Renal biomarkers, clinical parameters, and renal Doppler velocimetry in bitches with cystic endometrial hyperplasia-pyometra complex.

Cystic endometrial hyperplasia (CEH)-pyometra complex is the most common uterine infection in adult and elderly bitches and can cause renal dysfunction. The aim of this study was to measure and compare urinary creatinine, urea, symmetric dimethylarginine (SDMA), urinary protein-creatinine ratio (UPC), measurement of systolic blood pressure (SBP), and Doppler velocimetry of renal arteries in patients with CEH-pyometra complex before and after an average of 6 months of treatment, evaluating the possibility of the changes persisting. The evaluation was conducted at two moments: M1 (at the diagnosis of CEH-pyometra, n = 36) and M2 (after an average of six months of treatment, n = 16). For the control group, eight bitches with no changes in blood tests or history of conditions underwent Doppler ultrasound evaluation of the renal arteries. At both M1 and M2, we measured creatinine, urea, and serum SDMA, UPC, SBP, and Doppler ultrasound of the renal arteries. Patients were evaluated according to the following groups: azotemic (AZO) and non-azotemic (NAZO), and open and closed cervix pyometra. The parameters were compared between animals present in both moments presented as M1R (bitches that were in M1 and M2) and M2. Statistical significance was considered when p < .05. The medians found for creatinine in M1 were as follows: 1.15 mg/dL, being 1.8 mg/dL for AZO (12/36) and 0.95 mg/dL for NAZO (24/36); and in M2: 0.85 mg/dL (16/16), being 1.15 mg/dL for AZO (4/16) and 0.8 mg/dL for NAZO (12/36). For urea, in M1 it was 36 mg/dL (32/36), with AZO being 103 mg/dL (11/32) and 33 mg/dL in NAZO (21/32); and in M2 32 mg/dL (16/ 16), being 29 mg/dL for AZO (4/36), and 31 mg/dL for NAZO (3/15). The median SDMA measured in M1R was 17 µg/dL (15/16), with AZO being 31 µg/dL (3/15), and NAZO being 16.5 µg/dL (12/15); and in M2, SDMA was 12 µg/dL (16/16), with AZO being 12.5 µg/dL (4/16), and NAZO being 12 µg/dL (12/16). The median UPC measured in M1 was 1.15 (10/36), with AZO being 0.25 (1/10), and NAZO being 1.38 (9/10); and in M2, it was 0.2 (13/16), being 0.1 in AZO (4/13), and 0.2 (9/16) in NAZO. For SBP, in M1, it was 118 mmHg (30/36), with AZO being 102 mmHg (10/30) and 133 mmHg in NAZO (20/30); and in M2 142.5 mmHg (12/16), being 155 mmHg for AZO (4/12), and 140 mg/dL for NAZO (8/12). When comparing animals with open and closed cervixes, a difference was found between SDMA measurements (p = .001). There was a distinction between PI and RI of the left and right kidneys consecutively (p = .007; p = .033; p = .019; p = .041). Correlations found in M1: SDMA × PI RIM DIR (r = 0.873; p = .002), SDMA × PSV RIM ESQ (r = 0.840; p = .004), SDMA × EDV RIM ESQ (r = 0.675; p = .046). With this study, we conclude a return to normality of renal biomarkers and clinical parameters after six months. Yet, there is a persistence of Doppler velocimetric measurements between the two moments. Thus, this parameter is not suitable for identifying and classifying chronic kidney injury in bitches with pyometra.

Comparison of serum creatinine, point-of-care symmetric dimethylarginine and renal imaging with glomerular filtration rate measured by renal scintigraphy in healthy and early chronic kidney diseased cats.

