Wednesday, Sep 3, 2014

Visceral and Articular Gout

Index of Bird Diseases ... Symptoms and Potential Causes ... Bird Species and Diseases They are Most Susceptible to


Differences between Visceral Gout and Articular Gout in Birds


Gout: What is it?

Gout or Renal Disorder is the deposition of uric acid crystals (urate deposits) on

body organs (visceral gout)

in joints (articular gout) or

in the ureters (renal constipation).

The causes are high dietary levels of protein, calcium, hypervitaminosis D3, poor kidney response, dehydration, cold weather and other stress factors - which may interfere with the kidney's ability to adequately excrete uric acid.

Calcium, phosphorous, magnesium, sodium and vitamin D3 levels should be reduced in affected birds to avoid kidney mineralisation.

Gout can affect birds in two different ways, the first causing internal swelling and the second causing inflammation in the feet and legs.

Gout is a serious and painful condition that requires veterinary treatment. There are also several homeopathic treatments that might prove useful in managing this disorder.

Potential Causes:

High protein levels are typically associated with visceral gout, but there is no evidence that healthy kidneys will be harmed by excessive dietary protein. However, pet birds are often exposed to a numerous toxins (such as preservatives / chemicals in commercial bird food or drinking water and toxins in the environment - please refer to: Toxins in your Home) as well as pathogens that can cause damage to their pets’ kidneys. At that point dietary protein levels can become a potential hazard.

Treatment Options:

Traditional Treatments include:

  • An ample supply of clean / filtered water
  • Aloe Detox (for example: "Lily of the Desert Aloe Detoxifying Formula" - available over the following websites: http://www.vitacost.com; http://www.amazon.com; http://www.internatural.com/ingr/ingr199340.cfm or at better health food stores) has shown multiple benefits for gout sufferers - one way to get birds to drink it is to drip it on their favorite soft foods. Adding it to their water may stop from them drinking as they may not like the taste. The manufacturer reports that Aloe Detox needs to be refrigerated (obviously). After opening, it will keep for 7 to 9 months.

    Fresh gel from the leaves are superior to Aloe Vera gel bought commercially. Bird owners will cut off a small section each day and feed that section to their pet birds. The plant is easy to grow in most areas. It needs, however, to be grown organically -- without the use of chemical fertilizers, pesticides or herbicides.

    *NOTE: Even though Aloe Vera is helpful for many birds, some rare birds may have a reaction to Aloe Vera. Spray one of your fngers and touch your bird's foot. Leave for 24 hours and see if an reaction occurs


  • Allopathic drugs such as Allupurinol can lower uric acids levels and have been used in birds with varied results.
  • Supportive Nutrition:

    • Provide a diet rich on the organic vegetables, greens, fruits and Vitamin A and low in protein.

    • Nettle Tea increases the excretion of uric acid from the body and many swear by it for treating gouty joints. Nettle will work both as a tea or a tincture. The teas are fine for milder cases, but the tinctures are usually recommended in more severe cases of gout.

    • Devil's Claw is a natural anti inflammatory that also reduces pain. It also facilitates the elimination of uric acid from the body.

    • Bromelain and Quercetin are most effective when used together. Quercetin is an anti inflammatory and may reduce the production of uric acid. It occurs naturally in apples, pink grapefruit, watermelon, elderberries and green leafy vegetables, as well as black tea, green tea and elderberry juice. Bromelain is another anti-inflammatory that is found in pineapple.

    • Please also refer to this information by a list member who resolved gout in her pet bird.

The book "Diseases of Poultry" suggests as follows:

"Birds should be kept under sanitary conditions and given plenty of green food. When several birds develop the disease it is well to give the whole flock Epsom salts (1/2 to 1 teaspoon per bird) and to reduce the amount of meat scrap and increase the quantity of green food." (Important: Discuss with a holistic vet!)

Information on the website of the Tufts University website states as follows:

" Early stages of nutritionally induced gout have been reversed with probenecid (promotes uric acid excretion), and colchicine (anti-inflammatory) for up to 10 weeks, in association with a low protein diet. Treatment of either articular or visceral gout with allopurinol has only been able to partially halt the progression of the disease and does not reverse the condition."

