Innovative VOLUME 13 ISSUE 1
VETERINARY CARE
USING LASER THERAPY FOR URINARY AND RENAL DISEASE PHOTOBIOMODULATION HELPS REDUCE PAIN AND INFLAMMATION IN DOGS AND CATS WITH URINARY AND RENAL DISEASE. — P. 8
ALTERNATIVE APPROACHES TO RENAL DISEASE
ELECTROACUPUNCTURE FOR CHRONIC LAMENESS
www.IV C Journal.com
WINTER 2023
Ozone therapy and acupuncture are just two modalities that help treat kidney failure and related diseases in canine and feline patients. — P. 12
Chronic lameness in dogs and cats can have a range of causes. Find out how electroacupuncture can help get them moving again. — P. 42
FELINE CARDIOMYOPATHY: CREATING A BETTER OUTCOME FOR PATIENTS
WHY HIP DYSPLASIA BENEFITS FROM INTEGRATIVE APPROACH
Though often seen as hopeless, cats can respond to treatments such as nutritional therapy, herbs, and more. — P. 32
A TREATMENT PLAN FOR FLUTD, USING ESSENTIAL OILS When used safely, pure essential oils are a valuable treatment modality for lower urinary tract disease in cats. — P. 15
An integrative multimodal approach can help manage canine hip dysplasia and the osteoarthritis often arising from it. — P. 38
SUPPLEMENTS THAT SUPPORT DOGS AND CATS WITH CKD
A comprehensive look at the many supplements that can help address chronic kidney disease in dogs and cats. —P. 20
contents FEATURES
THERAPY FOR LOWER 8 LASER URINARY TRACT AND RENAL DISEASE IN PETS
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By Lisa A. Miller, DVM, CCRT
By Christ Bessent, DVM, MSOM, DIPL. OM, L.AC
How dogs and cats with urinary and renal disease can benefit from the pain-relieving and inflammation-reducing effects of photobiomodulation or laser therapy.
8
12
ALTERNATIVE APPROACHES TO RENAL DISEASES IN VETERINARY PATIENTS
The primary approach to CKD in cats is dietary management to lessen the abnormalities caused by marginal kidney function, and extend the lifespan of felines with this disease.
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By Margo Roman, DVM, CVA, COT, CPT
20
ESSENTIAL OILS FOR FLUTD By Jared Mitchell, DVM, CVMA, CVA, CVFT
By Nancy Scanlan, DVM, MS, CVA
27
A comprehensive look at the supplements that can help address chronic kidney disease in dogs and cats.
38 32 4
Heart disease in cats is often seen as hopeless, but alternative treatments such as nutritional therapy, herbs, and even medicinal leeches may offer some promise.
38
When used safely, pure essential oils are a valuable treatment modality for lower urinary tract disease in cats.
OF SUPPLEMENTS FOR 20 APETSSURVEY WITH CKD
IVC Winter 2023
FELINE CARDIOMYOPATHY & THROMBOEMBOLISM — ALTERNATIVE TREATMENTS CAN HELP By Jodie Gruenstern, DVM, CVA
Treatment for kidney failure and other renal diseases in dogs and cats can be supported by a range of alternative modalities, including ozone therapy, acupuncture, and more.
15
NUTRITIONAL MANAGEMENT OF CHRONIC KIDNEY DISEASE IN FELINES
INTEGRATIVE APPROACH TO CANINE HIP DYSPLASIA By Angie Krause, DVM, CVA, CCRT From physical therapy to acupuncture, an integrative multimodal approach is an effective way to manage canine hip dysplasia and the osteoarthritis that often arises from it.
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THE USE OF ELECTROACUPUNCTURE FOR CHRONIC LAMENESS IN SMALL ANIMALS By Cristina Firulete, DVM, CVA Chronic lameness in dogs and cats can have many causes, including osteoarthritis, hip dysplasia and more. Electroacupuncture can be an effective way to help treat the problem.