The aim of this study was to evaluate routinely used tests to diagnose cats in early stages of chronic kidney disease (CKD) and to describe a model for evaluating these variables simultaneously. Apparently healthy cats were screened using serum creatinine (sCr), point-of-care symmetric dimethylarginine (POC SDMA), urinalysis, urine protein/creatinine ratio (UPC) and imaging evaluation. Those parameters were compared to glomerular filtration rate (GFR) assessed by renal scintigraphy. Forty-four cats were included and consisted of 14 (31.8%) healthy cats (absence of abnormalities in renal morphology and sCr less than 1.6 mg/dL), 20 (45.5%) cats classified as CKD I (presence of abnormalities in renal morphology and sCr less than 1.6 mg/dL) and ten (22.7%) as CKD II (sCr equal to or greater than 1.6 mg/dL, with or without abnormalities in renal morphology). A large number (40.9%) of apparently healthy cats presented reduction in GFR, which included half of CKD I patients. Point-of-care SDMA was not a good predictor for decreased GFR, nor was it correlated with the variables GFR and sCr. Glomerular filtration rate was significantly lower in CKD I and II groups in comparison with healthy cats, but there was no significant difference between the CKD I and II groups. Multivariate logistic regression model identified three variables that affected the odds of a cat having decreased GFR (< 2.5 mL/min/kg): sCr (OR = 18.3; p = 0.019; CI = 1.6-207.2), and the ultrasonographic findings 'reduced corticomedullary definition' (OR = 19.9; p = 0.022; CI = 1.6-254.0) and 'irregular contour' (OR = 65.6; p = 0.003; CI = 4.2-1038.2). Renal ultrasonography evaluation should always be considered for screening early CKD in apparently healthy cats.

Correlación de biomarcadores de función renal en el primer acercamiento diagnóstico de la enfermedad renal crónica en perros

RESUMEN Objetivo. Determinar la correlación de los biomarcadores de funcionamiento renal en la primera evaluación en perros con diferentes factores de riesgo identificados para desarrollar enfermedad renal crónica (ERC). Materiales y métodos. Se realizó un estudio descriptivo, prospectivo de casos y controles de 388 animales, divididos en cinco grupos: grupo control (GC), y cuatro grupos de perros potencialmente enfermos renales (pERC). Se analizaron historia clínica, examen físico, condición corporal (CC), hemograma, perfil bioquímico con dimetilaginina simétrica (SDMA), urianálisis, ratio proteinuria/creatininuria (UPC) y medición de presión arterial sistémica. Se utilizó estadística no paramétrica y los datos fueron expresados en medianas y percentiles; para la CC se utilizó Xi2. Para los biomarcadores se realizó correlación de Spearman. Resultados. Para SDMA y la creatinina sérica (CrS) se observó una correlación moderada para pERC (r=0.69, p<0.001). Se observaron diferencias significativas en las variables edad (p=0.002), y CC (p<0.001) entre el GC y los pERC. Los animales azotemia leve (CrS 125-250 μmol/L) y/o con un valor de SDMA de 18-35 μg/dL, con o sin proteinuria tuvieron una mayor probabilidad de presentar un incremento de SDMA cuando se presentó una CC por debajo de 5/9 (OR=3.55, p=0.005). Conclusiones. El SDMA es un biomarcador complementario útil en etapas preazotémicas y en estadios avanzados donde existen caquexia y sarcopenia. Los biomarcadores deben evaluarse en conjunto para tener perspectiva completa de la función renal en los animales con factores de riesgo para desarrollar ERC.

