Association of ultrasonographic features with histologic findings in 71 dogs with protein-losing nephropathy (2008–2018)

Abstract OBJECTIVE To determine whether ultrasonographic features in dogs with protein-losing nephropathy (PLN) were associated with renal biopsy findings and compare corticomedullary ratios between dogs with PLN versus non-renal disease. ANIMALS 71 dogs with PLN and 33 dogs without renal disease. PROCEDURES Medical records and archived ultrasonographic images for dogs with PLN that underwent renal biopsy between 2008 and 2018 were reviewed. Corticomedullary ratios were measured. RESULTS In dogs with PLN, median serum creatinine and BUN concentrations and urine-protein-to-creatinine-ratio prior to renal biopsy were 3.4 mg/dL (interquartile range [IQR], 1.2 to 5.3 mg/dL), 80 mg/dL (IQR, 28 to 105 mg/dL), and 11.4 (IQR, 6.4 to 18.3), respectively. Histologic abnormalities within the tubulointerstitial space were associated with cortical echogenicity. Gastric wall thickness > 5 mm was associated with a histologic diagnosis of acute glomerular disease. Dogs with immune complex–mediated glomerular disease were more likely to have abnormal gastric mural architecture. Other ultrasonographic features of the kidneys, liver, and stomach and the presence of ascites did not help to differentiate immune complex–mediated from non-immune complex–mediated glomerular disease, acute from chronic disease, or amyloid from non-amyloid disease or distinguish whether tubulointerstitial disease was present or absent. Median left corticomedullary ratio for 66 dogs with PLN (1.2) was significantly higher than that for the 33 dogs without renal disease (1.0). Clinical Relevance Ultrasonographic features were poorly associated with specific pathological disorders in dogs with PLN. In this study, the corticomedullary ratio was higher in dogs with PLN, indicating the presence of cortical thickening, but the clinical relevance is unknown.

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Clinical, surgical, and pathological findings in client-owned rabbits with histologically confirmed appendicitis: 19 cases (2015–2019)

Journal of the American Veterinary Medical Association ◽

10.2460/javma.20.08.0446 ◽

2022 ◽

pp. 1-12

Author(s):

Nicola Di Girolamo ◽

Daniele Petrini ◽

Zoltan Szabo ◽

Laetitia Volait-Rosset ◽

Barbara L. Oglesbee ◽

...

Keyword(s):

Differential Diagnosis ◽

Medical Treatment ◽

Rectal Temperature ◽

Medical Records ◽

Clinical Relevance ◽

Pathological Findings ◽

Histologic Diagnosis ◽

Abdominal Ultrasonography ◽

Surgical Treatments ◽

Necrotic Debris

Abstract OBJECTIVE To report clinical, surgical, and pathological findings in client-owned rabbits with histologically confirmed appendicitis. ANIMALS 19 rabbits. PROCEDURES Medical records for client-owned rabbits that had a histologic diagnosis of appendicitis were reviewed. RESULTS Median age of the rabbits at presentation was 24.0 months (range, 4 to 84 months). Seventeen cases occurred during the summer and fall seasons. Decreased appetite (17/19 rabbits), abnormal rectal temperature (hyperthermia, 9/16 rabbits; hypothermia, 4/16 rabbits), hypocalcemia (8/11 rabbits), and hypoglycemia (7/15 rabbits) were common signs. Abdominal ultrasonography and CT findings were suggestive of appendicitis in 6 of 8 rabbits and in 1 of 2 rabbits, respectively. Of the 6 rabbits that received medical treatment, 3 died at 48 hours, 1 died at 24 hours after hospitalization, and 1 died at 10 days after presentation; 1 rabbit was alive at 1,030 days after presentation. Of the 8 rabbits that underwent appendectomy, 3 died before discharge from the hospital and 1 died 113 days after surgery; 4 rabbits were alive at 315, 334, 1,433, and 1,473 days after presentation. The remaining 5 rabbits either died or were euthanized before treatment could be instituted. In each of the 19 rabbits, the appendix had evidence of severe inflammation with mucosal ulceration, heterophilic inflammation, and necrotic debris. CLINICAL RELEVANCE For rabbits with decreased appetite and an apparently painful abdomen, hyperthermia, hypocalcemia, or hypoglycemia, appendicitis should be considered as a differential diagnosis. Further comparisons of medical and surgical treatments are required to establish treatment recommendations for rabbits with appendicitis.

