The concept of a regulatory link between the gastrointestinal tract and kidneys is not new. The idea that dietary intake and composition can affect renal function is perhaps self-evident, but defining this relationship, especially in terms of sensors and effectors, is proving more difficult. That the gastrointestinal tract can exert some control over renal function was strengthened by the early observation that oral ingestion of a sodium chloride load has a greater natriuretic effect than when the same amount is given intravenously. This effect was subsequently shown to be independent of changes in aldosterone and atrial natriuretic peptide, although not necessarily angiotensin-II. However, the nature of any intestinal natriuretic peptide remains uncertain, despite suggestions that various gut-derived hormones, including guanylin and uroguanylin, may be involved. There is also an emerging concept of gastrointestinal taste and taste-like receptor mechanisms present throughout the gastrointestinal tract, which may govern the excretion of other key electrolytes, including potassium and phosphate. The evidence for gut sensors of nutrients such as proteins, amino acids, glucose, and acid is now becoming more established. Thus, we can anticipate the existence and eventual characterization of several gut ion sensors.

This study is a meta-analysis of the metabolic profile (fasting plasma glucose and serum potassium) of low-dose thiazide and thiazide-like diuretics. The meta-analysis involved 10 randomized controlled clinical trials with a total sample size of 17,636 and 17,947 for the potassium and glucose arms respectively. The random effect model was used to calculate the odds ratio with 95 percent confidence interval. The cumulative mean change of fasting plasma glucose was +0.20 mmol/L (+3.6 mg/dL) for the diuretic arm versus +0.12 mmol/L (+2.2 mg/dL) for the comparator arm. The cumulative mean change of serum potassium was −0.22 mmol/L (−0.22 mEq/L) for the diuretic arm versus +0.05 mmol/L (+0.05 mEq/L) for the comparator arm. The aggregate odds ratio for having higher fasting plasma glucose in subjects on low-dose thiazide versus non-thiazide antihypertensive was 1.22 (1.11 to 1.33; P < .01). The odds ratio for having a lower serum potassium in subjects on low-dose thiazide versus non-thiazide antihypertensive was 0.36 (0.27 to 0.49; P < .01). The magnitude of the observed change in fasting plasma glucose associated with low-dose thiazide diuretic use, while statistically significant, does not appear to place patients at clinically significant risk. On the other hand, the observed change in serum potassium was also statistically significant, and may be clinically significant in patients whose baseline potassium concentration is low or low-normal, and could predispose at-risk patients, such as those with ischemic heart disease, to ventricular arrhythmias.

Oral rehydration therapy (ORT) for acute diarrhoea has advanced in contrary directions in humans and animals; the unresolved question is whether this reflects species differences or a divergence in scientific outlook. This review suggests that the explanation lies in the fact that developments in veterinary ORT have the advantage of utilising more reliable criteria than those available from human patients. The dilemma for human ORT is that the validity of systematic reviews and meta-analyses are undermined when the underlying data only reflect crucial variables indirectly and unreliably. It is therefore possible that the approaches currently used to treat calves, which are radically different from those used by paediatricians, could potentially benefit children and the necessary additional research should be initiated. At a time when the value of animal models of human disease is frequently questioned, the benefits of being able to utilise disease models in the target species for clinical research deserve to be emphasised.

This article summarizes the current state of veterinary education. It describes the needs of the profession, typical program structure, accreditation and licensing requirements, and the professional code of ethics. Within the context of recent recommendations for veterinary education, it describes the impetus for change in educational programs, a typical veterinary curriculum, and instructional approaches. Common themes in veterinary education are identified, including the integration of theoretical with practical knowledge, breadth versus depth, the development of professional expertise, clinical competency, diversity, student debt, and the use of animals in teaching. Future challenges that will affect veterinary colleges are also outlined.