogs had an elevated total and ionised plasma calcium concentration. Plasma phosphate concentrations were variable. Ultrasonography of the parathyroid gland revealed nodular enlargement which was found to correlate well with surgical findings. The majority of dogs underwent surgical parathyroidectomy. Five cases were treated by ultrasound-guided chemical ablation of the parathyroid gland, of which only two cases showed a partial response. Three dogs were euthanased within a week of presentation. Seven other dogs had renal failure diagnosed either at presentation or up to six months after parathyroidectomy. The development of renal failure was correlated with total calcium concentration but did not correlate with any other factor, including the calcium phosphate product. Thirteen treated dogs were known to be alive at the time of writing, which was six months to 3.5 years after parathyroidectomy. CLINICAL SIGNIFICANCE: Primary hyperparathyroidism cases with high total calcium were more likely to develop renal failure in this group of dogs; however, the calcium phosphate product did not seem to be a useful predictor. Ultrasound-guided chemical ablation seemed to have limited advantage over surgery.

Aldosteronoma in a dog with polyuria as the leading symptom.

In a 10-year-old castrated male shorthaired German pointer polyuria was associated with slight hypokalemia, hypophosphatemia and alkalosis, as well as elevated plasma concentrations of a glucocorticoid-inducible iso-enzyme of alkaline phosphatase. Repeated measurements of urinary corticoids and normal suppressibility of the hypothalamus-pituitary-adrenocorticial axis excluded glucocorticoid excess. Urine osmolality (Uosm) did not increase during administration of the vasopressin analogue desmopressin. At the time water deprivation had caused Uosm to rise from 300 to 788 mOsm/kg, there was also plasma hypertonicity. During hypertonic saline infusion the osmotic threshold for vasopressin release was increased. The combination of elevated plasma aldosterone concentrations and unmeasurably low plasma renin activity pointed to primary hyperaldosteronism. As initially computed tomography (CT) did not reveal an adrenocortical lesion, the dog was treated with the aldosterone antagonist spironolactone. This caused Uosm to rise in a dose-dependent manner. However, well-concentrated urine was only achieved with doses that gave rise to adverse effects. Once repeated CT, using 2-mm-thick slices, had revealed a small nodule in the cranial pole of the left adrenal, unilateral adrenalectomy was performed which resolved the polyuria completely. Also the plasma concentrations of kalium, aldosterone and renin activity returned to within their respective reference ranges. The adrenocortical nodule had the histological characteristics of an aldosteronoma, with the non-affected zona glomerulosa being atrophic.In this dog with primary hyperaldosteronism the polyuria was characterized by vasopressin resistance and increased osmotic threshold of vasopressin release, similar to the polyuria of glucocorticoid excess. The possibility is discussed that the polyuria of glucocorticoid excess is actually a mineralocorticoid effect.

Disturbed vasopressin release in 4 dogs with so-called primary polydipsia.

Primary polydipsia is characterized by a marked increase in water intake and secondary polyuria, and in dogs often is described as a behavioral problem or a psychological disorder. We describe 4 dogs with primary polydipsia, diagnosed on the basis of a modified water deprivation test, in which further examination included serial measurements of urine osmolality (UOsm) and plasma vasopressin (VP) measurements during water deprivation and hypertonic saline infusion. The dogs, ranging in age from 4 months to 4 years, all were presented for evaluation of polyuria and polydipsia. Physical examination, routine blood chemistry, and urinalysis disclosed no specific cause for the polyuria and polydipsia. During serial measurements UOsm spontaneously reached high concentrations in 2 dogs, whereas in the other 2 dogs UOsm also fluctuated but on no occasion exceeded 1,000 mosm/kg. Primary polydipsia was diagnosed when UOsm exceeded 1,000 mosm/kg at the end of the modified water deprivation test and plasma osmolality did not exceed the upper limit of the reference range during testing. During water deprivation, plasma VP concentrations remained relatively low. The VP response to hypertonic saline infusion was abnormal, with an increased threshold value in 3 dogs, an increased sensitivity in 2 dogs, and an exaggerated response in 1 dog. It is concluded that some dogs fulfilling current criteria for primary polydipsia produce concentrated urine spontaneously throughout the day in a pattern similar to what has been observed in healthy pet dogs. This finding can be regarded as diagnostic and precludes the need for a water deprivation test. During water deprivation testing, all 4 dogs produced highly concentrated urine in the face of low basal plasma VP concentrations. The observed abnormal VP release in response to hypertonic stimulation may be interpreted as a primary disturbance in the regulation of VP secretion, although it might also be the result of overhydration caused by a primary abnormality in drinking behavior.