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Azotemia

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Harriet M Syme – 1st expert on this subject based on the ideXlab platform

  • effect on renal function of restoration of euthyroidism in hyperthyroid cats with iatrogenic hypothyroidism
    Journal of Veterinary Internal Medicine, 2014
    Co-Authors: Tim Williams, J Elliott, Harriet M Syme

    Abstract:

    Background
    Iatrogenic hypothyroidism is associated with an increased incidence of Azotemia after treatment of hyperthyroidism, and decreased survival time in azotemic hyperthyroid cats.

    Hypothesis
    Restoration of euthyroidism will decrease plasma creatinine concentrations.

    Animals
    Nineteen client-owned, methimazole- or carbimazole-treated, hyperthyroid cats with documented iatrogenic hypothyroidism (based on subnormal plasma total thyroxine concentrations [TT4] and increased plasma thyroid-stimulating hormone concentrations).

    Methods
    Prospective interventional study. Doses of antithyroid medication were reduced until euthyroidism was restored (TT4 10–40 nmol/L). Plasma creatinine concentration and selected other clinicopathologic variables were evaluated before and after restoration of euthyroidism and compared by nonparametric statistics. Data are presented as median [25th, 75th percentile].

    Results
    Restoration of euthyroidism was associated with a significant decrease in plasma creatinine concentrations (2.61 [1.90, 3.26] mg/dL versus 2.07 [1.42, 2.82] mg/dL; P < .001) and body weight (4.03 [3.59, 4.53] kg versus 3.89 [3.34, 4.18] kg; P = .019), and a significant increase in packed cell volume (30 [28, 39]% versus 34 [29, 39]%; P = .038), heart rate (174 [163, 201] bpm versus 190 [164, 202] bpm; P = .009), and plasma alkaline phosphatase activity (26.6 [17.0, 33.0] IU/L versus 38.0 [23.5, 46.5] IU/L; P < .001). Conclusions and Clinical Importance Restoration of euthyroidism in medically treated hyperthyroid cats with iatrogenic hypothyroidism causes a reduction in plasma creatinine concentrations, and thus might improve renal function; however, this could be influenced by concurrent changes in body weight.

  • evaluation of mass spectrometry of urinary proteins and peptides as biomarkers for cats at risk of developing Azotemia
    American Journal of Veterinary Research, 2013
    Co-Authors: Rosanne E Jepson, Harriet M Syme, Gary R Coulton, Matthew L Cowan, P J Markwell, J Elliott

    Abstract:

    Objective—To evaluate proteomic delineation of feline urine by mass spectrometry as a method for identifying biomarkers in cats at risk of developing Azotemia. Samples—Urine samples from geriatric cats (> 9 years old) with chronic kidney disease and nonazotemic cats that either remained nonazotemic (n = 10) or developed Azotemia (10) within 1 year. Procedures—Optimization studies with pooled urine were performed to facilitate the use of surface enhanced laser desorption-ionization time-of-flight mass spectrometry (SELDI-TOF-MS) for analysis of the urinary proteome of cats. Urine samples from nonazotemic cats at entry to the study were analyzed via SELDI-TOF-MS with weak cation exchange and strong anion exchange arrays. Spectral data were compared to identify biomarkers for development of Azotemia. Results—Low protein concentration in feline urine precluded direct application to array surfaces, and a buffer exchange and concentration step was required prior to SELDI-TOF-MS analysis. Three preparation condi…

  • association of iatrogenic hypothyroidism with Azotemia and reduced survival time in cats treated for hyperthyroidism
    Journal of Veterinary Internal Medicine, 2010
    Co-Authors: Tim Williams, J Elliott, Harriet M Syme

    Abstract:

    Background: Iatrogenic hypothyroidism can occur after treatment of hyperthyroidism, and is correlated with a reduced glomerular filtration rate in humans and dogs.

    Hypothesis: Cats with iatrogenic hypothyroidism after treatment for hyperthyroidism will have a greater incidence of Azotemia than euthyroid cats.

    Animals: Eighty client owned cats with hyperthyroidism.