COLUMNS & DEPARTMENTS
advisoryboard
7 Editorial 19 From the AVH 25 From the VMAA 31 From the AATCVM & WATCVM 41 From the AHVMA 47 Industry innovations
Dr. Richard Palmquist, DVM GDipVCHM(CIVT) CVCHM (IVAS), graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, former president and research chair of the AHVMA, and an international speaker in integrative veterinary medicine. Dr. Palmquist is a consultant for the Veterinary Information Network (VIN) and a past president of the AHVM Foundation. He has published two books, one for conventional veterinarians and a second for clients discussing how integrative thinking works.
Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs. She is coowner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.
49 From the VBMA PROFITABLE PRACTICE
48 Profitable practice — Visbiome Vet IN THE NEWS
37 The carbon footprint of veterinary
practices — easy-to-use calculator measures
50 Big data tech being explored to
improve veterinary medicine
Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. Her practice is 100% holistic, using acupuncture, chiropractic, herbal medicine and homeopathy to treat horses to enhance performance and those with a variety of chronic conditions, with an emphasis on Lyme Disease. Her publications include the Pain Free Back and Saddle Fit Books, and numerous articles in lay and professional magazines. She maintains an informative website: www.harmanyequine.com. Dr. Steve Marsden, DVM, ND, MSOM, Lac. Dipl.CH, CVA, AHG lectures for IVAS, the AHVMA, the AVMA, and numerous other organizations. He is co-founder of the College of Integrative Veterinary Therapies and is a director emeritus of the National University of Natural Medicine in Portland OR. He authored the Manual of Natural Veterinary Medicine (Mosby); and Essential Guide to Chinese Herbal Formulas (CIVT). Dr. Marsden is extensively trained in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has holistic veterinary and naturopathic medical practices in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA; and Small Animal Veterinarian of the year by the CVMA in 2009. Dr. Jean Dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.
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Dr. Barbara Fougere, DVM, CVAA graduated in 1986, and was named the American Holistic Veterinary Medical Association Educator for 2011. Dr. Fougere is the principal and one of the founders of the College of Integrative Veterinary Therapies. She has continued studying over the last 26 years, and has three Bachelor degrees, two Masters degrees, three post Graduate Diplomas, several Certifications and numerous other courses under her belt.
Dr. Christina Chambreau, DVM, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program and is the former Associate Editor of IVC Journal. Dr. Chambreau teaches classes in homeopathy for animals, lectures on many topics, speaks on Radio and TV, and is the author of the Healthy Animal’s Journal among other titles. She is now on the faculty of the Holistic Actions Academy, which empowers members to keep their animals healthy with weekly live webinars.
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A comprehensive look at the supplements that can help address chronic kidney disease in dogs and cats.
A SURVEY OF SUPPLEMENTS FOR PETS WITH CKD BY NANCY SCANLAN, DVM, MS, CVA
Kidney disease is a common condition in dogs and cats, especially as they get older. Controlling the inflammatory reactions and oxidative stress that contribute to chronic kidney disease can be done with the help of a variety of supplements. This article discusses the pathology of CKD (see sidebar on page 22), and how supplements, including antioxidants, can address the inflammatory factors associated with this prevalent disease.
THE DIFFERENCE BETWEEN DRUGS AND SUPPLEMENTS Drugs with antioxidant effects, developed to try to deal with many of these problems, have “minor” side effects — such as the muscle spasms, nausea, and cardiotoxicity seen with bardoxolone use — restricting their status to investigational drugs only.6 In contrast, most nutraceuticals have few to no side effects, although some must be used in a narrow dose spectrum so enough is administered to be beneficial without the effects of overdose.7 Nutritional supplements can help address all the factors mentioned above, and increase the longevity of pets with CKD. Antioxidants are the primary way that oxidative stress can be combated naturally. Most kidney supplements have at least some antioxidant effects. When individual supplements are used one at a time, the evidence for their benefits can be slight or even conflicting. When looking at complete diets, or combinations of nutrients
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as nutritional interventions in healthy aging trials, additive or multiplicative effects are striking for both humans and animals.8,9,10 Commercial products for kidney support recognize this, and the best recommendations for pet owners would be to follow that tendency.