ABSTRACT Objective. To determine the correlation of kidney function biomarkers at the first evaluation in dogs with different risk factors identified for developing chronic kidney disease (CKD). Materials and methods. A descriptive, prospective study of cases and controls of 388 animals, divided into five groups: control group (CG), and four groups of potentially kidney-diseased dogs (pCKD) was carried out. Clinical history, physical examination, body condition score (BCS), complete blood count, biochemical profile with symmetrical dimethylarginine (SDMA), urinalysis, urine protein/creatinine ratio (UPC), and systemic blood pressure were analyzed. Non-parametric statistics were used, and data were expressed as medians and percentiles; for BCS, Xi2 was used. For biomarkers, Spearman's correlation was performed. Results. For SDMA and serum creatinine (sCr), a moderate correlation was observed for pCKD (r=0.69, p<0.001). Significant differences were observed in the variables age (p=0.002) and BCS (p<0.001) between the CG and the pCKD. Animals with mild azotemia (sCr 125-250 μmol/L) and/or with an SDMA value of 18-35 μm/dL, with or without proteinuria, had a greater probability of presenting an increase in SDMA when the BCS was below 5/9 (OR=3.55, p=0.005). Conclusions. SDMA is a useful complementary biomarker in pre-azotemic stages and advanced stages where there is cachexia and sarcopenia. Biomarkers must be evaluated together to have a complete perspective of renal function in animals with risk factors for developing CKD.

Clinical outcomes of 28 cats 12-24 months after urethrostomy.

OBJECTIVES: The aim of this study was to evaluate and compare the long-term clinical outcomes and quality of life of cats having undergone perineal urethrostomy (PU) or prepubic urethrostomy (PPU). METHODS: This clinical study followed 28 cats (PU, n = 22; PPU, n = 6) that underwent a urethrostomy, with a minimum of 1 year postoperative follow-up. Medical records, pet owner surveys and urologic laboratory tests were used for assessment. Urologic laboratory tests included serum symmetric dimethylarginine (SDMA), serum creatinine, urinalysis, urine specific gravity (USG), urine protein:creatinine (UPC) ratio and urine culture. RESULTS: The main indications for urethrostomy were multiple catheterizations and PU stricture. The overall complication rates of PU and PPU were 31.8% and 83.3%, respectively. Recurrent urinary tract infection (UTI) and urine scald dermatitis were less frequent in PU than in PPU cats (UTI 22.7% vs 66.6%; dermatitis 4.5% vs 83.3%). Bacteriuria was present in 77.2% and 100% of PU and PPU cats, respectively. Owner satisfaction rates were excellent in 81.8% of PU and 33.3% of PPU cases. CONCLUSIONS AND RELEVANCE: A proportion of cats that underwent urethrostomy showed bacteriuria, recurrent UTIs and increased levels of SDMA. PPU is important as a salvage procedure; however, it should be limited to cases in which standard techniques for PU cannot be performed, owing to the potential for recurrent complications and lower owner satisfaction.

Use of symmetric dimeltilarginine renal biomarker in early diagnosis off chronic renal failure in dogs and cats / Uso do biomarcador renal dimetilarginina simétrica no diagnóstico precoce da insuficiência renal crônica em cães e gatos

Kidney disease is commonly found in small animal clinics, but its diagnosis is often late. The research to find sensitive renal biomarkers has been performed in order to provide an early diagnosis allowing appropriate therapy for each patient, as well as improving his quality of life. The renal biomarker  Symmetric Dimethylarginine (SDMA) is presenting perspectives for the diagnosis of kidney disease in dogs and cats, detecting kidney damage when 50% of its function is compromised. This paper performs a review of the use of dimethyartinine in the diagnosis of kidney disease in these animals.(AU)

A doença renal é comumente encontrada na clínica de pequenos animais, porém o seu diagnóstico é geralmente muito tardio. Pesquisas por biomarcadores renais mais sensíveis são foco de estudos, pois poderão proporcionar um diagnóstico precoce, permitir o estabelecimento da terapia adequada a cada paciente e melhorar a sua qualidade de vida. O biomarcador renal Dimetilarginina Simétrica (SDMA), tem apresentado resultados significativos em termos de precocidade para o diagnóstico da doença renal, podendo detectar lesão renal quando 50% da função está comprometida. O presente trabalho faz uma revisão da situação atual e perspectivas do emprego da dimetilarginina simétrica para estabelecimento do diagnóstico da doença renal em cães e gatos.(AU)

