Evaluation of the clinical outcome of hypercalcemia of malignancy and concurrent azotemia in dogs with lymphoma.
T-cell lymphoma
acute kidney injury
chemotherapy
dog
Journal
Journal of veterinary internal medicine
ISSN: 1939-1676
Titre abrégé: J Vet Intern Med
Pays: United States
ID NLM: 8708660
Informations de publication
Date de publication:
22 Dec 2023
22 Dec 2023
Historique:
received:
23
04
2023
accepted:
01
12
2023
medline:
22
12
2023
pubmed:
22
12
2023
entrez:
22
12
2023
Statut:
aheadofprint
Résumé
Hypercalcemia of malignancy (HM) secondary to lymphoma in dogs has the potential to cause renal injury. Characterize outcomes related to acute kidney injury (AKI) secondary to HM. We hypothesized that dogs do suffer AKI regardless of HM severity at the time of lymphoma diagnosis or relapse. Retrospective study. Twenty-nine dogs with lymphoma, HM, and azotemia (International Renal Interest Society [IRIS] grade II or higher AKI) that underwent chemotherapy were identified at 2 veterinary institutions. Logistic regression and descriptive statistical analysis were performed to evaluate data for potential prognostic factors. After initiating treatment, resolution of hypercalcemia and azotemia occurred in 100% (29/29) and 79.3% (23/29) of dogs, respectively. Resolution of azotemia was influenced by serum creatinine concentration (odds ratio [OR], 0.148; Confidence interval [CI], 0.03-0.734; P = .02) and total hypercalcemia (OR, 0.36; CI, 0.14-0.93; P = .04) at diagnosis, whereas blood urea nitrogen concentration, IRIS grade, sex, and whether or not dogs were hospitalized were not significant factors. At data analysis, 13.8% (4/29) of dogs were alive or lost to follow-up. Of those dead, 4 dogs (15%) had renal disease at the time of death, 2/4 having concurrent lymphoma progression. Although AKI may be of clinical concern in dogs with HM secondary to lymphoma at diagnosis, death secondary to renal impairment appears to be infrequent.
Sections du résumé
BACKGROUND
BACKGROUND
Hypercalcemia of malignancy (HM) secondary to lymphoma in dogs has the potential to cause renal injury.
HYPOTHESIS/OBJECTIVES
OBJECTIVE
Characterize outcomes related to acute kidney injury (AKI) secondary to HM. We hypothesized that dogs do suffer AKI regardless of HM severity at the time of lymphoma diagnosis or relapse.
ANIMALS
METHODS
Retrospective study. Twenty-nine dogs with lymphoma, HM, and azotemia (International Renal Interest Society [IRIS] grade II or higher AKI) that underwent chemotherapy were identified at 2 veterinary institutions.
METHODS
METHODS
Logistic regression and descriptive statistical analysis were performed to evaluate data for potential prognostic factors.
RESULTS
RESULTS
After initiating treatment, resolution of hypercalcemia and azotemia occurred in 100% (29/29) and 79.3% (23/29) of dogs, respectively. Resolution of azotemia was influenced by serum creatinine concentration (odds ratio [OR], 0.148; Confidence interval [CI], 0.03-0.734; P = .02) and total hypercalcemia (OR, 0.36; CI, 0.14-0.93; P = .04) at diagnosis, whereas blood urea nitrogen concentration, IRIS grade, sex, and whether or not dogs were hospitalized were not significant factors. At data analysis, 13.8% (4/29) of dogs were alive or lost to follow-up. Of those dead, 4 dogs (15%) had renal disease at the time of death, 2/4 having concurrent lymphoma progression.
CONCLUSIONS AND CLINICAL IMPORTANCE
CONCLUSIONS
Although AKI may be of clinical concern in dogs with HM secondary to lymphoma at diagnosis, death secondary to renal impairment appears to be infrequent.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
Références
Pelosof LC, Gerber DE. Paraneoplastic syndromes: an approach to diagnosis and treatment. Mayo Clin Proc. 2010;85(9):838-854.
Bergman PJ. Paraneoplastic hypercalcemia. Top Companion Anim Med. 2012;27(4):156-158.
Bhandari A, Kumar R, Tripathi P, et al. Outcomes of hypercalcemia of malignancy in patients with solid cancer: a national inpatient analysis. Med Oncol. 2019;36(10):90.
Finora K. Common paraneoplastic syndromes. Clin Tech Small Anim Pract. 2003;18(2):123-126.
Kubota A, Kano R, Mizuno T, et al. Parathyroid hormone-related protein (PTHrP) produced by dog lymphoma cells. J Vet Med Sci. 2002;64(9):835-837.
Rosner MH, Dalkin AC. Onco-nephrology: the pathophysiology and treatment of malignancy-associated hypercalcemia. Clin J Am Soc Nephrol. 2012;7:1722-1729.