    Methods: Two retrospective studies. (1) Longitudinal study of 12 hyperthyroid cats treated with radioiodine (documented as euthyroid after treatment), to assess changes in plasma thyroid stimulating hormone (TSH) concentration over a 6-month follow-up period, (2) Cross-sectional study of 75 hyperthyroid cats (documented as euthyroid) 6 months after commencement of treatment for hyperthyroidism to identify the relationship between thyroid status and the development of Azotemia. Kaplan-Meier survival analysis was performed to identify relationships between thyroid and renal status and survival.

    Results: Plasma TSH concentrations were not suppressed in 7 of 8 cats with hypothyroidism 3 months after radioiodine treatment. The proportion of cats with Azotemia was significantly (P= .028) greater in the hypothyroid (16 of 28) than the euthyroid group (14 of 47). Twenty-eight of 41 cats (68%) with plasma TT4 concentration below the laboratory reference range had an increased plasma TSH concentration. Hypothyroid cats that developed Azotemia within the follow-up period had significantly (P= .018) shorter survival times (median survival time 456 days, range 231–1589 days) than those that remained nonazotemic (median survival time 905 days, range 316–1869 days).

    Conclusions and Clinical Importance: Iatrogenic hypothyroidism appears to contribute to the development of Azotemia after treatment of hyperthyroidism, and reduced survival time in azotemic cats.

J Elliott – 2nd expert on this subject based on the ideXlab platform

  • effect on renal function of restoration of euthyroidism in hyperthyroid cats with iatrogenic hypothyroidism
    Journal of Veterinary Internal Medicine, 2014
    Co-Authors: Tim Williams, J Elliott, Harriet M Syme

    Abstract:

    Background
    Iatrogenic hypothyroidism is associated with an increased incidence of Azotemia after treatment of hyperthyroidism, and decreased survival time in azotemic hyperthyroid cats.

    Hypothesis
    Restoration of euthyroidism will decrease plasma creatinine concentrations.

    Animals
    Nineteen client-owned, methimazole- or carbimazole-treated, hyperthyroid cats with documented iatrogenic hypothyroidism (based on subnormal plasma total thyroxine concentrations [TT4] and increased plasma thyroid-stimulating hormone concentrations).

    Methods
    Prospective interventional study. Doses of antithyroid medication were reduced until euthyroidism was restored (TT4 10–40 nmol/L). Plasma creatinine concentration and selected other clinicopathologic variables were evaluated before and after restoration of euthyroidism and compared by nonparametric statistics. Data are presented as median [25th, 75th percentile].

    Results
    Restoration of euthyroidism was associated with a significant decrease in plasma creatinine concentrations (2.61 [1.90, 3.26] mg/dL versus 2.07 [1.42, 2.82] mg/dL; P < .001) and body weight (4.03 [3.59, 4.53] kg versus 3.89 [3.34, 4.18] kg; P = .019), and a significant increase in packed cell volume (30 [28, 39]% versus 34 [29, 39]%; P = .038), heart rate (174 [163, 201] bpm versus 190 [164, 202] bpm; P = .009), and plasma alkaline phosphatase activity (26.6 [17.0, 33.0] IU/L versus 38.0 [23.5, 46.5] IU/L; P < .001). Conclusions and Clinical Importance Restoration of euthyroidism in medically treated hyperthyroid cats with iatrogenic hypothyroidism causes a reduction in plasma creatinine concentrations, and thus might improve renal function; however, this could be influenced by concurrent changes in body weight.

  • evaluation of mass spectrometry of urinary proteins and peptides as biomarkers for cats at risk of developing Azotemia
    American Journal of Veterinary Research, 2013
    Co-Authors: Rosanne E Jepson, Harriet M Syme, Gary R Coulton, Matthew L Cowan, P J Markwell, J Elliott

    Abstract:

    Objective—To evaluate proteomic delineation of feline urine by mass spectrometry as a method for identifying biomarkers in cats at risk of developing Azotemia. Samples—Urine samples from geriatric cats (> 9 years old) with chronic kidney disease and nonazotemic cats that either remained nonazotemic (n = 10) or developed Azotemia (10) within 1 year. Procedures—Optimization studies with pooled urine were performed to facilitate the use of surface enhanced laser desorption-ionization time-of-flight mass spectrometry (SELDI-TOF-MS) for analysis of the urinary proteome of cats. Urine samples from nonazotemic cats at entry to the study were analyzed via SELDI-TOF-MS with weak cation exchange and strong anion exchange arrays. Spectral data were compared to identify biomarkers for development of Azotemia. Results—Low protein concentration in feline urine precluded direct application to array surfaces, and a buffer exchange and concentration step was required prior to SELDI-TOF-MS analysis. Three preparation condi…