Use of symmetric dimeltilarginine renal biomarker in early diagnosis off chronic renal failure in dogs and cats / Uso do biomarcador renal dimetilarginina simétrica no diagnóstico precoce da insuficiência renal crônica em cães e gatos

Kidney disease is commonly found in small animal clinics, but its diagnosis is often late. The research to find sensitive renal biomarkers has been performed in order to provide an early diagnosis allowing appropriate therapy for each patient, as well as improving his quality of life. The renal biomarker  Symmetric Dimethylarginine (SDMA) is presenting perspectives for the diagnosis of kidney disease in dogs and cats, detecting kidney damage when 50% of its function is compromised. This paper performs a review of the use of dimethyartinine in the diagnosis of kidney disease in these animals.

A doença renal é comumente encontrada na clínica de pequenos animais, porém o seu diagnóstico é geralmente muito tardio. Pesquisas por biomarcadores renais mais sensíveis são foco de estudos, pois poderão proporcionar um diagnóstico precoce, permitir o estabelecimento da terapia adequada a cada paciente e melhorar a sua qualidade de vida. O biomarcador renal Dimetilarginina Simétrica (SDMA), tem apresentado resultados significativos em termos de precocidade para o diagnóstico da doença renal, podendo detectar lesão renal quando 50% da função está comprometida. O presente trabalho faz uma revisão da situação atual e perspectivas do emprego da dimetilarginina simétrica para estabelecimento do diagnóstico da doença renal em cães e gatos.

Symmetric dimethylarginine concentrations in dogs with International Renal Interest Society stage 4 chronic kidney disease undergoing intermittent hemodialysis.

BACKGROUND: Symmetric dimethylarginine (SDMA) is a methylated arginine derived from intranuclear methylation of l-arginine by protein-arginine methyltransferase and released into circulation after proteolysis. It is primarily eliminated by renal excretion, and its concentration is highly correlated with glomerular filtration rate (GFR) in animals and humans and is an earlier indicator of kidney dysfunction than serum creatinine concentration (sCr). OBJECTIVES: To evaluate and quantify the effects of IV fluid therapy (IF) or intermittent hemodialysis (IH) on renal function in a randomized group of dogs previously diagnosed with International Renal Interest Society (IRIS) stage 4 chronic kidney disease (CKD). ANIMALS: Twenty-four client-owned dogs with naturally occurring CKD. METHODS: Serum from 14 dogs treated by IH and 10 dogs treated with IF was submitted for measurement of sCr and SDMA. Dogs in each treatment group received up to 5 treatment sessions, administered 48 hours apart. RESULTS: Significant differences (P ≤ .05) were seen between treatment groups, but dogs from the IH group were the most affected based on SDMA (P < .001), sCr (P < .001), and blood urea (P < .001) concentrations. Furthermore, for each 10% increase in urea reduction ratio, there was a 6.2 µg/dL decrease in SDMA (P = .002). CONCLUSIONS AND CLINICAL IMPORTANCE: Although SDMA is dialyzable biomarker and despite its removal by IH, SDMA correlates better with renal function than does sCr in dogs with CKD undergoing IF and IH.

Asymmetric Dimethylarginine at Sea Level Is a Predictive Marker of Hypoxic Pulmonary Arterial Hypertension at High Altitude.

