Defauw P, Daminet S, Leisewitz A L, Goddard A, Paepe D, Duchateau L, Schoeman J P
Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
Vet Parasitol. 2018 Aug 30;260:22-29. doi: 10.1016/j.vetpar.2018.07.012. Epub 2018 Jul 29.
The occurrence of acute kidney injury in canine babesiosis is not well documented. Furthermore, interpretation of urine specific gravity (USG) to assess renal concentrating ability is hampered by the frequent presence of hemoglobinuria in this disease. This cross-sectional study aimed to test the hypothesis that renal azotemia (RA) is underdiagnosed according to current canine babesiosis literature by determining its occurrence at presentation, using urine osmolality instead of USG to measure urinary concentration. The second objective was to examine potential associations between the presence of RA and selected clinical and laboratory variables at presentation. Medical records available from 3 previously performed prospective data collections were reviewed retrospectively. Client-owned dogs that were diagnosed with babesiosis caused by Babesia rossi, were included if a complete blood count, biochemistry profile, and urinalysis was performed at admission. Urine osmolality was measured to identify dogs with RA. Differences between dogs with RA and dogs without RA were assessed by nonparametric statistics. One hundred and fifty-two dogs were included, of which 26 (17%) were azotemic at admission. The occurrence of RA was 14% (21/152), hence 81% (21/26) of all azotemic dogs were diagnosed with RA. In contrast, when diagnosis of RA was based on an admission USG < 1.030, only 23% (6/26) of the azotemic dogs would have been considered to have RA. Several signalment and clinicopathological findings were found to be associated with the presence of RA, including older age, and the presence of collapse, hypoglycemia, hyperphosphatemia, cerebral babesiosis, and acute respiratory distress syndrome. Lastly, survival at discharge was significantly lower in dogs diagnosed with RA at presentation. Our results clarified that RA is more common than previously reported in B. rossi. This study also demonstrated that USG determination is not a reliable method to evaluate renal concentrating ability in azotemic dogs with babesiosis. Thus, if available, urine osmolality should be part of the diagnostic work-up of dogs infected with B. rossi to avoid misclassification of dogs with RA as having prerenal azotemia. If urine osmolality cannot be measured, clinicians should realize that most azotemic dogs with B. rossi infection have RA.
犬巴贝斯虫病中急性肾损伤的发生情况尚无充分记录。此外，由于该病常出现血红蛋白尿，通过尿比重（USG）来评估肾脏浓缩能力会受到影响。这项横断面研究旨在验证一个假设，即根据当前犬巴贝斯虫病的文献，通过测定就诊时肾脏氮质血症（RA）的发生率，使用尿渗透压而非USG来测量尿液浓缩程度，RA可能未得到充分诊断。第二个目标是检查就诊时RA的存在与选定的临床和实验室变量之间的潜在关联。回顾性分析了3个先前进行的前瞻性数据收集的病历。如果入院时进行了全血细胞计数、生化指标和尿液分析，则纳入被诊断为由罗西巴贝斯虫引起的巴贝斯虫病的客户拥有的犬只。测量尿渗透压以识别患有RA的犬只。通过非参数统计评估患有RA的犬只和未患有RA的犬只之间的差异。共纳入152只犬，其中26只（17%）入院时存在氮质血症。RA的发生率为14%（21/152），因此所有氮质血症犬中有81%（21/26）被诊断为RA。相比之下，当基于入院时USG<1.030诊断RA时，只有23%（6/26）的氮质血症犬会被认为患有RA。发现几个信号和临床病理结果与RA的存在有关，包括年龄较大，以及出现虚脱、低血糖、高磷血症、脑型巴贝斯虫病和急性呼吸窘迫综合征。最后，就诊时被诊断为RA的犬只出院时的存活率显著较低。我们的结果表明，RA比先前报道的罗西巴贝斯虫病更为常见。这项研究还表明，USG测定不是评估患有巴贝斯虫病的氮质血症犬肾脏浓缩能力的可靠方法。因此，如果可行，尿渗透压应作为感染罗西巴贝斯虫犬诊断检查的一部分，以避免将患有RA的犬误诊为肾前性氮质血症。如果无法测量尿渗透压，临床医生应意识到，大多数感染罗西巴贝斯虫的氮质血症犬患有RA。
