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IV. Summary
There is little treatment available for chronic renal failure from a Western perspective. In contrast, Traditional Chinese Veterinary Medicine has treatment options for patients with CRF, which may minimize the progression of disease and may help maintain quality of life. The combination of herbal medicine, acupuncture, and dietary management, in addition to Western treatments, can be a very effective therapeutic approach to treat chronic renal failure in small animals.
Reference:
1. Polzin DJ, Osborne CA, Adams LD, O’Brien TD. Dietary management of
canine and feline chronic renal failure. Vet Clin North Am Small Anim Pract. 1989 May;19(3):539-60.
2. Finco DR, Brown SA, Crowell WA, Groves CA, Duncan JR, Barsanti JA. Effects of phosphorus/calcium-restricted and phosphorus/calcium-replete 32% protein diets in dogs with chronic renal failure. Am J Vet Res. 1992 Jan;53(1):157-63.
3. Brown SA, Brown CA, Crowell WA, et al. Beneficial effects of chronic administration of dietary ω-3 polyunsaturated fatty acids in dogs with renal insufficiency. J Clin Lab Med. 1998;131:447-455.
4. Grauer GR, Greco DS, Behrend EN, et al. Effects of dietary n-3 fatty acid supplementation versus thromboxane synthetase inhibition on gentamicin- induced nephrotoxicosis in healthy male dogs. Am J Vet Res. 1996;57(6):948- 956.
5. Zhongjie Liu and Jianqin Xu (ed). Traditional Chinese Veterinary Medicine (3rd Edition, In Chinese). Beijing: China Agricultural Press. Beijing, China. 2005.
6. Xie S, Yao Y, Zhu J. Evaluate curative effect of chronic renal failure by
methods of Bushen Jianpi Huoxue Paidu Zhongguo Zhong Yao Za Zhi. 2009 Aug;34(16):2097-100.
7. Liu J, Song KH, You MJ, Son DS, Cho SW, Kim DH. The effect of oculo- acupuncture on recovery from ethylene glycol-induced acute renal injury in dogs. Am J Chin Med. 2007;35(2):241-50.
8. Pugliese A, Gruppillo A, and Di Pietro S. Clinical nutrition in gerontology: chronic renal disorders of the dog and cat. Veterinary Research Communications. 2005;29(Suppl. 2):57-63.
9. Pugliese A, Gruppillo A, and Di Pietro S. Clinical nutrition in gerontology: chronic renal disorders of the dog and cat. Veterinary Research Communications. 2005;29(Suppl. 2):57-63.
10. Brown SA, Brown CA, Crowell WA, et al. Beneficial effects of chronic administration of dietary ω-3 polyunsaturated fatty acids in dogs with renal insufficiency. J Clin Lab Med. 1998;131:447-455.
11. Liu J, Song K-H, You M-J, et al. The effect of oculo-acupuncture on recovery from ethylene glycol-induced actue renal injury in dogs. American Journal of Chinese Medicine. 2007;35(2):241-250.
12. Chen HC. Effects of moxibusting Point Kuan-Yuan on cardiovascular and renal responses to histamine-induced shock. Am J Chin Med. 1987;15(1-2):77-82.
13. Xiaomei Li, Haiyan Wang, Chinese Herbal Medicine in the Treatment of Chronic Kidney Disease, Advances in Chronic Kidney Disease. 2005;12(3):276- 281.
14. Xie Zh-F. The knowledge and treatment of nephritis by traditional Chinese medicine, in Wang H (ed): Nephrology (ed 2). Beijing, China, People’s Health Press, 1995:1675-1688
15. Li L. End-stage renal disease in China. Kidney Int 49:287-301, 1996.
16. Li Z, Qng P, Guo L, et al. Systematic review of rhubarb for chronic renal failure [in Chinese]. Chinese Evidence-Based Medicine 4:468-473, 2004.
17. Kim DD, Sanchez FA, Duran RG, et al. Endothelial nitric oxide synthase is a molecular vascular target for the Chinese herb danshen in hypertension. Am J Physiol Heart Circ Physiol. 2007 May;292(5):H2131-7.
18. Ngai HHY, Sit W-H, and Wan JMF. The nephroprotective effects of the herbal medicine preparation, WH30+, on the chemical-induced acute and chronic renal failure in rats. American Journal of Chinese Medicine. 2005;33(3):491-500.
19. Cheng Q, Yu L, Shi S, et al: Effect of cordyceps sinensis on renal histological changes in 5/6 nephrectomized rat [in Chinese]. Chin J Nephrol 10:30-34, 1994. 20. Dong X, An Z, Yang H, et al: Effect of tetrandrine on extracellular matrix in nephrotic rats [in Chinese]. Chin J Nephrol 16:115-117, 2000.
21. Wang X, Yu R, Guo J, et al: Effect of extract from overground part of Tripterygium wilfordii hook. f. on masugi nephritis in rabbits. China Journal of Chinese Material Medicine 25:231-233, 2000.
Your Singapore, the Tropical Garden City
WSV18-0202
ENDOCRINOLOGY
MONITORING DOGS WITH DIABETES MELLITUS
N. Prakash1
1Mount Pleasant Veterinary Centre, Small Animal Medicine, Singapore, Singapore
MONITORING DOGS WITH DIABETES MELLITUS
Nathalee Prakash BSc BVMS (Hons) FANZCVS (Canine Medicine)
Mount Pleasant Veterinary Centre samedicine@mountpleasant.com.sg Aims of Management
Treatment of diabetes mellitus (DM) involves insulin along with dietary modification. Goals for treatment include eliminating clinical signs by controlling blood glucose levels below the renal threshold for as much of 24-hour period as possible and avoiding clinically significant hypoglycaemia.1 This is facilitated through determination of the optimal insulin type and dose, maintenance
of appropriate body weight and appetite, as well as manage or treatment of comorbidities.
Monitoring Tools
These include performance of blood glucose curves (BGC), monitoring of glucosuria, measuring fructosamine, clinical signs and weight. Results from these modalities may also yield conflicting information.2
i) Clinical signs and weight
An owner log would be useful to keep track of appetite, water consumption and urination habits. Clinical hypoglycemia should also be recorded. A physical examination including measurement of body weight should be performed at each visit.
ii) Urine glucose
Urine glucose measurements can be helpful but remain only an indication of the BG over the time interval
that the bladder was filling and relying solely on urine glucose measurements are not encouraged. Persistence of trends may also be more significant than single measures unless ketonuria is detected.
iii) Glycosylated proteins
Use of glycosylated proteins for monitoring diabetic patients includes serum fructosamine and glycosylated haemoglobin. Fructosamine forms from the Irreversible binding of glucose to serum proteins, mainly albumin. Fructosamine concentrations are proportional to the blood glucose levels as well as affected by the half-
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