Diseases / List of Miscellaneous / Metabolic / Multifactorial Diseases / Disease description:

Chronic Renal Failure in Lagomorphs with notes on Bonobos

Lateral radiograph urolithiasis, osteosclerosis and aortic mineralisation. Click here for full page view with caption.

INFORMATION AVAILABLE

GENERAL INFORMATION

CLINICAL CHARACTERISTICS & PATHOLOGY

INVESTIGATION & DIAGNOSIS

TREATMENT & CONTROL

SUSCEPTIBILITY & TRANSMISSION

ENVIRONMENT & GEOGRAPHY

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General and References

Disease Summary

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Lagomorphs A slowly developing condition often presenting with a history of weight loss and sometimes also of polyuria/polydipsia. (J3.160.w4, B601.9.w9)

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Alternative Names (Synonyms)

CRF

See also:

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Disease Type

Miscellaneous / Metabolic / Multifactorial

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Infectious/Non-Infectious Agent associated with the Disease

  • Encephalitozoonosis in Lagomorphs. (B601.9.w9, J3.160.w4)
    • In a study of 65 rabbits with suspected renal disease, 38 of 41 rabbits tested (92%) were seropositive for Encephalitozoon cuniculi; this is higher than the proportion seropositive in the general population (e.g. 45 and 52% in two surveys). Lesions consistent with infection with this organism were present in all of the 13 rabbits in which kidneys were submitted for histopathological examination, and the presence of the organism was confirmed in one rabbit. It is possible that this organism could provide the initial insult leading to later development of chronic renal failure. (J3.160.w4)
  • Nephrolithiasis - see Urolithiasis in Lagomorphs and Hydronephrosis in Lagomorphs
  • Kidney Calcification in Rabbits
  • Fatty degeneration. (B602.18.w18) See: Hepatic Lipidosis in Rabbits
  • Lymphosarcoma (Multicentric Lymphoma in Rabbits) with renal involvement, due to destruction of renal tissue as the tumour infiltrates. (B602.18.w18)

In Bonobos

  • Presumed immune-related in a 21-year-old male bonobo. (J23.20.w2)

Infective "Taxa"

Non-infective agents

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Physical agents

Indirect / Secondary

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References

Disease Author

Dr Debra Bourne MA VetMB PhD MRCVS (V.w5)
Click image for main Reference Section

Referees

Aidan Raftery MVB CertZooMed CBiol MIBiol MRCVS (V.w122)

Major References / Reviews

Code and Title List

In Rabbits
B600
.14.w14, B601.9.w9, B602.18.w18
J3.160.w4, J83.15.w1

In Bonobos
J23.20.w2

Other References

Code and Title List

 

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Clinical Characteristics and Pathology

Detailed Clinical and Pathological Characteristics

General --

Clinical Characteristics

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Lagomorphs
  • Clinical signs are non-specific. (J3.160.w4)
  • Weight loss, poor body condition. (B600.14.w14, B601.9.w9, J3.160.w4)
  • Lethargy/depression. (B600.14.w14, B602.18.w18, J3.160.w4)
    • In a study of 65 rabbits, this was found to be more common in individuals with osteosclerosis; these rabbits often had a hunched posture and were not grooming themselves, possibly associated with bone pain. (J3.160.w4)
  • Inappetance. (J3.160.w4)
    • Anorexia was noted in rabbits with uroliths in the ureter(s). (J3.160.w4)
  • Polyuria/polydipsia. (B600.14.w14, B601.9.w9, B602.18.w18, J3.160.w4)
    • This may not be noticed by the owner. (J3.160.w4)
  • Sometimes (occasionally) haematuria. (B601.9.w9)
  • Anaemia. (B600.14.w14)
  • Signs such as dysuria or stranguria, associated with lower urinary tract disease, may be present due to hypercalciuria. (B601.9.w9)
  • Anorexia. (B600.14.w14, B602.18.w18)
    • Intermittent anorexia and GIT ileus may be noted (probably due to pain from formation of uroliths secondary to hypercalciruria). (B601.9.w9)
  • Urine scalding. (B602.18.w18)
  • Neurological signs - e.g. ataxia or paresis, in 21 of 65 rabbits in one study. (J3.160.w4)
  • Spontaneous long bone fractures occurred in two rabbits with osteosclerosis, in one study. (J3.160.w4)
  • Signs of severe pain were noted in rabbits with uroliths in ureter(s). (J3.160.w4)
  • Physical examination:
    • Kidneys small and irregular. (B601.9.w9)
      • One or both kidneys may be enlarged if CRF is due to hydronephrosis. (B601.9.w9)
    • Ascites and oedema may be noted if there is severe protein loss. (B601.9.w9)
    • Systemic hypertension may be present - this can be measured by indirect Doppler. (B601.9.w9)
  • Clinical pathology:
    • Serum biochemistry: raised creatinine, sometimes raised urea, often hypercalcaemia. (B601.9.w9)
      • Urea is raised only after loss of 50-70% of renal function. (B601.9.w9)
      • In one study, serum urea and/or creatinine was found in all rabbits with renal disease; sometimes only one of these values was raised, and the rise was not always far outside the normal range (urea 2.5 - 6.7 mmol/L, creatinine 20 - 120 Ámol/L). (J3.160.w4)
      • Hypercalcaemia (J3.160.w4); this occurs when the kidneys are no longer able to excrete sufficient calcium. (B600.14.w14)
    • Urinalysis: isothenuria. (B602.18.w18)
      • Sometimes proteinuria, haematuria, pyuria and/or casts (less common than in acute renal failure). (B602.18.w18)
Bonobos In a 21-year-old male bonobo. (J23.20.w2)
  • Clinical pathology: moderate proteinuria. BUN slightly raised, gamma globulins slightly raised, circulating immune complexes. (J23.20.w2)