NUTRITIONAL KIDNEY SUPPLEMENTS ANTIOXIDANTS Reviews of research using a single antioxidant at a time often show mixed or no effects, and doses that are too low. The strongest research support comes from studies that showed the effects of two or more antioxidants used together. Some natural substances, such as vitamins C and E, CoQ10 and N-acetyl-cysteine, already exist in the body as part of the inflammation-limiting effect. In CKD patients, however, they tend to be depleted. Supplementation can help by restoring these antioxidants to a level that can once again fight inflammation from the disease.11
VITAMIN E A human study showed that vitamin E alleviates renal injury by mediating the inactivation of nitric oxide (NO), but that it has no effect on hypertension.12 Other studies showed a cardioprotective effect as CKD advanced.13,14 A study of vitamin E
supplementation in cats showed no difference in oxidative stress.15 In this author’s opinion, however, the dose used was too low, and no vitamin C was administered as a cofactor. So it is possible that the end result was an increase in the pro-oxidant form of vitamin E, which cannot act to reduce oxidative stress.
VITAMIN C In un-supplemented human CKD patients, renal dysfunction is associated with decreased plasma vitamin C levels, which may cause endothelial dysfunction via an increase in oxidative stress.16 In humans with CKD, the administration of vitamin C may prevent progression to end stage kidney disease (requiring dialysis and/or a kidney transplant).17 The majority of studies investigating antioxidant treatments in CKD patients show a reduction in oxidative stress, and many show improved renal function.11,18 It is possible that vitamin C levels could also be depleted in canine and feline patients. Vitamin C’s beneficial effects in human studies suggest that animals could benefit from its use as well, especially if vitamin E is part of the treatment. A study involving the use of vitamin E in combination with vitamin C and beta carotene showed significantly reduced DNA damage in cats with renal insufficiency.3 Another study using fish oil, antioxidants (lipoic acid, vitamins C and E), L-carnitine, and botanicals (fruits and vegetables) for six months showed no progression of CKD versus controls.10
VITAMIN A (NOT BETA CAROTENE) All-Trans Retinoic Acid (ATRA), a metabolite of retinol, is required for the production of erythropoietin by both the kidneys and liver. As CKD advances, urinary retinol excretion increases and the body’s supply of retinol decreases. Eventually, erythropoietin production is affected.19 In mice, renal-associated anemia has been reversed by vitamin A. In humans, clinical improvement has been seen in CKD patients treated with retinoids.20 This approach holds promise as a way to maintain the body’s ability to produce erythropoietin in the face of CKD, but research is needed to establish safe doses without causing toxicity.
THIAMIN (B-1) In humans, functional thiamin deficiency is common in patients with Type II diabetes. Normal top high plasma levels of thiamine are usually found, but are negated by the anti-metabolite oxythiamine. This contributes to microvascular endothelial dysfunction, a part of CKD. Daily thiamin supplements are often recommended for humans on dialysis, and this should be considered for CKD patients being treated with fluid therapy.1
VITAMIN D
(IN THE FORM OF CALCITRIOL)
Calcitriol is the final form of vitamin D used in the body, and is converted from vitamin D by 1-alpha-hydroxylase. Activity of this enzyme is reduced in CKD, so calcitriol is preferred over vitamin D supplementation. The goal of using calcitriol along with phosphorus binders is to restore, as much as possible, the normal balance between calcium and phosphorus in the body. Calcitriol’s primary use is to control renal secondary hyperparathyroidism. It slows both the loss of podocytes and the progression of fibrosis in the kidney, resulting in increased appetite and longer survival times. Calcitriol should be monitored to prevent hypercalcemia, the primary problem seen with vitamin D toxicity.21
PHOSPHORUS BINDERS Calcium carbonate is an inexpensive, over-the-counter agent that is widely used as a phosphorus binder. It also has the benefit of being an antacid, which helps address the problem of metabolic acidosis. Calcium acetate costs a little more but binds twice as much phosphorus per dose. 22 Chitosan is another phosphorus binder that boosts the effect of calcium compounds. At least one supplement on the market combines chitosan and calcium carbonate, and is palatable for cats. This combination has been shown to significantly decrease plasma phosphorus levels and the urinary excretion of phosphorus.23