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Pattern of glomerular disease in a tertiary care hospital in Nepal: A Shree Birendra Hospital experience

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v7i4.6742 ◽

2012 ◽

Vol 7 (4) ◽

pp. 48-52

Author(s):

A Sharma ◽

RK Deo ◽

RR Shahi

Keyword(s):

Renal Disease ◽

Renal Biopsy ◽

Glomerular Disease ◽

Renal Diseases ◽

Histopathological Diagnosis ◽

Care Hospital ◽

Glomerular Diseases ◽

Patient Profile ◽

Nephritic Syndrome ◽

Number Of Patients

The incidence of renal diseases varies greatly in various parts of the world. Percutaneous renal biopsy is an important procedure for many patients with renal disease. This hospital based retrospective study evaluated the pattern of various glomerular diseases in Shree Birendra hospital. Hospital records were searched for all the patients undergoing renal biopsy for all indication and patient profile and histopathological examination record were obtained. All the patients undergoing renal biopsy for any cause from January 2007 to December 2010 were included in the study. A total of 46 patients underwent renal biopsy in the study period. The number of patients in the various age groups were - <16 years – 5 patients, 16-50 years – 34 patients and > 50 years – 7 patients. The number of male and female patients was 34 and 12 respectively. Major indication for undergoing renal biopsy in this study was Nephrotic Syndrome (n=29, 63%), followed by RPGN (n=8, 17%), Persistent proteinuria (n=6, 13%) and Nephritic syndrome (n=3, 7%). The most common histopathological diagnosis in the study was Membranous nephropathy (n=10, 22%), followed by Focal Segmental Glomerulosclerosis (n=9, 20%), Membranoproliferative glomerulonephritis (n=9, 20%) and Minimal change disease (n=6, 13%). USG guided renal biopsy is safe in adults and is a very useful tool for the diagnosis of renal disease. The pattern of glomerular disease varies in different settings. There is a need for further evaluation of glomerular disease with larger sample size to determine the pattern of glomerular disease in Nepal. Journal of College of Medical Sciences-Nepal,2011,Vol-7,No-4, 48-52 DOI: http://dx.doi.org/10.3126/jcmsn.v7i4.6742

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POS1428 VALIDATION OF ANCA-ASSOCIATED VASCULITIS AS THE CAUSE OF END-STAGE RENAL DISEASE IN THE UNITED STATES RENAL DATA SYSTEM

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2138 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 997.2-998

Author(s):

C. Cook ◽

H. Choi ◽

Z. Wallace

Keyword(s):

