Kidney tubule health scores and their associations with incident CKD in women living with HIV.

OBJECTIVES: Individual kidney tubule biomarkers are associated with chronic kidney disease (CKD) risk in people living with HIV (PLWH). Whether a combination of kidney biomarkers can be integrated into informative summary scores for PLWH is unknown. METHODS: We measured eight urine biomarkers of kidney tubule health at two visits over a 3-year period in 647 women living with HIV in the Women's Interagency Health Study. We integrated biomarkers into factor scores using exploratory factor analysis. We evaluated associations between CKD risk factors and factor scores, and used generalized estimating equations to determine associations between factor scores and risk of incident CKD. RESULTS: Factor analysis identified two unique factor scores: a tubule reabsorption score comprising alpha-1-microglobulin, beta-2-microglobulin and trefoil factor-3; and a tubule injury score comprising interleukin-18 and kidney injury molecule-1. We modelled the two factor scores in combination with urine epidermal growth factor (EGF) and urine albumin. Predominantly HIV-related CKD risk factors were independently associated with worsening tubule reabsorption scores and tubule injury scores. During a median follow-up of 7 years, 9.7% (63/647) developed CKD. In multivariable time-updated models that adjusted for other factor scores and biomarkers simultaneously, higher tubule reabsorption scores [risk ratio (RR) = 1.27, 95% confidence interval (CI): 1.01-1.59 per 1 SD higher time-updated score], higher tubule injury scores (RR = 1.36, 95% CI: 1.05-1.76), lower urine EGF (RR = 0.75, 95% CI: 0.64-0.87), and higher urine albumin (RR = 1.20, 95% CI: 1.02-1.40) were jointly associated with risk of incident CKD. CONCLUSIONS: We identified two novel and distinct dimensions of kidney tubule health that appear to quantify informative metrics of CKD risk in PLWH.

Meningoencephalitis in a dog due to Trichosporon montevideense.

Meningoencephalitis due to infection with Trichosporon montevideense was diagnosed in a 4-year-old dog with a brief clinical history of rapidly progressing neurological signs that culminated in a comatose state. No significant gross lesions were found at post-mortem examination. Microscopically, a few scattered areas of pyogranulomatous inflammation with a few small, non-pigmented fungal hyphae were found within the cerebrum surrounding the lateral ventricles. A Trichosporon sp. was identified through culture of the brain and species was determined via sequence analysis of the internal transcribed spacer region of the Trichosporon rRNA gene. DNA in-situ hybridization confirmed the diagnosis. This is the first reported case of Trichosporon-associated meningoencephalitis in a dog.

Normal splenic volumes estimated using three-dimensional ultrasonography.

The purposes of this study were to determine splenic volumes using three-dimensional ultrasonography and to compare these measurements with two-dimensional splenic indices. Fifty-two healthy volunteers were studied. Two-dimensional volume measurements were based on length, width, and thickness, and the splenic index was calculated using the standard prolated ellipsoid formula (length x width x thickness x 0.523). Three-dimensional volume planar measurements were obtained with a slice by slice technique by manually drawing a region of interest around the spleen from one end of the sweep to the opposite end. These measurements were recorded three times by two observers. In addition, in vitro determination of splenic volume was performed using three cadaveric human spleens in a water bath. No statistically significant interobserver or intraobserver variability was present for either two-dimensional or three dimensional ultrasonography. Three-dimensional sonographic estimations of planar splenic volumes and ellipsoid splenic volumes were consistently smaller than two-dimensional sonographic estimations of splenic volumes. Three-dimensional sonographic splenic volumes calculated in vitro using the planar method were accurate to within 2% of in vitro water displacement volumes. Three-dimensional ultrasonography is potentially superior to two-dimensional sonography for evaluation of irregularly shaped objects, such as the spleen, and can provide improved accuracy over that of traditional two-dimensional techniques.

Three-dimensional gray scale ultrasonographic imaging of the celiac axis: preliminary report.