A LIST OF KIDNEY SUPPLEMENTS •
Fat-soluble vitamins A, C, D, E
•
Water-soluble vitamin B1 (Thiamin)
•
The minerals calcium acetate, and selenium
•
CoQ10
•
L-carnitine
•
Omega-3 fatty acids
•
Curcumin
•
Sulforaphane
•
Quercetin
•
Resveratrol
•
EGCG
•
Ursolic acid
•
Prebiotics and probiotics
•
Chitosan
carbonate,
calcium
IVC Winter 2023
21
Chitosan also adsorbs uremic products and lowers BUN and creatinine levels in humans with CKD.23
OMEGA-3 FATTY ACIDS “Adequate” (according to the NRC) levels of Omega-3 fatty acids can decrease proteinuria, kidney fibrosis, tissue calcification, inflammatory cytokines and inflammation in dogs and cats.4,25,26 “Higher than adequate” levels (more than twice the NRC “safe” limit) can also protect against malnutrition-inflammation syndrome in cats with CKD.27 Prolonged coagulation time has been reported as a side effect, but primarily at doses higher than the “higher than adequate dose,” so it may be worth trying this dose level in uremic cats who are losing weight. Nausea is a side effect, so it is advisable to start with a low dose and work up to whatever may be tolerated by the cat.
CURCUMIN Curcumin acts as an antioxidant by reacting directly with free radicals such as superoxide and NO, due to the presence of phenolic groups in its chemical structure.28, 29 Curcumin protects against kidney fibrosis by downregulating factors, including profibrotic cytokines, vascular endothelial growth factor (VEGF), TGF-β, and connective tissue growth factor (CTGF), among others, and decreasing extracellular matrix proteins such as fibronectin.30 Curcumin also upregulates enzymes and cytoprotective and antioxidant proteins such as superoxide dismutase, due to its ability to upregulate enzymes and cytoprotective and antioxidant proteins such as SOD.31,32,33
SULFORAPHANE Nuclear factor erythroid 2 (Nrf-2) is a transcription factor that activates genes containing a DNA sequence known as the antioxidant response element (ARE). AREs are present in the promoter regions of genes, which promote the production of natural antioxidants such as SOD. When active, genes containing AREs promote increased levels of natural antioxidants. These genes stimulate the production of antioxidant proteins, phase I oxidation, reduction, and hydrolysis genes, phase II detoxifying enzymes such as glutathione s-transferases (GSTs), NADPH-generating enzymes, drug transporters, and stress proteins involved in heme and metal metabolism, such as heme oxygenase 1 (HO-1). In a normal body, a protein (Kelch-like ECH-associated protein 1 known as KEAP 1) keeps Nrf-2 production at low levels as part of the homeostatic pro-oxidant-antioxidant balance. In CKD, there’s a decrease in natural antioxidants but no decrease in KEAP 1 and no increased ARE activity. Sulforaphane, an isothiocyanate found in cruciferous plants, has a potent Nrf-2 activating effect, which helps restore the body’s own normal levels of antioxidants.34
COQ10 The features of mitochondrial dysfunction seen in CKD include changes in mitochondrial morphology, increased oxidative stress, and significant decrease in ATP production and mitochondrial biogenesis. Mitochondria constantly change their shape and size through fission and fusion processes. Normal shapes range from spherical to hyperfused
THE PATHOLOGY OF CKD For decades, chronic kidney disease (CKD) in humans has been linked to hypertension, diabetes, and advanced age. But the current emphasis on the need to control inflammation and oxidative stress has gained traction in the last ten years. In CKD, pro-inflammatory reactions, needed to fight infection, and anti-inflammatory reactions, needed to limit the celldamaging effects of prolonged inflammation, are out of balance. Oxidative stress and inflammation are hallmarks of kidney disease, and the increasing severity of CKD is marked by increasing levels of pro-inflammatory markers in humans as well as dogs and cats.1,2,3,4 Chronic inflammation leads to the overproduction of inflammatory cytokines, impaired antioxidative systems, and kidney fibrosis. Telomeres are
