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. 2024 May-Jun;38(3):1563-1576.
doi: 10.1111/jvim.17034. Epub 2024 Mar 4.

Risk factors and implications associated with ultrasound-diagnosed nephrocalcinosis in cats with chronic kidney disease

Pak-Kan Tang  1 , Rebecca F Geddes  2 , Yu-Mei Chang  3 , Rosanne E Jepson  2 , Dirk Hendrik Nicolaas van den Broek  4 , Nicola Lötter  1 , Jonathan Elliott  1
Affiliations

Risk factors and implications associated with ultrasound-diagnosed nephrocalcinosis in cats with chronic kidney disease

Pak-Kan Tang et al. J Vet Intern Med. 2024 May-Jun.

Abstract

Background: Microscopic nephrocalcinosis is a common pathological feature of chronic kidney disease (CKD) in cats. Detection of macroscopic nephrocalcinosis using ultrasonography and its implications remain unexplored.

Objectives: Identify risk factors associated with ultrasound-diagnosed nephrocalcinosis and evaluate the influence of nephrocalcinosis on CKD progression.

Animals: Thirty-six euthyroid client-owned cats with CKD.

Methods: Prospective cohort study. Cats with CKD with and without ionized hypercalcemia were enrolled for renal ultrasonography. Cats were categorized according to the presence or absence of ultrasound-diagnosed nephrocalcinosis. Binary logistic regression was performed to identify nephrocalcinosis risk factors. The influence of nephrocalcinosis on CKD progression was assessed using linear mixed models.

Results: Ultrasound-diagnosed nephrocalcinosis was evident in 61% of CKD cats overall, with increased prevalence (81%) in those with hypercalcemia. At enrollment, higher blood ionized calcium concentration (odds ratio [OR], 1.27 per 0.1 mg/dL; P = .01), plasma phosphate concentration (OR, 1.16 per 0.1 mg/dL; P = .05), plasma creatinine concentration (OR, 1.29 per 0.1 mg/dL; P = .02) and alanine aminotransferase activity (OR, 2.08 per 10 U/L; P = .04) were independent nephrocalcinosis risk factors. The rate of change in log-transformed fibroblast growth factor-23 differed significantly between groups (P = .04). Cats with CKD and nephrocalcinosis had increasing plasma creatinine concentrations (.03 ± .01 mg/dL/month; P = .04) and phosphate concentrations (.06 ± .02 mg/dL/month; P < .001) and decreasing body weight (.02 ± .01 kg/month; P < .001) over time.

Conclusions and clinical importance: Nephrocalcinosis is prevalent in cats with CKD, especially in those with hypercalcemia. This pathological feature appears to be associated with CKD progression in cats.

Keywords: CKD‐MBD; feline; hypercalcemia; mineralization; nephrolithiasis; radiology and diagnostic imaging; ultrasonography.

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Conflict of interest statement

Pak Kan Tang received a PhD studentship funded by Royal Canin SAS. Rebecca Geddes received funding from Petplan, Royal Canin, an RVC Internal Grant, The Academy of Medical Sciences and The Everycat Foundation; has previously had a consultancy agreement with Boehringer Ingelheim; has received speaking honoraria from Boehringer Ingelheim, Idexx and Royal Canin. Rosanne Jepson received funding from PetPlan, Feline Foundation for Renal Research, RVC Internal Grant, PetSavers, and consultancy agreements: Boehringer Ingelheim, Merial, CEVA. Speaking honoraria: Boehringer Ingelheim, Hills Pet Nutrition, CEVA. Jonathan Elliott has Consultancy agreements with: Elanco Ltd, CEVA Animal Health Ltd, Boehringer Ingelheim Ltd, MSD Animal Health Ltd., Orion Incorp, Idexx Ltd, Waltham Petcare Science Institute, Invetx Inc and Zoetis Ltd. received grant funding from Elanco Ltd, Waltham Centre for Pet Nutrition, Royal Canin SAS, Idexx Ltd., CEVA Animal Health. He is a member of the International Renal Interest Society which receives sponsorship from Zoetis.

Figures

FIGURE 1
FIGURE 1
A CONSORT flow diagram of this prospective imaging study. (Created with BioRender.com)
FIGURE 2
FIGURE 2
Scatter plots illustrating the linear change of plasma (A) creatinine; (B) phosphate; (C) body weight; (D) ln[FGF23]; (E) ln[PTH]; (F) total calcium; and (G) ionized calcium in all enrolled cats in this prospective imaging study (n = 36) according to the classification of nephrocalcinosis determined by ultrasonography at enrolment (“absence of nephrocalcinosis” [crosses] vs “presence of nephrocalcinosis” [dots]) during the study period. The P‐value refers to the Group*Time interaction (as shown in Table 6) analyzed using linear mixed effects models, which assessed the difference in rate of change of the outcome variable between groups (“absence of nephrocalcinosis” vs “presence of nephrocalcinosis”) over time.
See this image and copyright information in PMC

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