  • association of iatrogenic hypothyroidism with Azotemia and reduced survival time in cats treated for hyperthyroidism
    Journal of Veterinary Internal Medicine, 2010
    Co-Authors: Tim Williams, J Elliott, Harriet M Syme

    Abstract:

    Background: Iatrogenic hypothyroidism can occur after treatment of hyperthyroidism, and is correlated with a reduced glomerular filtration rate in humans and dogs.

    Hypothesis: Cats with iatrogenic hypothyroidism after treatment for hyperthyroidism will have a greater incidence of Azotemia than euthyroid cats.

    Animals: Eighty client owned cats with hyperthyroidism.

    Methods: Two retrospective studies. (1) Longitudinal study of 12 hyperthyroid cats treated with radioiodine (documented as euthyroid after treatment), to assess changes in plasma thyroid stimulating hormone (TSH) concentration over a 6-month follow-up period, (2) Cross-sectional study of 75 hyperthyroid cats (documented as euthyroid) 6 months after commencement of treatment for hyperthyroidism to identify the relationship between thyroid status and the development of Azotemia. Kaplan-Meier survival analysis was performed to identify relationships between thyroid and renal status and survival.

    Results: Plasma TSH concentrations were not suppressed in 7 of 8 cats with hypothyroidism 3 months after radioiodine treatment. The proportion of cats with Azotemia was significantly (P= .028) greater in the hypothyroid (16 of 28) than the euthyroid group (14 of 47). Twenty-eight of 41 cats (68%) with plasma TT4 concentration below the laboratory reference range had an increased plasma TSH concentration. Hypothyroid cats that developed Azotemia within the follow-up period had significantly (P= .018) shorter survival times (median survival time 456 days, range 231–1589 days) than those that remained nonazotemic (median survival time 905 days, range 316–1869 days).

    Conclusions and Clinical Importance: Iatrogenic hypothyroidism appears to contribute to the development of Azotemia after treatment of hyperthyroidism, and reduced survival time in azotemic cats.

Tim Williams – 3rd expert on this subject based on the ideXlab platform

  • effect on renal function of restoration of euthyroidism in hyperthyroid cats with iatrogenic hypothyroidism
    Journal of Veterinary Internal Medicine, 2014
    Co-Authors: Tim Williams, J Elliott, Harriet M Syme

    Abstract:

    Background
    Iatrogenic hypothyroidism is associated with an increased incidence of Azotemia after treatment of hyperthyroidism, and decreased survival time in azotemic hyperthyroid cats.

    Hypothesis
    Restoration of euthyroidism will decrease plasma creatinine concentrations.

    Animals
    Nineteen client-owned, methimazole- or carbimazole-treated, hyperthyroid cats with documented iatrogenic hypothyroidism (based on subnormal plasma total thyroxine concentrations [TT4] and increased plasma thyroid-stimulating hormone concentrations).

    Methods
    Prospective interventional study. Doses of antithyroid medication were reduced until euthyroidism was restored (TT4 10–40 nmol/L). Plasma creatinine concentration and selected other clinicopathologic variables were evaluated before and after restoration of euthyroidism and compared by nonparametric statistics. Data are presented as median [25th, 75th percentile].

    Results
    Restoration of euthyroidism was associated with a significant decrease in plasma creatinine concentrations (2.61 [1.90, 3.26] mg/dL versus 2.07 [1.42, 2.82] mg/dL; P < .001) and body weight (4.03 [3.59, 4.53] kg versus 3.89 [3.34, 4.18] kg; P = .019), and a significant increase in packed cell volume (30 [28, 39]% versus 34 [29, 39]%; P = .038), heart rate (174 [163, 201] bpm versus 190 [164, 202] bpm; P = .009), and plasma alkaline phosphatase activity (26.6 [17.0, 33.0] IU/L versus 38.0 [23.5, 46.5] IU/L; P < .001). Conclusions and Clinical Importance Restoration of euthyroidism in medically treated hyperthyroid cats with iatrogenic hypothyroidism causes a reduction in plasma creatinine concentrations, and thus might improve renal function; however, this could be influenced by concurrent changes in body weight.