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shorter in cats with CKD, leading to premature senescence that contributes to kidney fibrosis.5 Accumulating metabolic end-products act as uremic toxins, leading to complications such as high (or higher) blood pressure, metabolic acidosis, altered immune response, and calcium-phosphorus imbalance leading to mineral/ bone disturbances. Dysbiosis and altered adipose tissue metabolism eventually come into play. Inflammatory cytokines Interleukin-1 and -6, associated with anorexia, and increased levels of the inflammatory markers C-reactive protein, Interleukin-1, and Tumor Necrosis Factor alpha, are associated with the severity of CKD and are predictive of mortality.1,6
reticular networks. Normally, there is a balance between fission and fusion, depending on metabolic and signaling cues in the cell.35 Excessive fission activity and increased mitochondrial fragmentation have been seen with increased ROS in CKD.36 This leads to mitochondrial dysfunction and can result in cell death.37 Kidneys have the highest levels of CoQ9 and CoQ10 as compared to all other organs in the body. CoQ10 is required for normal health and functioning of the mitochondria, and is directly involved in ATP generation. It also acts as an antioxidant in preventing lipid peroxidation, and interacts with alpha-tocopherol. CoQ10 supplementation is needed in CKD to ensure mitochondrial health.11
SELENIUM Selenium is involved with selenoproteins, most importantly (for CKD) glutathione peroxidase and phospholipid hydroperoxide glutathione peroxidase (PLGSH-Px), which play an important part in ROS metabolism and prolonged telomere length.38 They inhibit ferroptosis, a non-apoptotic form of cell death seen in cancer, hippocampal, and renal cells.39 They also prevent lipid peroxidation, as long as a normal amount of vitamin E is present in the membranes, and decrease the total amount of vitamin E necessary for this purpose.40 Homemade diets may be deficient in selenium, but care must be taken when adding it since an excess amount is toxic.
PREBIOTICS AND PROBIOTICS Animals with CKD have an imbalance of bacteria in the microbiome: an increase in bacteria such as Clostridium and Bacteroides and a decrease in Lactobacilli and Bifidobacteria.41 Administration of Lactobacillus acidophilus improves this balance and limits adhesions of pathogens, strengthening the gut barrier.42 Probiotics also reduce blood urea and serum phosphate concentration. Adding prebiotics such as psyllium to probiotics increases the numbers of Bifidobacteria and Lactobacillus, decreases formation of the uremic toxin p-cresol and its plasma levels, decreases blood urea nitrogen, and reduces inflammation and oxidative stress.43 In addition, studies indicate that a diet supplemented with specific antioxidants (e.g. European olea, vitamin E, IVC Winter 2023
23
carotenoids, polyphenols, and flavonoids) is important for limiting renal oxidative stress and the progression of CKD.2
L CARNITINE L carnitine is associated with improved nitrogen balance, inhibits apoptosis, and has anti-inflammatory and antioxidant effects. Dietary supplementation with L-carnitine is associated with improved nitrogen balance, the inhibition of apoptosis, and improved mitochondrial function. It is needed to transport long-chain FA from the cytosol to sites of FA β-oxidation in the mitochondria.10
QUERCETIN Quercetin is a flavonoid with antioxidant and anti-inflammatory properties. It can reduce levels of inorganic phosphate, blood urea nitrogen and creatinine, and increase total antioxidant activity. In one study, rats with CKD were treated with quercetin and showed fewer histopathic renal abnormalities, including fewer signs of chronic interstitial inflammation.1
RESVERATROL Resveratrol is a polyphenol that is safe to administer to dogs, and has immunomodulating, anti-inflammatory, antioxidant, and vaso-protective properties. It enhances the production of antioxidant enzymes44 and inhibits oxidative stress and renal interstitial fibrosis.45 It also decreases muscle atrophy from CKD.46
URSOLIC ACID
EGCG Present in green tea, EGCG neutralizes free radicals, acts as a ROS scavenger, and chelates metal ions. It inhibits oxidative stress in the kidney and decreases the levels of uremic toxins such as methylguanidine, slowing the progression of kidney disease.49
Rapa SF, Di Iorio BR, Campiglia P, Heidland A, Marzocco S. Inflammation and Oxidative Stress in Chronic Kidney Disease-Potential Therapeutic Role of Minerals, Vitamins and Plant-Derived Metabolites. Int J Mol Sci. 2019 Dec 30;21(1):263.