Background: Prolonged exposure to altitude-associated chronic hypoxia (CH) may cause high-altitude pulmonary hypertension (HAPH). Chronic intermittent hypobaric hypoxia (CIH) occurs in individuals who commute between sea level and high altitude. CIH is associated with repetitive acute hypoxic acclimatization and conveys the long-term risk of HAPH. As nitric oxide (NO) regulates pulmonary vascular tone and asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthesis, we investigated whether ADMA concentration at sea level predicts HAPH among Chilean frontiers personnel exposed to 6 months of CIH. Methods: In this prospective study, 123 healthy army draftees were subjected to CIH (5 days at 3,550 m, 2 days at sea level) for 6 months. In 100 study participants with complete data, ADMA, symmetric dimethylarginine (SDMA), L-arginine, arterial oxygen saturation (SaO2), systemic blood pressure, and hematocrit were assessed at months 0 (sea level), 1, 4, and 6. Acclimatization to altitude was determined using the Lake Louise Score (LLS) and the presence of acute mountain sickness (AMS). Echocardiography was performed after 6 months of CIH in 43 individuals with either good (n = 23) or poor (n = 20) acclimatization. Results: SaO2 acutely decreased at altitude and plateaued at 90% thereafter. ADMA increased and SDMA decreased during the study course. The incidence of AMS and the LLS was high after the first ascent (53 and 3.1 ± 2.4) and at 1 month of CIH (47 and 3.0 ± 2.6), but decreased to 20 and 1.4 ± 2.0 at month 6 (both p < 0.001). Eighteen participants (42%) showed a mean pulmonary arterial pressure (mPAP) >25 mm Hg, out of which 9 (21%) were classified as HAPH (mPAP ≥ 30 mm Hg). ADMA at sea level was significantly associated with mPAP at high altitude in month 6 (R = 0.413; p = 0.007). In ROC analysis, a cutoff for baseline ADMA of 0.665 µmol/L was determined to predict HAPH (mPAP > 30 mm Hg) with a sensitivity of 100% and a specificity of 63.6%. Conclusions: ADMA concentration increases during CIH. ADMA at sea level is an independent predictive biomarker of HAPH. SDMA concentration decreases during CIH and shows no association with HAPH. Our data support a role of impaired NO-mediated pulmonary vasodilation in the pathogenesis of HAPH.

O uso da dimetilarginina simétrica (SDMA) no diagnóstico e estadiamento da doença renal crônica em felinos: revisão de literatura / Symmetrical dimethylarginine (SDMA) use in diagnostic and staging of chronic kidney disease in felines: a literature review

O objetivo desta revisão de literatura é descrever os testes labora-toriais utilizados rotineiramente na clínica de pequenos animais para a detecção da doença renal crônica (DRC) em felinos, enfatizando o diagnóstico precoce desta afecção pela utilização de uma nova ferramenta laboratorial, a dimetilarginina simétrica (SDMA). A DRC caracteriza-se pela perda progressiva e irreversível dos néfrons, sendo a filtração a função mais básica dos rins, correlacionada, as-sim, à taxa de filtração glomerular (TFG) e à massa renal funcional. Embora a mensuração da taxa de filtração glomerular F seja método de referência para a avaliação da função renal, seu uso infrequente permite o uso de marcadores alternativos, como a concentração de uréia e creatinina séricas. O SDMA é uma molécula estável, sendo amplamente excretado pelo rim, o que o torna um bom candidato à biomarcador renal, pois seu tamanho e carga permitem que seja livremente excretado por filtração glomerular. A dosagem do SDMA é extremamente precisa, sendo o diagnóstico precoce de DRC pos-sível atualmente, intervenções renoprotetoras que retardam seu progresso, ou visam estabilizar a doença, são possíveis.(AU)

The purpose of this literature review is to describe laboratory tests routinely used in the small animal clinic for the detection of chronic kidney disease in felines, emphasizing the early diagnosis of this condition using a new laboratory tool for symmetrical dimethylarginine (SDMA). Chronic Kidney Disease (CKD) is characterized by the progressive and irreversible loss of the nephrons, which is the most basic function of the kidneys, correlated with the glomerular filtration rate (GFR) and the functional renal mass, respectively. Although the measurement of TF glomerular filtration rate is a reference method for the evaluation of renal function, its infrequent use allows the use of alternative markers such as serum urea and creatinine concentration. SDMA is a stable molecule, being widely excreted by the kidney, which makes it a good candidate for renal biomarker because its size and load allow it to be freely excreted by glomerular filtration. The SDMA dosage is extremely accurate, with the early diagnosis of CKD being currently possible, thus allowing for renoprotective interventions that delay its progress or aim to stabilize the disease.(AU)