Apple Cider Vinegar: The Cure? Please visit this webpage for info. (Relevant for human gout - but may have some application with pets as well.)



GOUT
A burning issue by
DR. M.M. CHAUDHARI

Technical letter: 10:05


WHAT IS GOUT?

Gout is a metabolic disorder associated with kidney. Visceral form of gout is commonly noticed in broilers resulting economic losses due to mortality and morbidity. In gout, the kidney function is slowed down to a point where uric acid accumulates in blood and body-fluids. Further, it leads accumulation of white uric acid or urate - crystals occurs in soft tissues of various organs in body.


WHAT ARE TYPES OF GOUT AND WHAT HAPPENS?

  1. VISCERAL GOUT: A condition in which white uric acid or uratecrystals deposits are seen in soft tissues of various organs in body.
  2. ARTICULAR GOUT: Conditions in which urate crystals deposit are seen in joints.

Visceral gout:

Many names have been used to describe visceral gout such as acute toxic nephritis, renal gout, kidney stones, nutritional gout, nephrosis and baby chick’s nephropathy is usually characterized by white chalk-like deposits covering on surface of various abdominal organs as well as the heart sac. The kidney’s are swollen and contains urates. The normal blood uric acid level goes up to 44 mg from normal 5.7 mg /100 ml. Similarly urate-crystals are seen within tubules with impaction of urater, urater branches and collecting ducts resulting to damage of primary tubules or to back pressure following obstruction of urater and its branches. The kidney is truly a vital organ. When renal function stops, uric acid normally excreated by the kidney in the urine, is then a deposited any place that blood is circulated. A bird with no renal function will likely to die within 36 hours.

Causes of visceral gout are mostly infectious, nutritional or toxic origin. The kidney damage can arise from infection with certain strains of infectious Bronchitis, Avian Nephritis virus, exposure to some mycotoxin or inadequate water intake. Baby Chick Nephropathy can be due to in appropriate egg storage conditions, excessive water loss during storage, incubation, chick holding or chick transport. Even low humidity during first 3 days of chick life or inadequate water intake during first few days of life can favour the gout condition along with other factors.

Post Mortem lesions: chalky-white uric acid and urate crystal deposits

Post-mortem lesions: Chalky-white uric acid and urate crystal deposits

High calcium diet with low phosphorous results in precipitation of calcium sodiumurate crystals. In addition excessive use of Sodium bicarbonate (baking soda) or excessive Sodium, low vitamin A diet, high protein diet (30%) and water deprivation due to any reason leads to concentration of uric acid and other minerals in the blood and later in the kidney. Hard water with higher metallic salts favors the condition and puts extra load on kidneys.

Mycotoxins, ocharatoxins and oosporin, antibiotics excreting through kidneys like sulpha drugs, Gentamycin and Nitrofurans causes’ renal damage.

Residual toxic effect due to some of the disinfectants like Phenyl, Cresol derivatives causes also been reported.


Articular gout:

This condition is rarely seen and usually a chronic condition. Kidneys are generally normal and may become abnormal with white urate deposits if bird gets dehydrated. Main causes are Genetic, High protein diet etc.

Signs:
1. Depression.
2 .Low feed intake and growth.
3. Dehydration.
4. Ruffled feathers.
5. Moist vent.
6. Post mortem lesions show irregular and enlarged kidneys having crystal chalkywhite urates deposition and all over other organs like Heart, under the skin etc.


HOW TO SOLVE THE PROBLEM:

Prevention and Control or Treatment.