1
Halfen DP, Caragelasco DS, Nogueira JPS, Jeremias JT, Pedrinelli V, Oba PM, Ruberti B, Pontieri CFF, Kogika MM, Brunetto MA. Evaluation of Electrolyte Concentration and Pro-Inflammatory and Oxidative Status in Dogs with Advanced Chronic Kidney Disease under Dietary Treatment. Toxins (Basel). 2019 Dec 19;12(1):3.
2
Y u S, Paetau-Robinson I. Dietary supplements of vitamins E and C and beta-carotene reduce oxidative stress in cats with renal insufficiency. Vet Res Commun. 2006 May;30(4):403-13.
3
Brown SA, Brown CA, Crowell WA, et al. Beneficial effects of chronic administration of dietary omega-3 polyunsaturated fatty acids in dogs with renal insufficiency. J Lab Clin Med. 1998;131:447–455.
4
Quimby J, Erickson A, Mcleland S, Cianciolo R, Maranon D, Lunn K, Elliott J, Lawson J, Hess A, Paschall R, Bailey S. Renal Senescence, Telomere Shortening and Nitrosative Stress in Feline Chronic Kidney Disease. Vet Sci. 2021 Dec 8;8(12):314.
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Rayego-Mateos S, Valdivielso JM. New therapeutic targets in chronic kidney disease progression and renal fibrosis. Expert Opin Ther Targets. 2020 Jul;24(7):655-670.
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Padayatty SJ, Levine M. Vitamin C: the known and the unknown and Goldilocks. Oral Dis. 2016 Sep;22(6):46393.
7
Lin JL, Fung TT, Hu FB, Curhan GC. Association of dietary patterns with albuminuria and kidney function decline in older white women: A subgroup analysis from the Nurses' Health Study. Am J Kidney Dis. 2011;57(2):245– 54. 10.1053
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(3)Hall JA, MacLeay J, Yerramilli M, Obare E, Yerramilli M, Schiefelbein H, Paetau-Robinson I, Jewell DE. Positive Impact of Nutritional Interventions on Serum Symmetric Dimethylarginine and Creatinine Concentrations in Client-Owned Geriatric Dogs. PLoS One. 2016 Ap
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(4) Hall JA, Jewell DE. Feeding healthy beagles medium-chain triglycerides, fish oil, and carnitine offsets agerelated changes in serum fatty acids and carnitine metabolites. PLoS One. 2012;7(11):e49510
10
Small DM, Coombes JS, Bennett N, Johnson DW, Gobe GC. Oxidative stress, antioxidant therapies and chronic kidney disease. Nephrology (Carlton). 2012 May;17(4):311-21.
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Tamay-Cach F, Quintana-Pérez JC, Trujillo-Ferrara JG, Cuevas-Hernández RI, Del Valle-Mondragón L, GarcíaTrejo EM, Arellano-Mendoza MG. A review of the impact of oxidative stress and some antioxidant therapies on renal damage. Ren Fail. 2016;38(2):171-5.
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Boaz M, Smetana S, Weinstein T, Matas Z, Gafter U, Iaina A, Knecht A, Weissgarten Y, Brunner D, Fainaru M, Green MS. Secondary prevention with antioxidants of cardiovascular disease in end stage renal disease (SPACE): randomized placebo-controlled trial. Lancet. 2000 Oct 7;356(9237):1213-8.