Incubation

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Lagomorphs
  • Weeks to years. (B601.9.w9)
Bonobos --

Mortality / Morbidity

  • --
Lagomorphs
  • Damage is irreversible, but the severity of clinical signs may be reduced and life prolonged if the condition is managed properly. (B600.14.w14, B601.9.w9)
Bonobos --

Pathology

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Lagomorphs Gross pathology
  • Renal: 
    • Kidneys grossly enlarged and appearing neoplastic in one individual. (J3.160.w4)
  • Skeletal: 
    • In three rabbits from which bones were prepared, bone surfaces were roughened, thick and whiter than those from a normal rabbit (bones smooth, slightly yellow in colour). (J3.160.w4)

Histopathology

  • Renal: In 13 rabbits (J3.160.w4)
    • Commonly interstitial nephritis, sometimes described as lymphoplasmacytic and/or granulomatous. (J3.160.w4)
    • Tubular degeneration, atrophy and loss of tubules. (J3.160.w4)
    • Glomerular sclerosis in some individuals. (J3.160.w4)
  • Skeletal: Osteosclerosis confirmed in two rabbits. (J3.160.w4)
Bonobos  

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Human Health Considerations

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Susceptibility / Transmission

General information on Susceptibility / Transmission

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Lagomorphs
  • Renal fibrosis has been noted to be more prevalent in older rabbits. (J83.15.w1)
Bonobos --

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Disease has been reported in either the wild or in captivity in:

  • Domestic rabbits. (B600.14.w14, B601.9.w9, B602.18.w18, J3.160.w4)
  • In a 21-year-old male bonobo at San Diego, USA. (J23.20.w2)
  • Membranous glomerulonephritis was detected at necropsy in an adult female bonobo, Camilla, which died from pneumonia. (J23.20.w2)

Further information on Host species has only been incorporated for species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Host species with further information available are listed below:

Host Species List

(List does not contain all other species groups affected by this disease)

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Disease has been specifically reported in Free-ranging populations of:

  • --

Further information on Host species has only been incorporated for species groups for which a full Wildpro "Health and Management" module has been completed (i.e. for which a comprehensive literature review has been undertaken). Host species with further information available are listed below:

Host Species List

  • --

(List does not contain all other species groups affected by this disease)

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Environment/Geography

General Information on Environmental Factors/Events and Seasonality

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Regions / Countries where the Infectious Agent or Disease has been recorded

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Regions / Countries where the Infectious Agent or Disease has been recorded in Free-ranging populations

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General Investigation / Diagnosis

General Information on Investigation / Diagnosis

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Lagomorphs Note: this disease may be underdiagnosed due to non-specific clinical signs, and the fact that polyuria/polydipsia may not be noticed by owners. (J3.160.w4)

Physical examination

  • Kidneys small and irregular. (B601.9.w9)
    • One or both kidneys may be enlarged if CRF is due to hydronephrosis (B601.9.w9) or neoplasia. (J3.160.w4)
  • Ascites and oedema may be present if there is severe protein loss. (B601.9.w9)
  • Systemic hypertension may be present - this can be measures by indirect Doppler. (B601.9.w9) 

