Page 5 - Clinical Connections - Spring 2023
P. 5
Emergency Care
HAEMODIALYSIS FOR ANURIC ACUTE
KIDNEY INJURY
Laura Cole, Staff Clinician in Veterinary Emergency and Critical Care, and Stefano Cortellini, Senior
Lecturer in Emergency and Critical Care
Labrador puppy with anuric therapy in humans. The machine allowed at his local vets at seven days and was
acute kidney injury (AKI) with us to perform prolonged intermittent renal found to be euhydrated and non-azotemic.
A fluid overload and hyperkalaemia replacement treatment over four hours and His leptospirosis microagglutination test
secondary to leptospirosis made a complete 30 minutes. confirmed a diagnosis of leptospirosis.
recovery after being treated at RVC Small After the first dialysis cycle, Oscar was
Animal Referrals. brighter, and his creatinine and potassium
Oscar was referred to the Queen Mother were respectively 414 μmol/L (R.I 27-14) and
Hospital for Animals (QMHA) at the age 3.9 mmol/L (R.I 3.6-4.6). A total of 150ml of
of six months for clinical signs compatible fluid was removed from his body. However,
with leptospirosis infection – azotaemia, he remained anuric over the next 36 hours
hepatopathy and thrombocytopaenia. and an additional dialysis cycle, lasting five
Despite supportive care (intravenous fluid hours, was therefore performed to reduce
therapy, anti-nausea medications) and again his rising potassium concentration
initiation of antibiotics, Oscar’s clinical signs and azotemia.
progressed, he became oliguric and was Fortunately, following the second cycle of
referred for more intensive management. dialysis, and within four days of admission,
On presentation Oscar was found to have Oscar converted to a polyuric phase of AKI
clinical signs compatible with fluid overload – producing as high as 16ml/kg/h of urine
– significant weight increase, chemosis and initially. Intravenous fluid therapy was re- Oscar was in hospital for ten days
gelatinous skin. On initial blood tests Oscar’s initiated at a rate to replace the renal loses,
potassium was within the reference interval and adjusted based on his weight, hydration The research study
but he had a severe azotaemia. Abdominal status and point of care blood tests. Oscar One of the Emergency and Critical Care
ultrasound supported a diagnosis of AKI. became hypokalaemic, as expected with specialists, Dr Laura Cole, has a particular
He was given diuretic therapy and a a polyuric patient, and required electrolyte interest in acute kidney injury in dogs and
urinary catheter was placed on admission. supplementation. at the time of Oscar’s visit was recruiting
His urine output was monitored closely over A nasogastric feeding tube was placed for for a study investigating the prevalence of
the subsequent 12 hours. Oscar produced assisted nutrition, and he was continued on chronic kidney disease post-acute kidney
minimal-no urine during that time, and he antibiotics and gastrointestinal medication. injury, using routine biomarkers (creatinine
became hyperkalaemic. In light of those He received anti-hypertensive therapy and SMDA) and direct measurement of
findings – fluid overload, oliguria and severe secondary to being transiently hypertensive glomerular filtration rate using iohexol
life-threatening electrolyte derangements – during hospitalisation. clearance test.
Oscar was a candidate for dialysis. Oscar spent ten days in hospital, during Oscar was enrolled in the study at the point
After placement of a specific dialysis which his creatinine normalised. He was of discharge and was first examined at three
catheter, Oscar immediately underwent discharged once he was eating and able months. He was then re-examined again 12
a dialysis cycle. Dialysis was performed to maintain his body weight. He still had months later for repeat measurements. At
using a Prismaflex machine – a platform an excessive thirst, compatible with the both visits he had initial blood tests and then
designed for continuous renal replacement recovery phase of AKI. Oscar had a recheck was injected with contrast agent iohexol
and had blood sample taken at 2,3,4 hours
post contrast administration. Samples were
submitted and analysed by the laboratory.
Oscar’s GFR has normalised at three
months and by 12 months it had increased
further and was better than average dog of
his weight, indicating by 12 months post-
injury Oscar has made a full renal recovery!
Oscar is one of 15 dogs enrolled in
the study. Enrolment in the study is now
complete and Laura looks forward to sharing
her findings with the veterinary community.
For small animal referrals, please call:
01707 666399
Oscar, who had two cycles of dialysis at RVC Email:
Small Animal Referrals qmhreception@rvc.ac.uk
Spring 2023 5