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This supplement is widely found in fruit peels, and in herbs such as rosemary and thyme. It is anti-inflammatory and protects against CKD and renal fibrosis. It inhibits proinflammatory cytokines in muscles, which slows the decline of muscle mass associated with the progressive loss of protein in CKD.47 Interestingly, ursolic acid has been shown to directly inhibit the expression of pro-inflammatory cytokines in the muscles of mice with CKD.48
Meagher EA. Treatment of atherosclerosis in the new millennium: is there a role for vitamin E? Prev Cardiol. 2003 Spring;6(2):85-90.
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Timmons RM, Webb CB. Vitamin E supplementation fails to impact measures of oxidative stress or the anemia of feline chronic kidney disease: a randomized, double-blinded placebo control study. Vet Med Sci. 2016 Jan 22;2(2):117-124.
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Takahashi, N.; Morimoto, S.; Okigaki, M.; Seo, M.; Someya, K.; Morita, T.; Matsubara, H.; Sugiura, T.; Iwasaka, T. Decreased plasma level of vitamin C in chronic kidney disease: Comparison between diabetic and non-diabetic patients. Nephrol. Dial. Transpl. 2011, 26, 1252–1257
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Jun M, Venkataraman V, Razavian M, Cooper B, Zoungas S, Ninomiya T, Webster AC, Perkovic V. Antioxidants for chronic kidney disease. Cochrane Database Syst Rev. 2012 Oct 17;10(10):CD008176.
17
S ung CC, Hsu YC, Chen CC, Lin YF, Wu CC. Oxidative stress and nucleic acid oxidation in patients with chronic kidney disease. Oxid Med Cell Longev. 2013;2013:301982
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Rojo-Trejo MH, Robles-Osorio ML, Sabath E. Liposoluble vitamins A and E in kidney disease. World J Nephrol. 2022 May 25;11(3):96-104.
19
Kinoshita K, Kishimoto K, Shimazu H, Nozaki Y, Sugiyama M, Ikoma S, Funauchi M. Successful treatment with retinoids in patients with lupus nephritis. Am J Kidney Dis. 2010;55:344–347
20
Corbee R. J. Vitamin D in Health and Disease in Dogs and Cats Advances in Small Animal Care 1 (2020) 265–277
21
Emmett, M. A Comparison of Calcium-Based Phosphorus Binders for Patients with Chronic Kidney Disease Dialysis & Transplantation May 2006
22
Wagner E, Schwendenwein I, Zentek J. Effects of a dietary chitosan and calcium supplement on Ca and P metabolism in cats. Berl Munch Tierarztl Wochenschr. 2004 Jul-Aug;117(7-8):310-5. PMID: 15298059.
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Jing SB, Li L, Ji D, Takiguchi Y, Yamaguchi T. Effect of chitosan on renal function in patients with chronic renal failure. J Pharm Pharmacol. 1997 Jul;49(7):721-3.
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From the VMAA
Roudebush P, Polzin DJ, Adams LG, Towell TL, Forrester SD. An evidence-based review of therapies for canine chronic kidney disease. J Small Anim Pract 2010; 51(5): 244–52.
25
Maniaki E, Finch N Chronic Kidney Disease in cats and Dogs, managing proteinuria In Practice London Vol. 40, Iss. 7, (Sep 2018): 266.
26
Harris M, Lunn K, Quimby J, etal Omega 3 fatty acids mitigate inflammation in felines with chronic kidney disease FASEB April 2012 Vol 26 Iss 51
27
Pan, Y.; Zhu, G.; Wang, Y.; Cai, L.; Cai, Y.; Hu, J.; Li, Y.; Yan, Y.; Wang, Z.; Li, X.; et al. Inhibition of high glucoseinduced inflammatory response and macrophage infiltration by a novel curcumin derivative prevents renal injury in diabetic rats. Br. J. Pharm. 2012, 166, 1169–1182
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Barzegar, A.; Moosavi-Movahedi, A.A. Intracellular ROS protection efficiency and free radical-scavenging activity of curcumin. PLoS ONE 2011, 6, e26012.