The vessels of the celiac axis were evaluated in 16 healthy volunteers with three-dimensional gray scale ultrasonography. Sonographic volume data sets were obtained from both sagittal and transverse planes. The visualization of specific branches of the celiac artery (hepatic, splenic, left gastric, gastroduodenal, left hepatic, right hepatic, right gastric) was evaluated, and each vessel was placed in one of four categories on the basis of the appearance of the specific vessel and image clarity (not seen, poorly seen, adequately seen, well seen). Each vessel was evaluated on an initial two-dimensional scan and on a second scan using the entire volume to optimize and follow the designated vessel using rotating, referencing, and scrolling display capabilities. The ability to manipulate an entire volume improved visualization of the selected vessels as noted by an improved score. The proportion of vessels in the "not seen" and "poorly seen" categories decreased from the initial scan (62.5%) to the scan utilizing the entire volume (36%). Alternatively, the percentage of vessels in the "adequately seen" to "well seen" categories improved from 37.50% on the initial examination to 64% on the scans using the entire volume to depict vascular anatomy. The optimal plane to image each vessel depended on the course of a specific vessel. For optimal imaging of all the selected vessels, both sagittal and transverse volume acquisitions and both sagittal and transverse planes were needed. Three-dimensional imaging provided a new imaging plane (coronal) that was useful in following and identifying vessels, especially those vessels coursing in a right to left direction. Vascular variants were identified by this technique in two of 16 subjects. Vascular imaging was improved with three-dimensional ultrasonography, and this imaging method may provide additional assistance in decision making when evaluating abdominal vessels.

A review of sonographic identification of abdominal blood vessels and juxtavascular organs.

Abdominal vasculature can be evaluated non-invasively using 2-D ultrasound imaging and Doppler ultrasonography. The identification of abdominal vessels using ultrasound is based on knowledge of their normal location, appearance and relationship to specific organs. Because anatomic location of major abdominal vessels is fairly consistent, finding and following vessels is a useful aid when attempting to locate and evaluate juxta-vascular organs. Sonographic vascular evaluation may be beneficial in providing information regarding central cardiovascular abnormalities, detection of abnormalities involving the vessel interrogated, or detection of abnormalities of the parenchymal bed that the vessel supplies. Knowledge of the location and appearance of the vessels is necessary for this information to be of diagnostic value. In this paper, abdominal vessels in the dog are reviewed and a sonographic map of major abdominal vessels is described. This includes the sonographic appearance of the aorta, caudal vena cava, and protal vein, their major branches and their anatomic relationship with adjacent organs. Identification of the medial iliac lymph nodes, mesenteric lymph nodes, abdominal esophagus, duodenum, spleen, kidneys, pancreas, adrenal glands and liver lobes are assisted by recognizing specific vascular landmarks. The locations and appearances of pertinent organs as pertains to abdominal vasculature (caudal vena cava and aorta) are described.

Unilateral nephrectomy in dogs with renal disease: 30 cases (1985-1994).

OBJECTIVE: To evaluate indications for and complications, efficacy, and effects on renal function of unilateral nephrectomy in dogs with renal disease, and to evaluate the role that scintigraphy had in the decision to excise a kidney. DESIGN: Retrospective case series. ANIMALS: 30 dogs with renal disease that underwent unilateral nephrectomy. A comparison group of 12 dogs with renal calculi that underwent renal scintigraphy but not nephrectomy was included. RESULTS: Indications for nephrectomy included renal or ureteral calculi (n = 10), renal mass (8), chronic pyelonephritis (5), perirenal mass (3), severe hydronephrosis and hydroureter (3), and renal hypoplasia with ureteral ectopia (1). None of the dogs were azotemic before surgery. Renal scintigraphy apparently influenced the decision to perform nephrectomy, because in 14 of 16 dogs that underwent nephrectomy, the affected kidney contributed < or = 33% of the total glomerular filtration rate, but in 6 of 8 comparison dogs that underwent nephrotomy, the affected kidney contributed > 33% of total glomerular filtration rate. Complications of nephrectomy included oliguria (5) and organ laceration (2). Mean +/- SD final serum creatinine concentration for 16 dogs alive at least 6 months after nephrectomy was 2.2 +/- 1.8 mg/dl. Three dogs had chronic renal failure of undetermined cause at the time of death. Nephrectomy did not completely resolve the underlying disease in 13 dogs. Renal function was evaluated in 6 dogs 2 to 3.5 years after nephrectomy and was impaired in 4. None of the dogs were anemic, azotemic, proteinuric, or hypertensive. Survival time varied depending on the underlying disease. CLINICAL IMPLICATIONS: Multiple factors contributed to the decision to perform nephrectomy. Unilateral nephrectomy resulted in few serious complications and was not detrimental to the remaining kidney, but did not always resolve the underlying disease.

Microsurgical excision of an abdominal mass in a gourami.