Polimorfismos genéticos da Alanina--Glioxilato Aminotransferase 2 (AGXT2) associados à disfunção erétil e marcadores de resposta aos iPDE-5 / Genetic polymorphysms of alanine - Glyoxylate Aminotransferase 2 (AGXT2) associated with erectile dysfunction and response markers to iPDE-5

Disfunção Erétil (DE) é caracterizada pela incapacidade de obter ou manter uma ereção suficiente para que ocorra atividade sexual satisfatória. Uma das principais características da DE está relacionada ao possível déficit na produção de Óxido Nítrico (NO) no corpo humano. O NO é produzido através da L-arginina, via Óxido Nítrico Sintase neuronal, endotelial e induzível (nNOS, eNOS e iNOS). As dimetilargininas assimétrica (ADMA) e a simétrica (SDMA) são formas metiladas da L-arginina e atuam como agentes inibidores das NOS, portanto os níveis aumentados de ADMA e SDMA estão associados a menor produção de NO. Uma das principais enzimas responsáveis pela degradação de ADMA e SDMA é a AGXT2, codificada pelo gene homônimo. Estudos têm relacionado polimorfismos genéticos da AGXT2 a doenças cardiovasculares e todo o contexto do NO, podendo ser utilizados como marcadores para o risco de desenvolvimento de DE. Os objetivos deste estudo visam relacionar polimorfismos genéticos da AGXT2 (rs37369 e rs16899974) ao risco para desenvolvimento de DE e ao resultado da terapia medicamentosa com inibidores da fosfodiesterase 5 (iPDE-5). Trata-se de um estudo de dois braços, sendo o primeiro um estudo caso-controle e outro apenas com os pacientes em uso de iPDE-5, avaliando a resposta a essa classe de fármacos. A função erétil dos voluntários desta pesquisa foi avaliada através da escala Índice Internacional de Função Erétil (IIEF). Os genótipos foram obtidos por PCR em tempo real. Foram encontrados associações significativas entre os marcadores genéticos e a resposta ao sildenafil e aos níveis de nitrito e ADMA. Quanto ao estudo caso-controle não foram encontrados associações significativas para este estudo

Erectile Dysfunction (ED) is characterized by the inability to obtain or maintain an erection sufficient for satisfactory sexual activity to occur. One of the main features of ED is related to the possible deficit in the production of nitric oxide (NO) in the human body. NO is produced through L-arginine via neuronal, endothelial and inducible nitric oxide synthase (nNOS, eNOS and iNOS). Asymmetric (ADMA) and symmetrical (SDMA) dimethylarginines are methylated forms of L-arginine and act as NOS inhibitory agents, so increased levels of ADMA and SDMA are associated with decreased NO production. One of the main enzymes responsible for the degradation of ADMA and SDMA is AGXT2, encoded by the homonymous gene. Studies have linked genetic polymorphisms of AGXT2 to cardiovascular diseases and the entire context of NO, and can be used as markers for the risk of developing ED. The objectives of this study were to correlate AGXT2 genetic polymorphisms (rs37369 and rs16899974) with the risk for developing ED and the outcome of the drug therapy with phosphodiesterase 5 inhibitors (iPDE-5). It is a two-arm study, the first being a case-control study and the other only with patients using iPDE-5, evaluating the response to this class of drugs. The erectile function of the volunteers of this research was evaluated through the International Index of Erectile Function (IIEF) scale. Genotypes were obtained by real-time PCR. Significant associations were found between genetic markers and response to sildenafil and levels of nitrite and ADMA. Regarding the case-control study, no significant associations were found for this study

