Disturbances in mineral metabolism play a central role in the development of renal bone disease. In a 54-wk, randomized, open-label study, 119 hemodialysis patients were enrolled to compare the effects of sevelamer hydrochloride and calcium carbonate on bone. Biopsy-proven adynamic bone disease was the most frequent bone abnormality at baseline (59%). Serum phosphorus, calcium, and intact parathyroid hormone were well controlled in both groups, although calcium was consistently lower and intact parathyroid hormone higher among patients who were randomly assigned to sevelamer. Compared with baseline values, there were no changes in mineralization lag time or measures of bone turnover (e.g., activation frequency) after 1 yr in either group. Osteoid thickness significantly increased in both groups, but there was no significant difference between them. Bone formation rate per bone surface, however, significantly increased from baseline only in the sevelamer group (P ϭ 0.019). In addition, of those with abnormal microarchitecture at baseline (i.e., trabecular separation), seven of 10 in the sevelamer group normalized after 1 yr compared with zero of three in the calcium group. In summary, sevelamer resulted in no statistically significant changes in bone turnover or mineralization compared with calcium carbonate, but bone formation increased and trabecular architecture improved with sevelamer. Further studies are required to assess whether these changes affect clinical outcomes, such as rates of fracture. 19: 405-412, 200819: 405-412, . doi: 10.1681 Patients with chronic kidney disease (CKD) typically have abnormal bone histology. Alterations in bone turnover, mineralization, and volume in renal patients depend on several factors. In particular, disturbances in calcium-phosphate, parathyroid hormone (PTH), and vitamin D metabolism are important in the development of renal osteodystrophy (ROD). J Am Soc NephrolThe pattern of ROD observed in patients with stage 5 CKD has changed in recent years. Previously, observed bone conditions in renal patients in order of prevalence were mixed uremic osteodystrophy (MUO), predominant hyperparathyroid bone disease (HPBD), and aluminum-related os-

Feline sporotrichosis is a major clinical problem among cats in Brazil and is also a neglected, but important, public health issue, due to its zoonotic potential. The nasal clinical form of the disease is particularly challenging, having treatment refractoriness and clinical signs relapse as common features. This case series study aimed to preliminarily describe the effects of the azolic antifungal drug, clotrimazole, as a topical 1% solution spray, together with per os itraconazole on inducing disease remission, as well as treatment tolerability and safety. Medical records of the Feline Medicine Service from the Universidade Federal Rural do Rio de Janeiro were reviewed, and 7 feline patients met the inclusion criteria (confirmatory diagnostic reached, available follow-up records, and use of intranasal clotrimazole 1% solution –1 spray per nostril every 24 hours– as adjunctive therapy to itraconazole – 100 mg/cat per os every 24 hours). Among these, 4 had a history of treatment refractoriness done until then. Follow-up records included clinical evaluation, along with complementary tests and owner reports on tolerability and occurrence of adverse reactions. All patients have undergone clinical remission within 60 days. Tolerability were satisfactory, and adverse reactions were only found on complementary tests (hepatic enzyme elevation), without clinical repercussion. The intranasal use of 1% clotrimazole solution has shown as a promising adjunctive therapy to itraconazole for feline nasal sporotrichosis, even in previous refractory cases.

Background: Histoplasmosis is a systemic mycosis whose etiologic agent is the fungus Histoplasma capsulatum. This fungal infection, which is the second most frequent systemic mycotic fungal disease in felines in the United States, has rarely been found in cats in Brazil. This paper reports on a case of acute pulmonary histoplasmosis in a domestic cat treated with oral itraconazole associated with amphotericin B administered subcutaneously. This treatment resulted in clinical remission of the patient’s symptoms, as evidenced by radiographic follow-ups.Case: A domestic cat suffering from acute dyspnea was taken to a veterinary clinic. The animal was subjected to emergency oxygen therapy, and kept at rest through sedation with midazolam. A physical examination revealed normally colored mucosa, 8% dehydration, bristly fur, body condition score 2/9, tachypnea with respiratory rate of 100 breaths per minute and expiratory dyspnea. The radiographic examination showed marked opacification of all the pulmonary fields, with a mixed pattern (interstitial and alveolar) of heterogeneous appearance and diffuse distribution, which are changes consistent with an inflammatory infectious process (pneumonia). A cytological analysis of the pleural fluid revealed round to oval-shaped intracytoplasmic structures, varying in size from 2 to 4 μm, inside foamy macrophages, consistent with Histoplasma capsulatum. Based on the diagnosis of pulmonary histoplasmosis, and in view of the patient’s acute respiratory distress, it was decided to treat the cat using itraconazole associated with amphotericin B. Itraconazole was administered orally at a dose of 100 mg/cat every 24 h, while amphotericin B was administered subcutaneously at a dose of 0.5 mg/kg, combined with 100 mL of sodium chloride 0.9% and 100 mL of 5% glycated serum, with monitoring of serum concentrations of symmetric dimethylarginine (SDMA). Amphotericin B was administered every 48 h up to the 7th dose, followed by three times a week up to the 11th dose, and then twice a week up to the 16th dose. The animal was released from the veterinary hospital 10 days after its admission, showing a considerably improved respiratory condition and a respiratory rate of 40 breaths per minute. Continuation of the antifungal treatment with itraconazole was prescribed, maintaining the same dose and frequency of administration until a new recommendation would be made, as well as frequent return visits for the administration of amphotericin B and reassessment of the animal. The administration of amphotericin B was discontinued when the animal’s respiratory condition stabilized; hence, the feline received a total of 16 doses of the drug. The animal showed remission of clinical respiratory symptoms, confirmed by follow-up chest X-rays, which revealed significantly less radiodense pulmonary parenchyma in response to treatment with itraconazole and amphotericin B. Five months after beginning its treatment, the cat is being treated orally with itraconazole (100 mg/cat, every 24 h), without recrudescence of the clinical symptoms.Discussion: To date, six cases of feline histoplasmosis have been reported in Brazil, only one of which had pulmonary involvement and was treated successfully. The use of oral itraconazole associated with subcutaneous amphotericin B has proved to be effective for the treatment of acute pulmonary histoplasmosis in domestic cats. Note that a rapid diagnosis of pulmonary disease is essential in order to immediately implement a combined drug therapy linked with monitoring to ensure the protocol is safe for the patient