  • association of iatrogenic hypothyroidism with Azotemia and reduced survival time in cats treated for hyperthyroidism
    Journal of Veterinary Internal Medicine, 2010
    Co-Authors: Tim Williams, J Elliott, Harriet M Syme

    Abstract:

    Background: Iatrogenic hypothyroidism can occur after treatment of hyperthyroidism, and is correlated with a reduced glomerular filtration rate in humans and dogs.

    Hypothesis: Cats with iatrogenic hypothyroidism after treatment for hyperthyroidism will have a greater incidence of Azotemia than euthyroid cats.

    Animals: Eighty client owned cats with hyperthyroidism.

    Methods: Two retrospective studies. (1) Longitudinal study of 12 hyperthyroid cats treated with radioiodine (documented as euthyroid after treatment), to assess changes in plasma thyroid stimulating hormone (TSH) concentration over a 6-month follow-up period, (2) Cross-sectional study of 75 hyperthyroid cats (documented as euthyroid) 6 months after commencement of treatment for hyperthyroidism to identify the relationship between thyroid status and the development of Azotemia. Kaplan-Meier survival analysis was performed to identify relationships between thyroid and renal status and survival.

    Results: Plasma TSH concentrations were not suppressed in 7 of 8 cats with hypothyroidism 3 months after radioiodine treatment. The proportion of cats with Azotemia was significantly (P= .028) greater in the hypothyroid (16 of 28) than the euthyroid group (14 of 47). Twenty-eight of 41 cats (68%) with plasma TT4 concentration below the laboratory reference range had an increased plasma TSH concentration. Hypothyroid cats that developed Azotemia within the follow-up period had significantly (P= .018) shorter survival times (median survival time 456 days, range 231–1589 days) than those that remained nonazotemic (median survival time 905 days, range 316–1869 days).

    Conclusions and Clinical Importance: Iatrogenic hypothyroidism appears to contribute to the development of Azotemia after treatment of hyperthyroidism, and reduced survival time in azotemic cats.

  • survival and the development of Azotemia after treatment of hyperthyroid cats
    Journal of Veterinary Internal Medicine, 2010
    Co-Authors: Tim Williams, J Elliott, K J Peak, D C Brodbelt, Harriet M Syme

    Abstract:

    Background: Hyperthyroidism complicates the diagnosis of chronic kidney disease (CKD) as it increases glomerular filtration rate. No practical and reliable means for identifying those cats that will develop Azotemia after treatment for hyperthyroidism has been identified. Hyperthyroidism is associated with proteinuria. Proteinuria has been correlated with decreased survival of cats with CKD and with progression of CKD.

    Hypothesis: Proteinuria and other clinical parameters measured at diagnosis of hyperthyroidism will be associated with the development of Azotemia and survival time.

    Animals: Three hundred client owned hyperthyroid cats treated in first opinion practice.

    Methods: Retrospective, cohort study relating clinical parameters in hyperthyroid cats at diagnosis to the development of Azotemia within 240 days of diagnosis and survival time (all cause mortality). Multivariable logistic regression analysis was used to identify factors that were predictive of the development of Azotemia. Multivariable Cox regression analysis was used to identify factors associated with survival.

    Results: Three hundred cats were eligible for survival analysis and 216 cats for analysis of factors associated with the development of Azotemia. The median survival time was 417 days, and 15.3% (41/268) cats developed Azotemia within 240 days of diagnosis of hyperthyroidism. Plasma concentrations of urea and creatinine were positively correlated with the development of Azotemia. Plasma globulin concentration was negatively correlated with the development of Azotemia. Age, urine protein : creatinine ratio, and the presence of hypertension were significantly correlated with decreased survival time. Urine specific gravity and PCV were significantly correlated with increased survival time.

    Conclusions and Clinical Importance: The proteinuria associated with hyperthyroidism is not a mediator of progression of CKD; however, it does correlate with all cause mortality.