O uso da dimetilarginina simétrica (SDMA) no diagnóstico e estadiamento da doença renal crônica em felinos: revisão de literatura / Symmetrical dimethylarginine (SDMA) use in diagnostic and staging of chronic kidney disease in felines: a literature review

O objetivo desta revisão de literatura é descrever os testes labora-toriais utilizados rotineiramente na clínica de pequenos animais para a detecção da doença renal crônica (DRC) em felinos, enfatizando o diagnóstico precoce desta afecção pela utilização de uma nova ferramenta laboratorial, a dimetilarginina simétrica (SDMA). A DRC caracteriza-se pela perda progressiva e irreversível dos néfrons, sendo a filtração a função mais básica dos rins, correlacionada, as-sim, à taxa de filtração glomerular (TFG) e à massa renal funcional. Embora a mensuração da taxa de filtração glomerular F seja método de referência para a avaliação da função renal, seu uso infrequente permite o uso de marcadores alternativos, como a concentração de uréia e creatinina séricas. O SDMA é uma molécula estável, sendo amplamente excretado pelo rim, o que o torna um bom candidato à biomarcador renal, pois seu tamanho e carga permitem que seja livremente excretado por filtração glomerular. A dosagem do SDMA é extremamente precisa, sendo o diagnóstico precoce de DRC pos-sível atualmente, intervenções renoprotetoras que retardam seu progresso, ou visam estabilizar a doença, são possíveis.

The purpose of this literature review is to describe laboratory tests routinely used in the small animal clinic for the detection of chronic kidney disease in felines, emphasizing the early diagnosis of this condition using a new laboratory tool for symmetrical dimethylarginine (SDMA). Chronic Kidney Disease (CKD) is characterized by the progressive and irreversible loss of the nephrons, which is the most basic function of the kidneys, correlated with the glomerular filtration rate (GFR) and the functional renal mass, respectively. Although the measurement of TF glomerular filtration rate is a reference method for the evaluation of renal function, its infrequent use allows the use of alternative markers such as serum urea and creatinine concentration. SDMA is a stable molecule, being widely excreted by the kidney, which makes it a good candidate for renal biomarker because its size and load allow it to be freely excreted by glomerular filtration. The SDMA dosage is extremely accurate, with the early diagnosis of CKD being currently possible, thus allowing for renoprotective interventions that delay its progress or aim to stabilize the disease.

Histoplasmose pulmonar grave em um gato doméstico: tratamento com Anfotericina B e Itraconazol / acute pulmonary histoplasmosis in a domestic cat treated with Amphotericin B and Itraconazole

Background: Histoplasmosis is a systemic mycosis whose etiologic agent is the fungus Histoplasma capsulatum. This fungal infection, which is the second most frequent systemic mycotic fungal disease in felines in the United States, has rarely been found in cats in Brazil. This paper reports on a case of acute pulmonary histoplasmosis in a domestic cat treated with oral itraconazole associated with amphotericin B administered subcutaneously. This treatment resulted in clinical remission of the patient’s symptoms, as evidenced by radiographic follow-ups.Case: A domestic cat suffering from acute dyspnea was taken to a veterinary clinic. The animal was subjected to emergency oxygen therapy, and kept at rest through sedation with midazolam. A physical examination revealed normally colored mucosa, 8% dehydration, bristly fur, body condition score 2/9, tachypnea with respiratory rate of 100 breaths per minute and expiratory dyspnea. The radiographic examination showed marked opacification of all the pulmonary fields, with a mixed pattern (interstitial and alveolar) of heterogeneous appearance and diffuse distribution, which are changes consistent with an inflammatory infectious process (pneumonia). A cytological analysis of the pleural fluid revealed round to oval-shaped intracytoplasmic structures, varying in size from 2 to 4 μm, inside foamy macrophages, consistent with Histoplasma capsulatum. Based on the diagnosis of pulmonary histoplasmosis, and in view of the patient’s acute respiratory distress, it was decided to treat the cat using itraconazole associated with amphotericin B. Itraconazole was administered orally at a dose of 100 mg/cat every 24 h, while amphotericin B was administered subcutaneously at a dose of 0.5 mg/kg, combined with 100 mL of sodium chloride 0.9% and 100 mL of 5% glycated serum, with monitoring of serum concentrations of symmetric dimethylarginine (SDMA).[...]