Tumor necrosis factor receptor associated periodic syndrome (TRAPS) is a rare monogenic autoinflammatory disease. Its most severe manifestation is secondary amyloidosis. A 44-year-old male presented with nephrotic syndrome. Kidney biopsy was conclusive for secondary amyloidosis. The patient and his children had a history of recurrent febrile periods since infancy. All subjects were positive for a heterozygous variant of the TNFRSF1A gene, confirming TRAPS diagnosis. The patient progressed to end-stage renal failure and developed recurrent pericarditis episodes. He was started on anakinra while on hemodialysis with marked reduction of his serum amyloid A protein (SAA) levels. Meanwhile he received a cadaveric renal transplant and maintains anakinra treatment. Despite renal failure being the most feared complication of AA amyloidosis caused by TRAPS, little data is available about safety of anti-IL-1 treatment in patients with severe kidney failure. The authors report this case of a patient on dialysis treated with anakinra in which no complications were registered. Though amyloidosis is established, the authors believe containing its progression and reducing inflammatory activity can improve patient prognosis and reduce recurrence of amyloidosis in kidney transplant, as has been demonstrated in transplanted patients due to familial Mediterranean fever amyloidosis.

Background: Chylothorax in cats represents a challenge due to the possibility of involvement of multiple etiologies and the harmful consequences resulting of the presence of the chylous effusion in the thorax. The causes include neoplasms in the thoracic cavity, heart disease and thoracic injuries. It is imperative that clinical nutritional and therapeutic and / or surgical management be immediate and directed to the treatment of the cause. The objective of this work was to report a case of idiopathic chylothorax in a domestic cat solved through surgical intervention and dietary maintenance applied.Case: A 4-year-old male cat, fed with diet for the age range of adult cats, was attended at the Veterinary Hospital of the Federal Rural University of Rio de Janeiro (HV - UFRRJ), with clinical complaint of difficulty breathing, inappetence, prostration and weight loss. In the clinical examination was verified intense tachypnea, presence of heart murmur, normocoratedmucosae, dehydration 7%. The animal was sedated to be submitted to radiographic examination of the thorax with pethidine and midazolam. Thoracic radiographs on the lateral, ventral-dorsal and orthostatic positions were realized and severe pleural effusion was observed in both hemitorax with drainage of 180 mL of lactescent fluid from the right hemithorax and 120 mL of left hemithorax liquid. Through analysis of cavity liquids the effusion was classified as chylous effusion. The hemogram showed a neutrophilic leukocytosis. Serum cholesterol and triglyceride concentrations (28 mg/dL and 43 mg/dL, respectively) were lower than the concentrations of the cavity liquid (67 mg/dL and 722 mg/dL, respectively).Ultrasound examination revealed no mass in the thoracic cavity and no changes in the pulmonary parenchyma. The echocardiographic examination was also performed and did not reveal any cardiac alterations. The initial treatment consisted of the clinical approach, through the exclusive alimentary management with low fat diet, in order to reduce toreduce the amount of chylous in the thorax. The rutine was administered at a dose of 250 mg/cat every 8 h orally. After 15 days, due to an unsatisfactory response to conservative treatment, surgical intervention was indicated. The technique used was pleural omentalization with block ligation of the thoracic duct without mesenteric lymphangiography together with pericardectomy and placement of the thoracic drain. During the postoperative period the animal remained under intensive care, with nasal oxygen therapy and intense analgesia during the first 72 h. After 20 days, the production of the chylous liquid was 2 mL/kg/ day, which made it possible to remove the drain. The cat received continuously with the exclusive diet of low fat to reduce the production of the chylous, without recurrence of chylous up to the present moment.Discussion: It is important to establish in a first approach of animals with chylous exudation the management of low-fat foods, along with appropriate pharmacological therapy, monitoring the patient in a constant and cautious way. If conservative clinical intervention is not satisfactory within 5 to 10 days, rapid surgical treatment is essential, due to the risk offibrosing pleuritis with consequent involvement of the pulmonary parenchyma, as occurred in this report. Duct ligation surgery and the pericardectomy was satisfactory for the resolution of the constant chylous production in the thorax of the animal, as well as the use of the low fat diet was essential to reduce the chylous effusion and fibrosing pleurisy, both the interventions made possible the maintenance of the patient’s health and well-being.Keywords: feline, cavitary fluid, quilting effusion, thoracic duct.