Use of Renal Replacement Therapy in a Neonatal Foal with Postresuscitation Acute Renal Failure

A newborn foal was presented because it was unresponsive and in cardiopulmonary arrest. Aggressive cardiopulmonary cerebral resuscitation was administered to the foal, which revived the foal; however, acute renal failure developed. Fluid retention and azotemia occurred although the foal was alert and able to suckle. A 6‐hour renal replacement therapy session using hemodiafiltration and a continuous renal replacement therapy machine was administered to the foal at 3 days of age which lowered the foal's azotemia and facilitated removal of some of the excess body fluid. Despite therapy, the foal developed pulmonary edema and was euthanized. Although the foal in this case did not survive, this report highlights the possibility of developing postresuscitation complications such as acute renal failure and describes the use of renal replacement therapy using hemodiafiltration as a viable option in neonatal foals with acute kidney injury.     

Use of Tissue Plasminogen Activator in Catheters Used for Extracorporeal Renal Replacement Therapy

Background

Intraluminal thrombosis of central venous catheters used for renal replacement therapy (RRT) decreases the ability to provide adequate treatment. Alteplase is a recombinant tissue plasminogen activator that has been used to improve the function of catheters used for RRT in humans.

Objectives

To retrospectively review alteplase instillation in dysfunctional catheters used for RRT in dogs and cats.

Animals

Seventeen dogs and 8 cats receiving RRT for kidney failure.

Methods

Medical records of patients in which alteplase was used for RRT catheter dysfunction from 2004 to 2012 were retrospectively reviewed to characterize reasons for use, improvement in function, increase in blood flow, and duration of improvement.

Results

Alteplase was instilled 43 times in 29 catheters, most commonly because of suspicion that the catheter would not provide sufficient flow on the next treatment (n = 21). The second most common reason was inability to start a dialysis treatment (n = 12). Catheter function improved after alteplase instillation in 34 of 43 treatments (79%). Median blood flow rate increased by 13% (18 mL/min) in the dialysis session after alteplase instillation. Seven of 29 catheters (24%) were treated with alteplase on >1 occasion (median time to second treatment, 8 days), and 1 catheter had to be replaced because of intractable dysfunction.

Conclusions and Clinical Importance

Alteplase is effective at improving function of central venous catheters used to provide RRT, but the results are short‐lived.     

Renal Replacement Therapy in Healthy Adult Horses

Background

Renal replacement therapy (RRT) has been implemented extensively in people to facilitate recovery from acute renal failure (ARF). RRT has not been explored in horses, but might provide a further treatment option in horses with ARF.

Objective

To investigate efficacy and safety of RRT in horses.

Animals

Five healthy adult horses.

Methods

A prospective study was performed on horses restrained in stocks and intravenously connected to a commercial RRT machine to allow continuous venovenous hemodiafiltration to be performed for 6 hours. The RRT machine was set at the following flow rates: blood flow rate 250 mL/min; dialysate rate 3,000 mL/h; prefilter replacement pump 3,000 mL/h; and postfilter replacement pump rate 2,000 mL/h. Balanced electrolyte solution was used as dialysate and replacement fluid. Heart rate, respiratory rate, body temperature, direct arterial blood pressure, urine output, and various clinicopathologic parameters were measured over the study period.

Results

Renal replacement therapy was successfully performed in horses, resulting in a mean creatinine clearance of 0.127 mL/kg/min (68.9 mL/min) and urea reduction ratio of 24%. No adverse effects were detected although a significant decrease in rectal temperature was observed (P ≤ .007). A significant increase in serum phosphorus (P ≤ .001) and decrease in BUN (P < .001) were also noted. A significant prolongation of prothrombin (P < .01) and partial thromboplastin time (P < .0001) were observed along with a decrease in platelet count (P ≤ .04).

Conclusions and Clinical Importance

Renal replacement therapy can safely and effectively be used in adult horses.     

去卵巢及雌激素替代治疗后家兔海马nNOS阳性神经元的形态结构及分布变化

用SABC免疫组织化学技术,观察家兔海马各区nNOS阳性神经元在去卵巢及雌激素替代治疗后的形态结构及分布变化,为雌激素类药物防治绝经后老年性痴呆症提供理论依据。结果表明,家兔海马各区都有nNOS阳性神经元分布;去卵巢后海马nNOS阳性神经元的形态结构及分布变化有区域差异性:与假手术对照组相比,在海马CA1区、CA3区、齿状回(DG)阳性神经元数量明显减少(P0.05),而在CA2区数量明显增多(P0.05)。CA1、CA3区和DG的阳性神经元胞体截面积明显变小,最长突起长度明显变短,第一级突起数变少,与假手术组有显著差异(P0.05)。CA2区阳性神经元胞体截面积明显变小(P0.05),最长突起长度、第一级突起数增多,但差异不显著(P0.05);nNOS阳性神经元的4种指标在雌激素替代治疗组与假手术组之间无显著差异(P0.05)。结果提示:雌激素可能通过影响海马nNOS的表达来影响脑的学习和记忆功能。