A female, sunset, thick-lipped gourami (Colisa labiosa) that weighed 8 g and was 5.4 cm from the snout to the end of the vertebral column was examined because of a 5-mm-diameter, midventrally located mass that had developed suddenly 1 month earlier. Cytologic examination of a sample obtained by use of fine-needle aspiration, survey radiography, positive-contrast radiography of the gastrointestinal tract, and Doppler ultrasonography were performed to evaluate the mass. These procedures were not able to provide a definitive diagnosis, but did facilitate surgical planning. The mass was excised, and the abdominal musculature was repaired, using microsurgical techniques. Redevelopment of the mass was not detected during the 5-month period after surgery. Histologic evaluation of the mass revealed an organized hematoma of undetermined cause. Successful management of this gourami illustrated that size should not be a deterrent to diagnostic evaluation and surgical intervention in diminutive fish.

Diagnostic imaging in companion animal theriogenology.

Clinical assessment of reproductive problems in companion animals is greatly enhanced by the availability of various imaging modalities. Specifically, survey radiography, contrast radiography, real-time ultrasonography, and ultrasound-guided biopsy and/or aspiration cytology, alone or in various combinations, offer sophisticated methods of extension of the physical examination of the reproductive systems of dogs and cats. In particular, real-time ultrasonography offers invaluable assistance. It is nonionizing, largely noninvasive, rapid, and capable of providing certain dynamic information that is not conveniently available in any other way. Judging from its rapid growth in recent years, it has apparently become an integral part of the complete reproductive assessment of domestic animals. This is not to slight the importance of some of the contrast radiographic procedures that have been developed and refined. Some of them, such as maximum distention retrograde urothrocystography, provide unique information not available with presently routinely used ultrasound techniques. Other imaging modalities, such as magnetic resonance imaging, have heretofore provided limited benefit to theriogenology; that will probably change in years to come.

Tethered spinal cord and an intradural lipoma associated with a meningocele in a Manx-type cat.

An 8-month-old neutered male Manx-type cat was evaluated because of clear fluid that had been draining from a skin mass dorsocaudal to the sacrum for 1 week. Neurologically, the cat had poor postural reactions and poor withdrawal reflexes in the hind limbs. Ultrasonography of the dorsal sacral area revealed a 3-cm-long hypoechoic tract extending from the skin mass cranioventrally to the area of the sacrum. The tract appeared to contain a circular mass. Results of myelography and computed tomography helped to confirm the diagnosis of a meningocutaneous tract containing a mass. Surgical exploration was performed and the tract was excised. Histologic changes were similar to those in human beings with tethered spinal cord syndrome and an intradural lumbosacral lipoma. Surgery was indicated in this cat to prevent progression of neurologic signs associated with tethered cord syndrome and to prevent problems associated with loss of CSF through a fistulated meningocele.

Unusual prostatic mass in a dog.

Marginal surgical resection and castration were successfully used to treat a dog with a large benign mass involving only the left lobe of the prostate. Pathologic findings were compatible with unusual nodular hyperplasia or adenoma, with smooth muscle proliferation. Although the definitive diagnosis remains controversial, the mass was termed nodular hyperplasia because of histologic and clinical similarities to the disease in human beings.

Intrahepatic postsinusoidal venous obstruction in a dog.

Intrahepatic postsinusoidal obstruction, similar to congenital Budd-Chiari syndrome in human patients, was diagnosed in a young Basenji dog. Sonographic, radiographic, and manometric studies were used in antemortem localization of this unusual functional lesion, that was believed to be congenital.

Subtotal canine prostatectomy with the neodymium: yttrium-aluminum-garnet laser.

A technique was developed for subtotal prostatectomy in dogs with the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. In six normal dogs, full-thickness necrosis of the prostate occurred if the central-lateral region within 5 mm of the urethra was photoablated at 60 watts for 1 second. Moderate to superficial necrosis occurred when the prostate within 5 mm of the urethra was photoablated at 35 watts for 2 seconds or 60 watts for 0.5 second. At necropsy, leakage of the urethra occurred in two dogs at sites treated at 60 watts for 1 second. In a clinical study, complications associated with subtotal prostatectomy with the Nd:YAG laser (n = 6) were compared with complications associated with prostatic drainage (n = 6) in dogs with prostatic disease. Intraoperative death (2/6 dogs) and nocturnal incontinence (4/4 surviving dogs) occurred with subtotal prostatectomy. Uncontrolled prostatic infection (2/6 dogs) occurred with prostatic drainage and resulted in the death of one dog on day 11. Four of five dogs surviving prostatic drainage developed recurrent urinary tract infection.