Clinical pathology

  • Serum biochemistry: raised creatinine, sometimes raised urea, often hypercalcaemia. (B601.9.w9)
    • Urea is raised only after loss of 50-70% of renal function. (B601.9.w9)
    • In one study, all rabbits with suspected renal disease in which blood urea (BUN)and creatinine concentrations were measured had urea and/or creatinine values above the reference range, although in some cases only a slight rise above reference values was present. In 43/47 individuals creatinine was increased (> 130 Ámol/L); in five of these, BUN was within the normal range. In 42/47 individuals, BUN was increased (> 6.7 mmol/L). (J3.160.w4)
    • In one study, serum calcium was above the reference range (2.6 - 3.6 mmol/L) in 33/38 rabbits in which it was measured; this may be due to impairment of calcium excretion by diseased kidneys. (J3.160.w4)
    • In one study, serum phosphorus was raised above the reference range (1.0 - 2.0 mmol/L) in 17/34 rabbits and below reference range in 5/34 rabbits; these variations "were probably due to aberrations in phosphorus regulation associated with renal disease." Hyperphosphataemia was noted particularly in the rabbits with osteosclerosis. (J3.160.w4)
    • Note: serum calcium x serum phosphorus was consistently higher in the osteosclerotic rabbits. (J3.160.w4)
  • Urinalysis: e.g. haematuria and proteinurea with urolithiasis, increased urine protein:creatinine ratio with glomerular disease. (B601.9.w9)
  • See: Clinical Pathology of Lagomorphs
Radiography
  • Soft tissue mineralisation (including of the aorta, particularly near the heart base, and the renal vessels). (B600.14.w14, B601.9.w9) 
    • In one study, metastatic calcification (particularly of the aorta, and sometimes also of other organs including the kidneys and subclavian arteries, was confirmed by radiography in 26/65 rabbits with signs of chronic renal disease. (J3.160.w4)
    • See: Kidney Calcification in Rabbits
  • Uroliths may be present; (B601.9.w9) nephrolithiasis is commonly present. (J3.160.w4)
    • In one study, uroliths were confirmed by radiography in 24/65 rabbits with signs of chronic renal disease. (J3.160.w4)
    • See: Urolithiasis in Lagomorphs
  • Kidney enlargement may be noted (J3.160.w4) particularly with hydronephrosis. (B601.9.w9)
  • Osteosclerosis (increased bone opacity) was confirmed radiographically in 40 of 65 cases of suspected renal disease in one study. In all these rabbits the hyoid bone was calcified (which was never noted in individuals without generalised osteosclerosis). (J3.160.w4)
    • In addition to increased bone density, bones may have a blurred outline due to an irregular surface. (J3.160.w4)
  • Note: the presence of some radiodense sediment in the bladder is normal in rabbits. (B601.9.w9)
  • See: Imaging in Lagomorph Diagnosis and Treatment

Ultrasonography

Bonobos n a 21-year-old male bonobo. (J23.20.w2)
  • Clinical pathology: moderate proteinuria. BUN slightly raised, gamma globulins slightly raised, circulating immune complexes. (J23.20.w2)
Related Techniques
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Similar Diseases (Differential Diagnosis)

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Lagomorphs
  • --
Bonobos  

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Treatment and Control

Specific Medical Treatment

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Lagomorphs
  • Stop any nephrotoxic drugs. (B601.9.w9)
  • Prophylactic treatment for gastritis/gastric ulceration (due to uraemia). (B601.9.w9)
  • Benazepril up to 0.1 mg/kg orally once daily (B601.9.w9); 0.1 - 0.5 mg/kg orally once daily. (B601.15.w15, P3.2003b.w1); 0.5 mg/kg. (V.w122)
    • This ACE inhibitor lowers blood pressure and increases renal perfusion, helping preserve the remaining function of the kidneys. (P3.2003b.w1)
      • In a preliminary study, benazepril (0.1 - 0.5 mg/kg daily orally) increased survival rates of rabbits with renal disease; urea and creatinine were decreased (suggesting an improvement in renal function). (P3.2003b.w1)
      • Note: benazepril can cause fatal hypotension in normotensive rabbits, but this has not been noted as a problem in rabbits with CRF (which tend to be hypertensive). (B601.9.w9, P3.2003b.w1) Ina study, during the first week of treatment, blood pressures dropped to average 85 mmHG, then increased slightly to 88 mmHG (compared with normal average 91 mmHG). (P3.2003b.w1)
      • Treated rabbits showed a mild lethargy in the first 3-4 days of treatment. Appetite improved after 1-2 weeks. (P3.2003b.w1)
      • Monitor blood potassium since overdose leads to hyperkalaemia (normal range 3.6-6.9 mmol/L). (P3.2003b.w1)
  • For anaemia:
    • Anabolic steroids, nandralone 2 mg/kg subcutaneously.
    • If PCV is below 18%, consider blood transfusions.
  • For systemic hypertension:
    • ACE inhibitors or calcium channel blockers. (B601.9.w9)
      • Reduce or stop treatment with an ACE if there is an increase in azotaemia, development of hypotension, or hyperkalaemia. (B601.9.w9)
  • Antibiotics for treatment of renal infection (including renal/ureteral calculi, which usually have associated pus. (B600.14.w14)
Bonobos
  • In a 21-year-old male bonobo with presumed immune-related renal disease, low-dose prednisolone. (J23.20.w2)
Related Techniques

 

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General Nursing and Surgical Techniques

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Lagomorphs Supportive treatment
  • Oral fluid replacement therapy to maintain hydration and electrolyte balance. (B600.14.w14)
  • Diet restricted in calcium (but not too low a level. (B600.14.w14)
Bonobos --
Related Techniques
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Preventative Measures

Vaccination --
Lagomorphs --
Bonobos --
Prophylactic Treatment

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Lagomorphs --
Bonobos --
Related Techniques
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Environmental and Population Control Measures

General Environment Changes, Cleaning and Disinfection --

Lagomorphs

  • --
Bonobos --
Population Control Measures --
Lagomorphs --
Bonobos --
Isolation, Quarantine and Screening --
Lagomorphs --
Bonobos --
Related Techniques
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