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Soetikno, V.; Watanabe, K.; Sari, F.R.; Harima, M.; Thandavarayan, R.A.; Veeraveedu, P.T.; Arozal, W.; Sukumaran, V.; Lakshmanan, A.P.; Arumugam, S.; et al. Curcumin attenuates diabetic nephropathy by inhibiting PKC-α and PKC-β1 activity in streptozotocin-induced type I diabetic rats. Mol. Nutr. Food Res. 2011, 55, 1655–1665.
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Leong, G.S.; Oh, G.S.; Pae, H.O.; Jeong, S.O.; Kim, Y.C.; Shin, M.K.; Seo, B.Y.; Han, S.Y.; Lee, H.S.; Jeong, J.G.; et al. Comparative effects of curcuminoids on endothelial heme oxygenase-1 expression: Orthomethoxy groups are essential to enhance heme oxygenase activity and protection. Exp. Mol. Med. 2006, 38, 393–400
The Veterinary Medical Aromatherapy® Association (VMAA) is an organization of veterinarians and veterinary technicians dedicated to the responsible use of aromatherapy in animal practices. Their mission is to promote standards of excellence in animal aromatherapy, to provide outreach and education to veterinarians and auxiliary animal practices, and to promote continual improvements in Veterinary Medical Aromatherapy®. The VMAA is elevating the veterinary profession through innovation, education, and advocacy of integrative medicine.
ESSENTIAL OILS FOR THE PET’S URINARY SYSTEM
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Ye, S.F.; Hou, Z.Q.; Zhong, L.M.; Zhang, Q.Q. Effect of curcumin on the induction of glutathione S-transferases and NADP(H): Quinone oxidoreductase and its possible mechanism of action. Yao Xue Xue Bao 2007, 42, 376–380.
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Rushworth, S.A.; Ogborne, R.M.; Charalambos, C.A.; O’Connell, M.A. Role of protein kinase C delta in curcumin-induced antioxidant response element-mediated gene expression in human monocytes. Biochem. Biophys. Res. Commun. 2006, 341, 1007–1016.
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Liebman SE, Le TH. Eat Your Broccoli: Oxidative Stress, NRF2, and Sulforaphane in Chronic Kidney Disease. Nutrients. 2021 Jan 18;13(1):266.
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Essential oils have adaptogenic properties that make them useful in veterinary medicine. One oil may be used for different diagnosed conditions while several oils may be appropriate for the same condition. Chronic kidney disease (CKD) is a challenge in older pets. Along with dietary considerations and medication options, essential oils may be useful when combined with acupuncture/acupressure points. These three essential oils can be beneficial for kidney/bladder issues: 1.
Lemongrass (Cymbopogon flexuosus) has been studied for its antibacterial, anti-inflammatory and pain-relieving effects. In vitro research demonstrated inhibition of several urinary tract pathogens, including E. coli.* Another study suggested that lemongrass prevents edema* — a concern in animals with CKD. Dilution is recommended for topical use.
2.
Geranium (Pelargonium graveolens) is another essential oil with research on its antioxidant, anti-inflammatory and antibacterial actions. In vitro studies show inhibition for some of the same urinary tract pathogens as lemongrass. Geranium improved the effectiveness of ciprofloxacin in treating UTIs.* Citronellol, a primary constituent of this oil, has been studied for its effects on lowering blood pressure by increasing vasodilation.*
3.
Juniper ( Juniperus osteosperma) essential oil has been traditionally used to support urinary tract health. It’s considered to be a diuretic and can reduce fluid retention in the body. Antioxidant and antibacterial actions similar to lemongrass and geranium make this essential oil another good choice.*
Mishra P, Chan DC. Mitochondrial dynamics and inheritance during cell division, development and disease. Nat Rev Mol Cell Biol. 2014; 15:634–646.
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Topical application of these oils (singly or in a layering fashion) several times daily at BL23 (an easy point to teach owners) can be incorporated into existing protocols for CKD and UTI patients.
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Submitted by Susan Albright, DVM IVC Winter 2023
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