United States ◽

Renal Disease ◽

Renal Biopsy ◽

End Stage Renal Disease ◽

Medical Records ◽

The United States ◽

Diagnosis Code ◽

Anca Associated Vasculitis ◽

Stage Renal Disease ◽

End Stage

Background:Glomerulonephritis and other renal manifestations are common in ANCA-associated vasculitis (AAV). Renal involvement in AAV is associated with adverse outcomes, including end-stage renal disease (ESRD) in up to 25% of patients (1). The United States Renal Data System (USRDS), a national registry of ESRD patients, represents a unique nationwide data source for studying AAV patients with ESRD. Prior research has assessed how often patients with ESRD attributed to AAV have biopsy-proven glomerulonephritis in USRDS (2), but the validity of the diagnosis of AAV as the cause of ESRD in the USRDS remains unknown.Objectives:We aim to validate the diagnosis of AAV as the primary cause of ESRD listed in USRDS.Methods:We identified all patients in the Mass General Brigham (MGB) healthcare system with a billing code for advanced chronic kidney disease or end-stage renal disease or procedure code for dialysis or renal transplantation. We identified all MGB patients fulfilling these criteria to records in the USRDS by name, sex, date of birth, and social security number. From this cohort of patients, we identified those with AAV or related diagnoses listed as the primary disease causing ESRD (ICD9: 446.0, 446.4 or ICD10: M31.3X, M31.7). Two authors reviewed medical records to collect information on whether or not a physician had diagnosed AAV, details of AAV history, renal and non-renal biopsies, and antineutrophil cytoplasmic antibody (ANCA) tests. Discrepancies were resolved through consensus. Details regarding initial ESRD onset date were obtained from the USRDS. To calculate the positive predictive value (PPV) for AAV as the primary cause of ESRD a definite physician diagnosis of AAV (a diagnosis confirmed by two physicians based on available data) in the MGB medical record was used as the gold standard. To calculate sensitivity, we linked the Partners (MGB) AAV Cohort to USRDS records using the same methods. A diagnosis code of AAV as the cause of ESRD was considered a true positive and a diagnosis code for other types of nephritis was considered a false negative.Results:We identified 89 USRDS records linked to MGB medical records in which the primary cause of ESRD was attributed to AAV. Of these, 85 were confirmed to be true cases of AAV after medical record review (PPV=96%) (Table 1). Among the cases classified as AAV, 84 (99%) had a positive ANCA test, which was predominantly MPO/P-ANCA (47, 55%); 36 (42%) had a renal biopsy, all of which were supportive of the diagnosis. The majority of cases were identified as AAV by ICD9 or 10 codes for Wegener’s granulomatosis (446.4 or M313.1). Within the Partners (MGB) AAV cohort linked to USRDS records, 33 (55%) of 60 identified cases had AAV listed as the cause of ESRD; in the remainder, ESRD was attributed to non-specific nephritis codes.Table 1.AAV and non-AAV patients in the USRDS with ESRD due to AAV (N=89)Physician-Diagnosed AAV(N=85)ANCA type n (%)84 (98.8)MPO/P-ANCA+47 (55.3)PR3/C-ANCA+33 (38.8)Renal biopsy n (%)36 (42.4)Pauci-Immune Glomerulonephritis n (%)16 (44%)Non-renal biopsy n (%) Yes10 (11.8) No74 (87.1)Years from AAV diagnosis to ESRD median [IQR]1 [0, 6]Principal diagnosis code (ICD9/ICD10) n (%) Wegener’s granulomatosis (446.4, 446.4B, or M313.1)81 (95.3)Conclusion:We found that the diagnosis of AAV as the primary cause of ESRD in the USRD had a high PPV, suggesting accurate classification of ESRD due to AAV in the USRDS, but that sensitivity was moderate. These findings support the past and future use of the USRDS for research with ESRD attributed to AAV.References:[1]Moiseev S, Novikov P, Jayne D, Mukhin N. End-stage renal disease in ANCA-associated vasculitis. Nephrol Dial Transplant. 2017;32(2):248-53.[2]Layton JB, Hogan SL, Jennette CE, Kenderes B, Krisher J, Jennette JC, et al. Discrepancy between Medical Evidence Form 2728 and renal biopsy for glomerular diseases. Clin J Am Soc Nephrol. 2010;5(11):2046-52.Disclosure of Interests:None declared

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The clinical relevance of anti-dsDNA antibodies determined by the Elia™ dsDNA assay in patients with negative indirect immunofluorescence on the HEp-2 cell

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2020-1408 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Christoph Robier ◽

Maximiliane Haas ◽

Franz Quehenberger

Keyword(s):