  1. At hatchery level try to minimize dehydration at all stages including chick holding and transport etc. Try to start chick life during day time in cold weather when temperature is ideal.
  2. Make sure that the chicks get free and ample access to drinking water. Maintain water temperature to room temperature. Adjust proper height of drinkers. In case of nipple drinking system use water cups for few days or water fonts. Maintain correct temperature at litter level during arrival of chicks and first 10 days at-least. Try to maintain 60 % plus or 70% humidity during first3 days of chick life. Allow chicks to drink water for 1 or 2 hours and then only offer pre-starter feed.
  3. Ensure correct level of calcium and phosphorous levels in feed. Use toxin binders and liver tonics to keep minimum levels of fungal toxins in feed. Avoid excessive protein levels in diet over suggested.
  4. Use recommended levels of aluminum-free Sodium bicarbonate (baking soda) in feed during high temperatures. Use of Jaggery 2to5 grams per liter. Of water or electrolyte at recommended doses in water.
  5. Review Infectious Bronchitis vaccine programme in Breeders and broiler farms. Even vaccine spray at hatchery level found to be effective in field condition. Even farms having history Gout problem show this problem to some extent to up coming batch also been reported. However more work needs to be done on this matter. Use of antiviral preparations is found helpful to some extent to farmers.
  6. Depending upon the history one can use Ammonium-sulphate 5 gram/kg or Ammonium chloride 10 grams/Kg in feed. Wet dropping may be a side effect of Ammonium chloride usage but it is not true with Ammonium sulphate. Use of Potassium Chloride 0.5 gram to 1 gram per liter water also been used. High level of Methionine in feed also found helpful to some extent. Use of diuretic drug preparations like Lasix, Zyloric also been used. Coconut water is also a good diuretic.
  7. When gout is noticed, reduce the load on kidney by reducing the daily intake of protein either by reducing the quantity of feed or use grinded maize fortified with vitamins and salt at correct level for 24 to 48 hours along with uses of Ammonium sulphate or Ammonium chloride or Potassium chloride at correct levels.
  8. Use of Homeopathic drugs like Barbaris valgaris 200 x is also found helpful in relief during the infection.

OVERVIEW:

Gout is a metabolic disorder associated with kidney. Variety of reasons is associated for above problem resulting economic losses to farmers. Therefore, correct identification of cause is necessary. Prevention and control programme is necessary to reduce the economic losses till the time solution is found. Gout is still a diagnostic challenge for technical peoples even today although the condition has existed for over 30 years. Interaction between farmer, field people, technical people and researchers must continue to solve the problem.

© 2007 - Article and Photos Courtesy of: DR. M.M. CHAUDHARI




Gout and Nutrition

Gout is the most familiar example of an arthritis-related disease linked with diet. When an excess of uric acid remains in the body — because too much is produced or too little is excreted — it can deposit microscopic crystals in the joints. This causes inflammation of the joint lining and considerable pain.

Certain uncooked dried beans contain enzyme inhibitors and are indigestible , and may cause visceral gout in birds. These enzyme inhibitors may prevent or decrease the utilization in the body of substances such as trypsin and chymotrypsin and, therefore, produce nutritional deficiencies. Beans that can interfere with proteolytic enzymes are lima, kidney and soybeans. Cooking the beans for at least 2 hours destroys these enzyme inhibitors. Other dried beans do not appear to contain these enzyme inhibitors, or if present, are in low concentrations. To be on the safe side, it is recommended to cook ALL varieties of beans.

A healthy diet is important. Fortunately, medications to control uric acid levels in the blood are effective.

Cherries are said to be an effective natural cure.

Gout and Other Causes and Sample Protocol:

However, Gout could be caused by anything that interferes with / overloads our kidneys: viruses, bacteria or toxic agents, or nutritional factors could cause visceral gout too, such as too much protein or "hot spots" in formulated diets (chemicals such as ethoxiquin, over-supplementation, under-supplementation, etc.) or metabolic disease. My own pet bird died from that and the first sign that I noticed was loss of appetite. Unfortunately, he was dead within days of us noticing anything, spending his last two days at the vet's. A necropsy was performed, as I wanted to make sure that there was no viral involvement; but the vet did not see any viral lesions and identified metabolic dysfunction; probably linked to his "stargazing condition."

Some people are luckier than I was -- they noticed something was wrong at a time when actions to correct the condition could still be taken.

