{"title":"Uraemic syndrome following acute renal failure in horses","authors":"G. van Galen","doi":"10.1111/eve.14125","DOIUrl":"https://doi.org/10.1111/eve.14125","url":null,"abstract":"<p>This clinical commentary accompanies the case report from Fernandes and Robin (<span>2025</span>) that describes an interesting case with multiple metabolic problems including acute renal failure (ARF), metabolic encephalopathy, uraemic syndrome and hyperammonaemia. The aim of this commentary is to review the definition and extrarenal effects of the uraemic syndrome in acute kidney injury (AKI) and ARF. As little data are available on horses, a descriptive comparison is made across species.</p><p><i>Azotaemia</i> is a pure biochemical abnormality, that is defined as the elevation or buildup of nitrogenous products and other secondary waste products within the body because of reduced renal function (Tyagi & Aeddula, <span>2025</span>). When the severity of azotaemia increases, and it becomes manifested with clinical signs, this is called <i>uraemia</i> (Tyagi & Aeddula, <span>2025</span>). Uraemia literally means ‘urine in the blood’. The increasing concentration of waste metabolites can lead to toxic levels (these are then called uraemic toxins - UTs), which can have widespread effects throughout the body because of their deleterious effects on cell metabolism and function (Schott, <span>2010b</span>). <i>Uraemic syndrome</i> describes the combination of clinical signs that develop consequently (Schott, <span>2010b</span>; Tyagi & Aeddula, <span>2025</span>).</p><p><i>Acute kidney injury (AKI)</i> means that the kidney has sustained acute damage leading to a sudden decrease in the kidney's excretory function. AKI covers the whole spectrum ranging from mild non-azotaemic kidney injury to advanced renal failure with severe uraemia (Segev et al., <span>2024</span>; van Galen et al., <span>2024</span>).</p><p>On a cellular level UTs cause endoplasmic reticulum and mitochondrial stress and reduced mitochondrial respiration (Andre et al., <span>2023</span>). They also cause activation of the aryl hydrocarbon receptor and nuclear factor kappa B (NF-κB), reactive oxygen species production and the mitogen-activated protein kinase (MAPK), extracellular signal-regulated kinase (ERK) and transforming growth factor β (TGF-β) signalling pathways. These effects lead to a pro-inflammatory state, cellular dysfunction and apoptosis (Andre et al., <span>2023</span>).</p><p>Some 150 molecules are considered to be <i>UTs</i> and are believed to contribute to the uraemic syndrome when their concentrations increase following a decline in renal function (Andre et al., <span>2023</span>). The most well-known UTs are blood urea nitrogen (BUN), serum creatinine, ammonia, uric acid, phenol, guanidino compounds and products of intestinal metabolism (secondary methylamines, polyamines and tryptophan breakdown products such as indole, skatole, indoleacetic acid; Lee & Downing, <span>1981</span>; Schott, <span>2010b</span>). Although some UTs are inversely correlated with renal function (glomerular filtration rate or serum creatinine concentrations; Ebrahimi ","PeriodicalId":11786,"journal":{"name":"Equine Veterinary Education","volume":"37 5","pages":"235-240"},"PeriodicalIF":0.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eve.14125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143749529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Atypical myopathy associated with box elder in Europe","authors":"E. J. Knowles, R. J. Piercy","doi":"10.1111/eve.14117","DOIUrl":"https://doi.org/10.1111/eve.14117","url":null,"abstract":"<p>The case report by Jahn et al. (<span>2025</span>) describes a case of atypical myopathy in Europe caused by ingestion of the protoxin hypoglycin A (HGA) from box elder seedlings. This is an important report. It reminds clinicians in Europe that trees other than The European sycamore (<i>Acer pseudoplatanus</i>) may contain HGA and that there is a potential for other unfamiliar plant species to cause pasture-associated toxicities.</p><p>After many years of research, the pathogenesis of atypical myopathy, also known as seasonal pasture myopathy, is now well understood. The severe myopathy results from the ingestion of the seeds or seedlings of European sycamore (<i>Acer pseudoplatanus</i>) in Europe and the box elder (<i>Acer negundo</i>) in the USA (Valberg et al., <span>2013</span>; Westermann et al., <span>2008</span>). The seeds, seedlings, and leaves of these trees contain the protoxin HGA, and to a lesser extent its analogue methylenecyclopropylglycine (MCPrG; Bochnia et al., <span>2019</span>). These protoxins are metabolised to the active toxins methylenecyclopropylacetyl-CoA (MCPA-CoA) and MCPrG-CoA, respectively, at tissue-specific rates and primarily in skeletal muscle (Sander et al., <span>2023</span>). The toxic effects mainly occur in the highly-oxidative ‘slow-twitch’ type I muscle fibres such as the postural muscles, masseters, diaphragm and cardiac muscle (Cassart et al., <span>2007</span>). The primary toxin, MCPA-CoA inhibits acyl-CoA dehydrogenase enzymes involved in the beta-oxidation of fatty acids and catabolism of branched-chain amino acids resulting in failure of mitochondrial energy generation and subsequently muscle cell death (Westermann et al., <span>2008</span>). Inhibition of Acyl-CoA dehydrogenase enzymes causes an accumulation of their acyl-CoA substrates and the carnitine and glycine conjugates of those substrates in serum and urine, a characteristic metabolic profile known as multiple acyl-CoA dehydrogenase deficiency (MADD) (Westermann et al., <span>2008</span>). The accumulation of acylcarnitines together with the protoxins (HGA and MCPrG) and the carnitine conjugates of the toxins (MCPA-carnitine and MCPF-carnitine) can be detected in serum by liquid-chromatography-mass-spectometry (LCMS) (Bochnia et al., <span>2019</span>; González-Medina et al., <span>2021</span>; Valberg et al., <span>2013</span>).