Page 4 - Clinical Connections - Autumn 2024
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RVC RESEARCH STUDY VETERINARY SERVICES RVC.AC.UK
Emergency case
CUTANEOUS AND RENAL GLOMERULAR
VASCULOPATHY CASE
Nadine Jones, Staff Clinician in Emergency and Critical Care, and Tom Greensmith, Senior Lecturer in
Emergency and Critical Care
harlie, a four-year-old retired bound therapeutic plasma exchange, on the
racing greyhound, was referred first and third day of his admission. He was
C for management of suspected also started on pentoxifylline and clopidogrel
cutaneous and renal glomerular in an effort to treat the vasculopathy
vasculopathy (CRGV) last autumn. associated with CRGV.
On presentation, Charlie had severe While the exact cause of CRGV remains
generalised peripheral oedema; his skin unknown, plasma exchange is one of
was erythematous on his entire ventrum, several treatment modalities for some
extending cranially to his neck as well forms of thrombotic microangiopathy in
as involving all four limbs. An ulcerative human patients. One possible mechanism,
skin lesion was present on his dorsal right ADAMTS13 dysregulation, is currently
antebrachium. He was markedly polyuric being researched by clinicians at the
and markedly thrombocytopenic. QMHA. The team is also collaborating in
a multicentre study to assess if plasma
exchange is associated with improved
survival in affected dogs.
Following his second cycle of therapeutic
plasma exchange, Charlie's platelet count Charlie at the point of discharge
normalised and his other signs also began Clinical Connections got in touch with
to improve, with his severe cutaneous owner Anette Gallacher recently to find
erythema resolving within five days of out how Charlie has been getting on since
admission to the RVC. discharge. Anette, who adopted Charlie after
Charlie's wound progressed during he retired from racing, said: 鈥淟ast November
his hospitalisation to span approximately something terrible happened 鈥� Charlie got
75% of his right antebrachium. The team very sick. We were extremely worried but
discussed with Charlie's owners his ongoing the RVC team was very kind and that gave
options: continuing with management of his us hope, despite the severity of Charlie鈥檚
extensive wound or limb amputation. Given condition. He had plasma exchange therapy
that Charlie could ambulate and, out of a twice over three days and the staff worked
desire to salvage the limb, it was decided to incredibly hard to manage Charlie鈥檚 wounds.
proceed with wound management. 鈥淏y mid-January this year, Charlie was
Initially Charlie underwent general back to being his energetic, boisterous
Charlie's leg anaesthesia several times for wet to and enthusiastic self and his appetite had
dry bandage application but due to fully returned. The wound on his leg took
Charlie was hospitalised at the Queen improvements in the appearance of the several months to fully heal and our local
Mother Hospital for Animals (QMHA) for wound, a vacuum dressing was applied vets were also invaluable at managing that.
almost two weeks before returning home while under general anaesthetic six days Our local practice, which managed Charlie鈥檚
and making a good recovery thanks to the after admission. leg wound for many months, with so much
collaboration between the RVC team and Subsequent dressing changes under kindness and care, is Oaks Veterinary
his referring vet practice. sedation were performed and the wound Centre in Birmingham."
As there are no confirmatory tests for continued to heal well. By discharge, there
CRGV, diagnosis was made on the basis was a healthy granulation bed and the edges
of compatible clinical signs and excluding of the wound were starting to epithelialise.
other causes of acute kidney injury and
thrombocytopenia. While skin biopsies can After discharge
be helpful in the diagnosis, they do not The referring vet practice continued the
always confirm the disease, even in animals wound management following discharge,
who have it. changing Charlie鈥檚 bandage regularly. As
Charlie's wound cultures revealed multidrug
Plasma exchange and wound resistant bacteria, the team was advised to Charlie back home
management barrier nurse him and keep him away from
Charlie underwent two cycles of membrane- their other patients.
For small animal referrals, please call:
01707 666399
Email:
qmhreception@rvc.ac.uk
4 Autumn 2024