Here is the post of Pat, who is one of my list members:

"Two years ago, my dusky pi had a severely elevated uric acid level - normal range is 1-10, his was 150-160, which is considered lethal! Fortunately, it appears that I caught it in time - x-rays showed no crystallization of the kidneys. Approached it in two manners. Drastic diet change. Completely changed pellets and feed much fewer, Fed Aloe Detox (one recommended brand is "Lily of the Desert Aloe Detoxifying Formula" available over the following websites: http://www.vitacost.com; http://www.amazon.com; http://www.internatural.com/ingr/ingr199340.cfm), Dandelion greens and black cherries. At the time, black cherries were in season. As an alternative you can buy black cherry juice at a health food store, mix it up with some water and give it instead of water in the drinking bowl. His UA level dropped about fifty points in two weeks, but still not low enough, fast enough, so the vet put him on allopurinol. He was on that for about 6 months. I have blood work done on him twice a year now, and so far, his UA level has remained normal. So, don't give up hope. If caught early enough, it can be reversed. My vet said that although the kidney cells don't actually regenerate, that the remaining cells become larger and are able to do the job.


Differences between Visceral Gout and Articular Gout in Birds

Onset:

  • Visceral gout (Visceral urate deposition): It is usually an acute condition but can be chronic.
  • Articular gout: It is usually a chronic disease.

Frequency:

  • Visceral gout: It is very common.
  • Articular gout: It is rare or sporadic.

Age:

  • Visceral gout: 1 day and above.
  • Articular gout: 4-5 months and above. However, immature genetically susceptible chickens may be induced by high protein levels in the diet.

Sex:

  • Visceral gout: Both males and females are susceptible.
  • Articular gout: Mostly males.

Gross Lesions:

Kidneys

  • Visceral gout: Kidneys are almost always involved and they look grossly abnormal with deposition of white, chalky precipitates.
  • Articular gout: Kidneys are normal grossly. Kidneys may become abnormal with white urate deposits if the bird gets dehydrated.

Soft Tissues

  • Visceral gout: Visceral organs like liver, myocardium, spleen or serosal surfaces like pleura, pericardium, air sacs, mesentery, etc. are commonly involved.
  • Articular gout: Soft tissues other than synovium are rarely involved, however, comb, wattles, and trachea have been observed to be involved.

Joints

  • Visceral gout: Soft tissues around the joints may or may not be involved. Surfaces of muscles, synovial sheaths of tendons and joints are involved in severe cases.
  • Articular gout: Soft tissues around the joints are always involved, especially feet. Other joints of the legs, wing, spine, and beak are also commonly involved.

Microscopic lesions

  • Visceral gout: Generally no inflammatory reaction in synovium or visceral surfaces. Kidney has inflammatory reaction around tophus.
  • Articular gout: Granulomatous inflammation in synovium and other tissues.

Pathogenesis

  • Visceral gout: It is generally due to failure of urate excretion (renal failure).
  • Articular gout: It is probably due to a metabolic defect in the secretion of urates by the kidney tubules.

Causes

  • Visceral gout:
    • Dehydration
    • Nephrotoxicity: calcium, mycotoxins, (ochratoxins, oosporein, aflatoxins, etc.), certain antibiotics, heavy metals (lead), ethylene glycol, ethoxyquin etc.
    • Infectious agents: nephrotropic IBV and avian nephritis virus (chickens), polyomavirus, PMV-1 (pigeons), Salmonella sp., Yersinia sp., Chlamydia psittaci, Eimeria truncata, microsporidia, cryptosporidia, Aspergillus sp., etc.
    • Vitamin A deficiency (please refer to below)
    • Urolithiasis
    • Neoplasia (lymphoma, primary renal tumors)
    • Immune mediated glomerulonephritis
    • Anomalies
    • Others?
  • Articular gout:
    • Genetics
    • High protein in the diet
    • Others?

Ref: Shivaprasad, H. L. An overview of anatomy, physiology and pathology of urinary system in birds, AAV Proceedings, pp. 201-205, 1998




Vitamin A Deficiency:

Vitamin A promotes appetite, digestion, and also increases resistance to infection and to some parasites.

Please refer to "Bird Nutrition" for food items rich in Vitamin A.


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