Nutrition-Focused Physical Examination and Assessment in Chronic Kidney Disease

2020 ◽  
pp. 79-93
Author(s):  
Jane Ziegler
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Physical Examination

Retrospective evaluation of risk factors and treatment outcome predictors in cats presenting to the emergency room for constipation

2019 ◽  
Vol 22 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Sarah E Benjamin ◽  
Kenneth J Drobatz
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Physical Examination ◽  
Emergency Room ◽  
Treatment Protocol ◽  
Urgent Care ◽  
Hospital Data ◽  
Increased Risk ◽  
Clinicopathologic Findings

Objectives Constipation is a common complaint in cats presenting to the emergency room and can become a frustrating recurrent condition. Despite widespread anecdotal reports of risk factors for constipation, at the time of writing there have been no studies supporting these associations or assessing treatment outcomes. The aim of this study was to identify risk factors in the signalment, history, physical examination and clinicopathologic findings of cats presenting to the emergency room for constipation. In addition, we aimed to assess factors contributing to the success or failure of enemas administered to these cats. Methods A medical record search identified 189 cats with a diagnosis of constipation/obstipation that were treated and discharged by the emergency service at an academic veterinary hospital. Data regarding signalment, medical history, physical examination and clinicopathologic findings, as well as treatments performed, were recorded. Ninety-nine cats presenting to the emergency room for other reasons were identified as controls. Statistical analysis was performed to assess risk factors for constipation, as well as success/failure of enema treatments. Results Older, overweight cats and cats with chronic kidney disease or previous episodes of constipation were found to be at increased risk of constipation ( P <0.0001, P = 0.0004, P = 0.0046 and P <0.0001, respectively). Ionized calcium levels were significantly higher in constipated cats, though varied significantly within the cohort ( P = 0.0133). Cats noted to be painful on abdominal palpation were less likely to defecate following an enema. Adjunctive treatments (fluids, laxatives) increased the likelihood of a successful enema but were not statistically significant. Conclusions and relevance Older, overweight cats with a history of constipation or chronic kidney disease are more likely to present for constipation. Further studies are needed to determine the most appropriate treatment protocol in an urgent care setting.

A CONTINUED STUDY TO DERTERMINE THE ASSOCIATION BETWEEN CHRONIC KIDNEY DISEASE AND NON-ALCOHALIC FATTY LIVER DISEASE AND ITS EFFECT ON eGFR

2021 ◽  
pp. 133-136
Author(s):  
Arvind Gupta ◽  
Poonam Gupta ◽  
Anubha Srivastava ◽  
Amit Kumar Panday
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Physical Examination ◽  
Sample Size ◽  
Care Center ◽  
Tertiary Care ◽  
Ckd Stage ◽  
High Prevalence ◽  
Larger Sample

Background: The present study was conduct in Motilal Nehru Medical College, Swaroop Rani Nehru Hospital Prayagraj, a tertiary care center and data was collected over a period from January 2019 to April 2020. All 78 patients of CKD attending OPD & IPD of General Medicine and Nephrology, diagnosed by suggestive symptoms and conrmed by physical examination and laboratory investigations were taken , Among the subjects, those having NAFLD were grouped as cases. Patients of Chronic Kidney disease not having NAFLD were grouped as controls. Aim & Objective: To study the prevalence of NAFLD in patients of CKD and establish the association between NAFLD and CKD by studying the effect of NAFLD on eGFR. Methodology: This was a 16 month case control study. Total 78 patients with age 18-65 years , Either sex with Chronic kidney disease diagnosed by USG, KFT, physical examination and having NAFLD Patients with known diagnosis of metabolic syndrome, diabetes and/or hypothyroidism. Those on hepatotoxic medication (amiodarone, barbiturates, glucocorticoids, etc.). The data so collected was entered into computer using Microsoft Excel 2013 software and was subjected to statistical analysis. Result : The ndings of present study thus reafrm the observations of previous studies that highlight a high prevalence of NAFLD in CKD patients and link it to the deranged metabolic factors. In present study we could not found a convincing evidence supporting a relationship between NAFLD and its severity with progression of CKD, probably owing to three major factors – rst, owing to Discussion 71 limitation of study population in only CKD stage 3 and secondly, owing to absence of retrospective data tracing the time of development of NAFLD in these patients and thirdly, inability to carry out long-time follow-up of patients. In present study, though minor changes in eGFR values in patients were seen, however, during the limited period of follow-up no shift from Stage 3 to other stages of CKD was observed. All the patients were regular in follow-up and had a good medical compliance and in general did not show a phenomenal deterioration in renal function within the short span of study. Keeping in view these limitations, further studies are recommended on a larger sample size with inclusion of patients from different stages of CKD spanning over a longer duration of follow-up to see whether NAFLD presence and its severity has a relationship with long-term progression of CKD. Conclusion: The present study showed that, CKD patients had a high prevalence of NAFLD. The ndings also show that FIB-4 scores are useful noninvasive methods for detection of NAFLD in CKD patients. The ndings showed a possible signicant association between NAFLD and lower eGFR rates. One of the limitations of the present study was presence of only Stage 3 CKD patients, owing to which the linear correlations between eGFR and NAFLD severity could not be assessed properly. Further studies on larger sample size with inclusion of patients with other CKD stages too are recommended.

scholarly journals Efficacy of Oclacitinib on Feline Atopic Syndrome Management

2018 ◽  
Vol 47 ◽  
Author(s):  
Keylla Suellen Batalha Rocha Fernandes ◽  
Mirlla Baracho Ferreira ◽  
Alessandra Moreira Da Silva ◽  
Kayana Cunha Marques ◽  
Brizza Zorayd Luz Lopes Rocha ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Adverse Effects ◽  
Physical Examination ◽  
Clinical Signs ◽  
Janus Kinase ◽  
Term Therapy ◽  
The Third ◽  
Stage 1