</p><p>In many cases a diagnosis of atypical myopathy can be made relatively confidently based on the characteristic clinical signs, serum biochemical changes, the seasonal occurrence and, in Europe, the presence of sycamore (<i>Acer psuedoplatanus</i>) seeds or seedlings on the pasture (Dunkel et al., <span>2018</span>; González-Medina et al., <span>2017</span>). Detection of serum HGA or MCPA-carnitine by LCMS may be useful to confirm the diagnosis and may be particularly useful to identify sub-clinically affected cases, or those with less-severe or unusual presentations or when a toxic (tree) source cannot r","PeriodicalId":11786,"journal":{"name":"Equine Veterinary Education","volume":"37 5","pages":"231-233"},"PeriodicalIF":0.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/eve.14117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143749972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Metabolic encephalopathy associated with uraemic syndrome and hyperammonaemia in a horse presenting with renal failure","authors":"T. Fernandes, M. Robin","doi":"10.1111/eve.14096","DOIUrl":"https://doi.org/10.1111/eve.14096","url":null,"abstract":"<div>\u0000 \u0000 <p>A 3-year-old racing Arabian mare was admitted to the hospital with a 5-day history of muscle pain, lethargy and anorexia. The mare arrived at the hospital with marked neurological abnormalities, dehydration and melaena. Investigation revealed severe azotaemia, acute renal failure, hyperammonaemia and evidence of recent myopathy. Therapeutic objectives were the correction of fluid deficiencies and restoration of normal renal function and urine production. The mare responded rapidly to treatment and was discharged after 12 days, before going on to race the following year. To the authors' knowledge, this is the first report of survival of a case of acute renal failure with metabolic encephalopathy associated with hyperammonaemia and uraemic syndrome in the horse. Additionally, the case had symptoms of GI disease consistent with uraemic damage to the intestine.</p>\u0000 </div>","PeriodicalId":11786,"journal":{"name":"Equine Veterinary Education","volume":"37 5","pages":"e85-e91"},"PeriodicalIF":0.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143749881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Climate change. What role should equine veterinarians take?","authors":"Q. H. W. Wedmore, T. S. Mair","doi":"10.1111/eve.14084","DOIUrl":"https://doi.org/10.1111/eve.14084","url":null,"abstract":"","PeriodicalId":11786,"journal":{"name":"Equine Veterinary Education","volume":"37 5","pages":"228-229"},"PeriodicalIF":0.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143749746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Review of intra-articular 2.5% polyacrylamide hydrogel, a new concept in the management of osteoarthritis","authors":"A. Tnibar","doi":"10.1111/eve.14087","DOIUrl":"https://doi.org/10.1111/eve.14087","url":null,"abstract":"<div>\u0000 \u0000 <p>Recent observational and experimental trials have demonstrated that intra-articular 2.5% injectable polyacrylamide hydrogel (2.5 iPAAG) is highly effective, lasting and safe for the treatment of equine osteoarthritis (OA). Over the last decade, intra-articular 2.5 iPAAG has shown to be a potent and promising drug in the medication of OA in horses, as no other single medical treatment for OA has such prolonged efficacy. Preliminary observations on the mechanisms of action of intra-articular 2.5 iPAAG support a mechanical effect through integration into the synovial membrane, an increase in joint elasticity possibly reducing overall joint capsule stiffness, and provision of lasting viscosupplementation which contributes to protecting articular surfaces. Because 2.5 iPAAG is an inert and biocompatible hydrogel, no effects on arthrocentesis cytology parameters have been observed. Studies also suggest that the positive effects of 2.5 iPAAG occur in the absence of intra-articular neurotoxicity or fibrosis, with a low-level macrophage-driven foreign body response. The effect on the synovial membrane and joint capsule and the long-acting viscosupplementation represent new concepts in the management of equine OA.</p>\u0000 </div>","PeriodicalId":11786,"journal":{"name":"Equine Veterinary Education","volume":"37 3","pages":"161-168"},"PeriodicalIF":0.8,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143253387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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