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


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