Background: The feline atopic syndrome (FAS) associated to environmental allergens is the third most common allergic dermatosis in domestic cats. In general, clinical signs are not pathognomonic and the exclusion of other pruritus causes is necessary to reach the diagnosis of FAS. The treatment is based on the use of drugs to control the pruritus, such as glucocorticoids, cyclosporine and, recently, oclacitinib, a Janus kinase inhibitor. This study aimed to report the efficacy of oclacitinib on the treatment of FAS associated to environmental allergens.Case: A 10-year-old female feline, crossbred, presented a history of pruritic dermatitis during ten months and diarrhea. The animal had been submitted to treatment for ectoparasites with pour-on selamectin and was fed with a commercial hypoallergenic diet in the last eight weeks or so. However, no improvement on the skin condition was observed. Physical examination revealed disseminated furfuraceous desquamation, excoriation and erythema on the right supraorbital region. Bilateral conjunctivitis was also observed. Complete blood cell count, biochemistry profile, urinalysis, immunochromathographic test for feline immunodeffiency virus (FIV) and feline leukemia virus (FeLV), fungic culture and abdominal ultrasonography were requested. The abnormalities observed were reduced urinary density and discrete loss of renal corticomedullary differentiation. Thus, based on physical examination and complementary exams, the animal was diagnosis with FAS, since the main other causes of pruritus (hypersensitivity to ectoparasites and alimentary allergens) were excluded. The animal was also diagnosed with stage 1 chronic kidney disease. Therapy based on oclacitinib was instituted with an induction dose of 1 mg/kg twice daily for 14 days, followed by a maintenance dose of 1 mg/kg once daily. After 30 days of treatment, a satisfactory therapeutic response was observed, with complete remission of pruritus. The animal was regularly evaluated, with clinical and laboratorial exams, to check the efficacy of treatment and to identify the possible adverse effects of the drug. After 300 days of treatment the animal presented a relapse of pruritic dermatitis, and the dose was changed to 1 mg/kg twice daily, with remission of clinical signs. No adverse reactions or changes in laboratorial exams were observed during the follow-up, and the chronic kidney disease remained on stage 1.Discussion: In spite of being the third most frequent allergic dermatopathy in cats, FAS is still considered as an uncommon disease. FAS is a diagnosis of exclusion, where hypersensivity to ectoparasites and alimentary allergens must be investigated before reaching the diagnosis of FAS. Clinical signs are not pathognomonic. Thus, pruritus, skin lesions on head and/or neck, miliaris dermatitis, symmetric alopecia and eosinophilic dermatitis can be observed. Other dermatologic and systemic manifestations, such as gastrointestinal, ophthalmic and respiratory signs, may be present. The reported animal presented dermatologic and systemic signs of FAS, since all the clinical alterations disappeared with the use of oclacitinib. Because some dogs demonstrated immunosuppression and developed diseases related to this, such as papilomatosis and demodicosis, while using this drug, we decided to rule out the presence of the infection by FIV and FeLV, before the beginning of the therapy. Other drugs can be used for treat cats with FAS, such as glucocorticoids and ciclosporin. However, these drugs are associated to side effects in a long-term therapy. In this case report, a cat treated with oclacitinib showed a long-term control of pruritus and clinical signs remission without adverse effects. Oclacitinib demonstrated to be a good therapeutic option on the treatment of FAS associated to environmental allergens.

No effect of vitamin D supplementation on metabolic parameters but on lipids in patients with type 2 diabetes and chronic kidney disease

2020 ◽  
pp. 1-10
Author(s):  
Jiwoon Kim ◽  
Ji Sun Nam ◽  
Heejung Kim ◽  
Hye Sun Lee ◽  
Jung Eun Lee
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Vitamin D Supplementation ◽  
Lipid Profiles ◽  
Metabolic Parameters ◽  
Injection Group ◽  
Different Doses

Abstract. Background/Aims: Trials on the effects of cholecalciferol supplementation in type 2 diabetes with chronic kidney disease patients were underexplored. Therefore, the aim of this study was to investigate the effects of two different doses of vitamin D supplementation on serum 25-hydroxyvitamin D [25(OH)D] concentrations and metabolic parameters in vitamin D-deficient Korean diabetes patients with chronic kidney disease. Methods: 92 patients completed this study: the placebo group (A, n = 33), the oral cholecalciferol 1,000 IU/day group (B, n = 34), or the single 200,000 IU injection group (C, n = 25, equivalent to 2,000 IU/day). 52% of the patients had less than 60 mL/min/1.73m2 of glomerular filtration rates. Laboratory test and pulse wave velocity were performed before and after supplementation. Results: After 12 weeks, serum 25(OH)D concentrations of the patients who received vitamin D supplementation were significantly increased (A, -2.4 ± 1.2 ng/mL vs. B, 10.7 ± 1.2 ng/mL vs. C, 14.6 ± 1.7 ng/mL; p < 0.001). In addition, the lipid profiles in the vitamin D injection group (C) showed a significant decrease in triglyceride and a rise in HDL cholesterol. However, the other parameters showed no differences. Conclusions: Our data indicated that two different doses and routes of vitamin D administration significantly and safely increased serum 25(OH)D concentrations in vitamin D-deficient diabetes patients with comorbid chronic kidney disease. In the group that received the higher vitamin D dose, the lipid profiles showed significant improvement, but there were no beneficial effects on other metabolic parameters.

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