Cutaneous and renal glomerular vasculopathy (CRGV) or "Alabama Rot" GFR Study

RE: Cutaneous and renal glomerular vasculopathy (CRGV) or "Alabama Rot" GFR Study

Rosanne Jepson — Mon, 21 Nov 2016 18:15:56 GMT

Dear Julien,

Thanks for your message. We will indeed be looking at SDMA but this is something that unfortunately for research reasons will be batch analysed meaning that the results will not be available for clinical use to the patient. As you say, we don't have any published data on the utility of SDMA in an early AKI setting but this is something which could be considered should a renal panel be performed in these patients.

I think you are right to highlight the potential concern relating to iohexol administration which is a recognised concern in human medicine. The data in dogs is sparse and clinical experience in terms of the frequency with which we administer iohexol suggests that induction of AKI is rare. A recent publication has attempted to assess risk of contrast induced nephropathy (see below) but the data are challenging to interpret due to the use of several different in-house/external analysers for the measurement of creatinine and the number of different underlying conditions etc. To date we have not had an issue with exacerbating AKI associated with any dogs that have been enrolled on this study and feel that the potential benefit of early detection of reduced renal function exceeds any risk. We will obviously continue to monitor the outcome of these cases carefully.

There is no charge associated with the measurement of GFR in this study or the shipment of samples. This cost is covered by the study. The only cost incurred to the client will be the charge that they may make for examining the dog and performing the test i.e. administering iohexol and taking blood samples which will obviously be practice dependent. If the patient was unfortunate enough to die between the first and second sample then, particularly if the patient was ultimately diagnosed with CRGV, the cost of the first sample would be covered by the study. This has fortunately not happened so far.

Please do not hesitate to let me know if you have any further questions.

Kind regards

Rosanne

A retrospective evaluation of contrast-induced kidney injury in dogs (2006–2012)

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE

Volume 26, Issue 5, September/October 2016, Pages: 713–719, Joana B. Goic, Amy M. Koenigshof, Lindsey D. McGuire, Anthony C. Klinger and Matthew W. Beal

Version of Record online : 24 AUG 2016, DOI: 10.1111/vec.12511

Plasma creatinine in dogs: intra- and inter-laboratory variation in 10 European veterinary laboratories.

Ulleberg T, Robben J, Nordahl KM, Ulleberg T, Heiene R.

Acta Vet Scand. 2011 Apr 10;53:25. doi: 10.1186/1751-0147-53-25

RE: Cutaneous and renal glomerular vasculopathy (CRGV) or "Alabama Rot" GFR Study

Timothy Miles — Mon, 21 Nov 2016 16:01:44 GMT

This condition bears some similarities with PDNS ( Porcine Dermatitis Nephropathy Syndrome) in growing swine. Antibody/ bacterial antigen complexes ( Pasteurellae) were identified in the glomerulae. One of the agents involved was identified as porcine circovirus but a co-factor also seems to be needed to create clinical disease as porcine circovirus antibodies can be found in normal pigs. A vaccine was produced for current use in the pig industry for control of this and the concurrent PMWS ( porcine multi systemic wasting syndrome) of younger piglets.

RE: Cutaneous and renal glomerular vasculopathy (CRGV) or "Alabama Rot" GFR Study

Bob Russell — Mon, 21 Nov 2016 15:57:31 GMT

[quote user="Hannah Wynne Richards"]

Why not stick with Alabama Rot, which we can all easily remember, instead of yet another lot of initials?

Wynne

[/quote]

Probably because it is probably not from Alabama and they don't rot (at least before death or euthanasia)!

RE: Cutaneous and renal glomerular vasculopathy (CRGV) or "Alabama Rot" GFR Study

Julien Bazelle — Mon, 21 Nov 2016 15:42:10 GMT

Dear Rosanne,

This seems an interesting study as it would be great to be able to predict which dog will eventually develop acute renal failure to start treatment at an earlier stage.

I was just wondering if you had consider using other parameters, such as SDMA. I am well aware that it is too early to know if SDMA is useful in this situation but that would be a good opportunity to test it! And what about the potential nephrotoxicity of iohexol in patients that may well develop soon acute renal failure? Do you think that GFR measurement in this situation may not be potentially detrimental?

Last thing, can you clarify how much it will cost for the owners of the patients that are not retained for the study? For example, if the dog unfortunately dies before the second iohexol clearance test is done?

Thanks

Julien

RE: Cutaneous and renal glomerular vasculopathy (CRGV) or "Alabama Rot" GFR Study

Rosanne Jepson — Wed, 09 Dec 2015 19:15:12 GMT

Dear Emily,

If the case is considered eligible then the cost of the GFR test & courier of samples will be paid for by the study, so free of charge. The iohexol would need to be provided by the practice but this is just the contrast agent that most practices will stock anyway. Even if your client does not want to proceed with the test then I know David Walker is keen to hear about any suspect or histopathologically confirmed cases.

Please let me know if you have any other questions.

best wishes

Rosanne

RE: Cutaneous and renal glomerular vasculopathy (CRGV) or "Alabama Rot" GFR Study

Emily Rainbow — Wed, 09 Dec 2015 19:05:49 GMT

What is the charge for this testing?

RE: Cutaneous and renal glomerular vasculopathy (CRGV) or "Alabama Rot" GFR Study

Hannah Wynne Richards — Wed, 09 Dec 2015 17:25:49 GMT

Why not stick with Alabama Rot, which we can all easily remember, instead of yet another lot of initials?

Wynne