Histoplasmose pulmonar grave em um gato doméstico: tratamento com Anfotericina B e Itraconazol / acute pulmonary histoplasmosis in a domestic cat treated with Amphotericin B and Itraconazole

Background: Histoplasmosis is a systemic mycosis whose etiologic agent is the fungus Histoplasma capsulatum. This fungal infection, which is the second most frequent systemic mycotic fungal disease in felines in the United States, has rarely been found in cats in Brazil. This paper reports on a case of acute pulmonary histoplasmosis in a domestic cat treated with oral itraconazole associated with amphotericin B administered subcutaneously. This treatment resulted in clinical remission of the patients symptoms, as evidenced by radiographic follow-ups.Case: A domestic cat suffering from acute dyspnea was taken to a veterinary clinic. The animal was subjected to emergency oxygen therapy, and kept at rest through sedation with midazolam. A physical examination revealed normally colored mucosa, 8% dehydration, bristly fur, body condition score 2/9, tachypnea with respiratory rate of 100 breaths per minute and expiratory dyspnea. The radiographic examination showed marked opacification of all the pulmonary fields, with a mixed pattern (interstitial and alveolar) of heterogeneous appearance and diffuse distribution, which are changes consistent with an inflammatory infectious process (pneumonia). A cytological analysis of the pleural fluid revealed round to oval-shaped intracytoplasmic structures, varying in size from 2 to 4 μm, inside foamy macrophages, consistent with Histoplasma capsulatum. Based on the diagnosis of pulmonary histoplasmosis, and in view of the patients acute respiratory distress, it was decided to treat the cat using itraconazole associated with amphotericin B. Itraconazole was administered orally at a dose of 100 mg/cat every 24 h, while amphotericin B was administered subcutaneously at a dose of 0.5 mg/kg, combined with 100 mL of sodium chloride 0.9% and 100 mL of 5% glycated serum, with monitoring of serum concentrations of symmetric dimethylarginine (SDMA).[...](AU)

Nitric oxide synthesis capacity, ambulatory blood pressure and end organ damage in a black and white population: the SABPA study.

Nitric oxide (NO) synthesis capacity is determined by the availability of substrate(s) such as L-arginine and the influence of nitric oxide synthase (NOS) inhibitors, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA). These factors may be important in black South Africans with a very high prevalence of hypertension. We compared ambulatory blood pressure (BP), markers of end organ damage and NO synthesis capacity markers [L-arginine, L-homoarginine, L-citrulline, L-arginine:ADMA, ADMA, SDMA and dimethylarginine (DMA)], between black and white teachers (n = 390). Associations of nighttime BP and markers of end organ damage with NO synthesis capacity markers were also investigated. Although black men and women had higher BP and albumin-to-creatinine ratio (ACR) (all p < 0.001), they also had higher L-arginine, L-homoarginine, L-arginine:ADMA and lower SDMA and DMA levels (all p < 0.05). Only in white men ADMA concentrations associated positively with nighttime systolic blood pressure (R (2) = 0.20, ß = 0.26, p = 0.009), nighttime diastolic blood pressure (R (2) = 0.23, ß = 0.27, p = 0.007), carotid intima media thickness (cIMT) (R (2) = 0.36, ß = 0.22, p = 0.008) and ACR (R (2) = 0.14, ß = 0.32, p = 0.001). Our findings suggest that despite an adverse cardiovascular profile in blacks, their NO synthesis capacity profile seems favourable, and that other factors, such as NO inactivation, may prove to be more important.