Indirect Immunofluorescence ◽

Lupus Erythematosus ◽

Medical Records ◽

Clinical Relevance ◽

Solid Phase ◽

Clinical Importance ◽

Discoid Lupus Erythematosus ◽

Combined Use ◽

Significant Difference ◽

Dsdna Antibodies

AbstractObjectivesData on the clinical importance of the detection of anti-dsDNA antibodies in patients with negative indirect immunofluorescence on the HEp-2 cell (IIF) are sparse and are especially not available for all common commercially available assays. This study aimed to assess the clinical significance of anti-dsDNA antibodies determined by the Elia™ dsDNA assay in patients with negative IIF.MethodsWe retrospectively examined the medical records of 234 consecutive subjects with detectable anti-dsDNA antibodies determined by the Elia™ dsDNA assay.ResultsA total of 124 subjects with detectable anti-dsDNA autoantibodies were IIF-negative, but yielded positive or borderline results in the Elia™ CTD screen assay for antinuclear antibodies (ANA). Within this group, 6/49 IIF-negative patients (12%) with ANA-associated systemic autoimmune rheumatic disorders (AASARD) and 118/185 subjects (64%) with various other diseases (Non-AASARD) were identified. There was no statistically significant difference with regard to the concentrations of anti-dsDNA antibodies (p=0.53) between the AASARD and the Non-AASARD group. Within the AASARD group, four patients diagnosed with systemic lupus erythematosus (SLE, treated), discoid lupus erythematosus (untreated), indetermined connective tissue disease (untreated) and polymyositis (treated) had positive anti-dsDNA autoantibodies, whereas two patients with treated SLE, thereby one in remission, had borderline concentrations of anti-dsDNA antibodies.ConclusionsOur findings suggest that the detection of anti-dsDNA antibodies in IIF-negative patients can be of clinical relevance in some cases. Our results further support the combined use of IIF and solid-phase assays in screening algorithms for ANA, in order to avoid overlooking potentially important autoantibody entities.

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Outcome of rest with or without bandaging for treatment of carpal flexural contracture deformities in puppies: 47 puppies and 75 joints (2000–2018)

Journal of the American Veterinary Medical Association ◽

10.2460/javma.20.10.0556 ◽

2021 ◽

pp. 1-6

Author(s):

Massimo Petazzoni ◽

Carlo M. Mortellaro ◽

Alessandro Esposito ◽

Francesco Ferrari ◽

Alessandro Piras ◽

...

Keyword(s):

Treatment Option ◽

Conservative Management ◽

Medical Records ◽

Clinical Relevance ◽

Final Visit ◽

Full Extension ◽

Treatment Groups ◽

Severity Grade ◽

Grade 3 ◽

Mean Time

Abstract OBJECTIVE To review outcome of dogs with carpal flexural contracture deformities treated with rest alone or with rest and bandaging. ANIMALS 47 dogs (75 joints). PROCEDURES Medical records of dogs with unilateral or bilateral carpal flexural contracture deformities were reviewed, and dogs were grouped according to deformity severity grade (graded on a scale from 1 to 3) at the time of diagnosis. Two treatment groups were compared: rest only and rest with a modified Robert-Jones bandage. All dogs were reevaluated weekly until recovery (ie, resolution of the deformity and lameness). RESULTS All dogs responded to conservative management, with all dogs regaining full extension of the antebrachiocarpal joint and ambulating normally at the time of the final visit. Mean ± SD time from initial diagnosis to recovery (ie, resolution of the deformity and lameness) was 2.9 ± 2.2 weeks (median, 2 weeks; range, 1 to 9 weeks). For dogs with grade 1 or 2 severity, mean time to recovery did not differ significantly between treatment groups. For dogs with grade 3 severity, however, mean time to recovery was significantly shorter for dogs treated with rest and bandaging than for dogs treated with rest alone. CLINICAL RELEVANCE Results suggested that conservative management (rest alone or rest and bandaging) was a successful treatment option for puppies with carpal flexural contracture deformity and that bandaging resulted in a shorter time to recovery for dogs that were severely affected.