Toro C, Rinaldo A, Silver CE, Politi M, Ferlito A. Paraneoplastic syndromes in patients with oral cancer. Oral Oncol. 2010;46(1):14-18.
Moore EL, Vernau W, Rebhun RB, Skorupski KA, Burton JH. Patient characteristics, prognostics factors and outcomes of dogs with high-grade primary mediastinal lymphoma. Vet Comp Oncol. 2018;16(1):E45-E51.
Messinger JS, Windham WR, Ward CR. Ionized hypercalcemia in dogs: a retrospective study of 109 cases (1998-2003). J Vet Intern Med. 2009;23(3):514-519.
Liou JHL, Cho LC, Hsu YH. Paraneoplastic hypercalcemia with metastatic calcification - clinicopathologic studies. Kaohsiung J Med Sci. 2006;22(2):85-88.
Bhat NA, Mustaga F, Sheikh RY, et al. Incidence, etiology, and course of hypercalcemia-induced AKI in a tertiary care center from northern India, Egypt. J Intern Med. 2021;33(36).
Moyses-Neto M, Guimaraes FM, Ayoub FH, et al. Acute renal failure and hypercalcemia. Ren Fail. 2009;28(2):153-159.
Bar-Nathan M, Chen H, Rimer D, Segev G. Long-term outcome of dogs recovering from acute kidney injury: 132 cases. J Vet Intern Med. 2022;36(3):1024-1031.
Weller RE, Hoffman WE. Renal function in dogs with lymphosarcoma and associated hypercalcemia. J Small Anim Pract. 1992;33(2):61-66.
Polzin DJ. Evidence-based step-wise approach to managing chronic kidney disease in dogs and cats. J Vet Emergen Crit Care. 2013;23(2):205-215.
Groth EM, Chew DJ, Lulich JP, et al. Determination of a serum total calcium concentration threshold for accurate prediction of ionized calcium in dogs with and without hyperphosphatemia. J Vet Intern Med. 2019;34(1):74-82.
Iris-kidney.com [Internet]. IRIS International Renal Interest Society. 2016 [cited November 20, 2022]. http://www.iris-kidney.com/guidelines/grading.html
Vail DM, Pinkerton M, Young KM. Hematopoietic tumors. In: Vail DM, Thamm DH, Liptak JM, eds. Withrow and MacEwen's Small Animal Clinical Oncology. 6th ed. St. Louis, MO: Elsevier; 2020:688-715.
Gavazza A, Sacchini F, Lubas G, Gugliucci B, Valori E. Clinical, laboratory, diagnostic and prognostic aspects of canine lymphoma: a retrospective study. Comp Clin Pathol. 2009;18:291-299.
Lurie DM, Milner RJ, Suter SE, Vernau W. Immunophenotypic and cytomorphologic subclassification of T-cell lymphoma in the boxer breed. Vet Immunol Immunopathol. 2008;125(1-2):102-110.
Ponce F, Magnol JP, Ledieu D, et al. Prognostic significance of morphological subtypes in canine malignant lymphomas during chemotherapy. Vet J. 2004;167(2):158-166.
Benabe JE, Martinez-Maldonado M. Hypercalcemic nephropathy. Arch Intern Med. 1978;138(5):777-779.
Kruger JM, Osborne CA, Nachreiner RF, Refsal KR. Hypercalcemia and renal failure: etiology, pathophysiology, diagnosis, and treatment. Vet Clin North Am Small Anim. 1996;26(6):1417-1445.
Barber LG, Weishaar KM. Criteria for designation of clinical substage in canine lymphoma: a survey of veterinary oncologists. Vet Comp Oncol. 2016;1:32-39.
Škor O, Bicanová L, Wolfesberger B, et al. Are B-symptoms more reliable prognostic indicators than substage in canine nodal diffuse large B-cell lymphoma. Vet Comp Oncol. 2021;19(1):201-208.
D'Anjou MA, Bedard A, Dunn ME. Clinical significance of renal pelvic dilatation on ultrasound in dogs and cats. Vet Radiol Ultrasound. 2011;52(1):88-94.
Biller DS, Bradely GA, Partington BP. Renal medullary rim sign: ultrasonographic evidence of renal disease. Vet Radiol Ultrasound. 1992;33(5):286-290.
Mantis P, Lamb CR. Most dogs with renal medullary rim sign on ultrasonography have no demonstrable renal dysfunction. Vet Radiol Ultrasound. 2000;41(2):164-166.
Barr FJ, Patteson MW, Lucke VM, Gibbs C. Hypercalcemia nephropathy in three dogs: sonographic appearance. Vet Radiol. 1989;30(4):169-173.
Rebhun RB, Kent MS, Borrofka SA, et al. CHOP chemotherapy for the treatment of canine multicentric T-cell lymphoma. Vet Comp Oncol. 2010;9:38-44.
Littman MP. Protein-losing nephropathy in small animals. Vet Clin North Am Small Anim Pract. 2011;41(1):31-62.