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RENAL HISTOLOGY DURING TREATMENT WITH OXAZOLIDINE-DIONES (TRIMETHADIONE, ETHADIONE, AND PARAMETHADIONE)

PEDIATRICS ◽

10.1542/peds.30.4.601 ◽

1962 ◽

Vol 30 (4) ◽

pp. 601-607

Author(s):

A. Bergstrand ◽

C. G. Bergstrand ◽

N. Engström ◽

K. M. Herrlin

Keyword(s):

Electron Microscopy ◽

Nephrotic Syndrome ◽

Renal Disease ◽

Renal Biopsy ◽

Clinical Symptoms ◽

Clinical Signs ◽

Present Knowledge ◽

Short Report ◽

Renal Histology ◽

Renal Changes

Seven patients with petit mal seizures treated with trimethadione, ethadione, or paramethadione for long periods were subjected to renal biopsy at the age of 14½ 16½ years. None of the patients had clinical signs of renal disease at the time of the biopsy, but three of them had previously shown transient hematuria or proteinuria. The renal histology was studied by conventional methods and by electron microscopy, the latter method only including the glomeruli. The changes found must with the present knowledge be regarded as physiological. A short report is given of a patient with phenylketonuria and epilepsy who developed a nephrotic syndrome during treatment with tridione. No definite pathologic renal changes were demonstrated at the when the clinical symptoms had disappeared.

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PERCUTANEOUS RENAL BIOPSY IN CHILDREN

PEDIATRICS ◽

10.1542/peds.30.2.287 ◽

1962 ◽

Vol 30 (2) ◽

pp. 287-296

Author(s):

W. F. Dodge ◽

C. W. Daeschner ◽

J. C. Brennan ◽

H. S. Rosenberg ◽

L. B. Travis ◽

...

Keyword(s):

Renal Disease ◽

Renal Biopsy ◽

Clinical Importance ◽

Renal Diseases ◽

Renal Lesion ◽

Bleeding Tendency ◽

Percutaneous Renal Biopsy ◽

The One ◽

Selection Of

Since 1951, when the percutaneous renal biopsy was introduced as an adjunctive method for study of patients with renal disease, reports of some 4,000 kidney biopsies have appeared in the literature. Only about 250 of these, however, have been performed in children. A biopsy specimen containing 5 to 10 glomeruli has been reported to be adequate for interpretation and to be representative of the total renal parenchyma in 84% of the cases with diffuse renal disease. Using a biopsy technique similar to that described by Kark, we have obtained an adequate specimen in 92% of 205 kidney biopsies performed in 168 children with diffuse renal diseases. Seven deaths have been previously reported in the literature. The circumstances surrounding the death of these seven patients and of the one death that occurred in our series are described. Perirenal hematoma has had a reported incidence of 0.4%. It has been our experience, as well as that of the other investigators, that if blood boss is replaced, the patient has an otherwise uneventful course and the mass subsequently disappears. Gross hematuria has had a reported incidence of 5.2%. Microscopic hematuria, lasting for 6 to 12 hours after biopsy, has been found to be the rule rather than the exception. The complications which have occurred have been associated with bleeding, and therefore a careful history concerning bleeding tendency and a study of the clotting mechanism is essential if the risk of needle renal biopsy is to be minimized. In addition to a bleeding tendency or defect in clotting mechanism, most investigators are agreed that the presence of only one kidney or an uncooperative patient are absolute contraindications to renal biopsy. The renal biopsy is primarily, at present, an additional and most useful investigative tool in the elucidation of the pathogenesis, natural history (by serial studies) and effectiveness of specific therapy upon the various renal diseases. It is of practical clinical importance in the selection of those patients with the nephrotic syndrome in whom glucocorticoid therapy is likely to be beneficial or the patient with anuria whose renal lesion is probably reversible with time; and, as a guide to the effectiveness of therapy in patients with pyelonephritis or lupus nephritis. It is not a technique that can be recommended for general or casual use. A classification of the pathohistobogic findings of diffuse glomerulonephritis, patterned after Ellis, is presented and discussed. This classification will be used in the description and discussion of various renal diseases and systemic diseases with associated nephritis in the three subsequent papers.

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