Pleural dialysis in the management of acute renal failure in two dogs

Pleural dialysis, as an alternative to peritoneal dialysis and hemodialysis, was shown in a limited number of cases to be an inexpensive and easily applied technique for use in dogs. It is a viable modality for the management of acute renal failure in dogs that have suffered an acute but reversible renal insult, in which volume replacement and dopamine/furosemide infusion fails to reverse the oliguric state.     

Fluid therapy for acute and chronic renal failure

Animals with renal failure have a number of fairly predictable metabolic abnormalities. They are commonly presented to the veterinarian in a state of negative water balance, although prior fluid therapy in an oliguric patient may result in overhydration. Animals with oliguric ARF have sodium retention; those with polyuric ARF have increased urinary sodium loss. Chronic renal failure does not necessarily affect the ability of the renal tubule to conserve or excrete sodium, although the response to changes in sodium load is much slower than in the normal animal. Potassium retention occurs in oliguric ARF and potassium wasting in polyuric ARF; potassium balance is approximately normal in animals with CRF. Both ARF and CRF cause metabolic acidosis, although the acid-base status in a given animal will be affected by respiratory compensation, as well as other problems such as vomiting. Calcium levels are usually normal to slightly decreased in renal failure, whereas phosphorus levels are generally increased. The basic principles of fluid therapy should be used when constructing a plan for such therapy in an animal with renal failure. Intravenous administration of fluids is almost always necessary. The choice of the type of fluid, solutes, and electrolytes to be administered is based on the predicted abnormalities associated with renal failure as well as the laboratory abnormalities in the animal. Careful monitoring of the patient and periodic assessment of various laboratory parameters are necessary in order to make appropriate adjustments in fluid therapy.     

Peritoneal dialysis in the management of acute renal failure in 5 dogs with leptospirosis

Objective: To describe the use of peritoneal dialysis (PD) in the management of 5 dogs with acute renal failure (ARF) caused by leptospirosis. Case Series Summary: All dogs were treated for leptospirosis with intravenous (IV) fluids and ampicillin prior to PD. Median age of dogs was 5 years (range 2–6 years). All dogs had positive titers for Leptospira bratislava. Median duration of PD was 4 days (range 3–16 days). PD resulted in a decrease in azotemia in all dogs. Median serum blood urea nitrogen at the start of PD was 192 mg/dL (range 140–235 mg/dL) and at the end of PD was 63 mg/dL (range 48–139 mg/dL). Median serum creatinine at the start of PD and the end was 12.8 mg/dL (range 7.7–16.9 mg/dL) and 3.4 mg/dL (range 1.4–11.1 mg/dL), respectively. Complications identified during PD included hypokalemia (n=3, 60%), hypoalbuminemia (n=2, 40%), hypomagnesemia (n=1, 20%), pelvic limb edema (n=2, 40%), central nervous system signs (n=2, 40%), dialysate retention (n=1, 20%), and leakage from the catheter site (n=1, 20%). Peritonitis was not identified in any of the dogs. Four dogs (80%) survived to discharge from the hospital. PD was effective for management of uremia in dogs with ARF caused by leptospirosis.     

Use of dopamine in acute renal failure

Objective: To review the current understanding of dopamine and its use in the prevention and treatment of acute renal failure (ARF). Data sources: Original research articles and scientific reviews. Human data synthesis: Low‐dose dopamine administration has been shown to increase natriuresis and urinary output in both healthy individuals and in a few small studies in human patients with renal insufficiency. However, in several large meta‐analyses, dopamine treatment did not change mortality or the need for dialysis. Due to the potential side effects, the use of dopamine for prevention and treatment of ARF is no longer recommended in human medicine. Veterinary data synthesis: Low‐dose dopamine increases urinary output in healthy animals and animal models of ARF if given before the insult. There are no available studies looking at the effect of low‐dose dopamine therapy in naturally occurring ARF in dogs or cats. Conclusion: Due to the potential side effects of low‐dose dopamine therapy, the results from large human trials, and the lack of information in veterinary medicine, the use of dopamine for treatment of ARF in veterinary patients should be further evaluated.     

Gentamicin-associated acute renal failure in the dog

Gentamicin-associated acute renal failure was diagnosed in 10 dogs. The disease was characterized by a poor prognosis and lengthy hospitalization. Hypoalbuminemia, disorders of potassium homeostasis, proteinuria, hematuria, and cylindruria were common during therapy for renal failure. Fever and dehydration were the most commonly identified potential predisposing factors.     

Hemodialysis of a dog with acute renal failure

A dog with oliguric acute renal failure presumed to have been caused by ethylene glycol ingestion was treated by hemodialysis for 1 month. Hemodialysis was effective in controlling azotemia, hyperphosphatemia, and hyperkalemia when performed on a daily or alternate-day basis. The major complications during treatment were infection and severe weight loss. Serial renal biopsies disclosed a progression from initial acute tubular necrosis to severe diffuse interstitial fibrosis and mononuclear cell inflammation. Infection, cachexia, development of end-stage renal lesions, and terminal hyperkalemia contributed to the eventual death of the dog.     

New and unusual causes of acute renal failure in dogs and cats.

This article provides a source for easy reference, summarizing in one location newly recognized and unusual causes of acute renal failure (ARF) in dogs and cats. Several of the causes discussed in this article have been described previously. New or unusual causes of ARF in dogs and cats include infectious diseases (leptospirosis,borreliosis, and babesiosis), nephrotoxicants (aminoglycosides,vitamin D, and nonsteroidal anti-inflammatory drugs), and plant material (lilies and raisins/grapes).     

Dietary management of renal senescence and failure in dogs

SUMMARY The need for dietary management of renal senescence and the beginning of chronic renal failure should be evaluated in all middle-aged dogs. One survey found that 35% were overweight and 10% underweight; another that 25% were mildly azotaemic, with 5% showing slight clinical signs of chronic renal failure. Dogs in prime condition or overweight are candidates for a diet low in energy (for example 3.0–3.3 kcal/g dry matter, DM), but thin dogs need a higher caloric density (such as 4.0–4.5 kcal/g DM). Healthy older dogs need higher dietary protein than the minimum for maintenance (about 20% on a metabolisable energy basis, ME) of young mature dogs. Thin older dogs showing signs of renal insufficiency may benefit from moderate protein and near-minimal phosphorus in the diet. In dogs with chronic renal failure, clinical, haematological and biochemical responses to the combination of low protein (13–16% ME) and low phosphorus (0.4% DM) were positive in one clinical trial but not in three others. Only beneficial responses, such as less proteinuria, less renal impairment and lower mortality, have been reported for diets containing low phosphorus and moderate protein (20–31% ME). Individual dietary goals for energy, protein and phosphorus should be chosen for each middle-aged or older dog; these goals may be met by a single product or mixtures of products.     

Dietary management of canine and feline chronic renal failure

Nutritional therapy is the mainstay of management of chronic renal failure in dogs and cats. Diets designed for use in renal failure are typically reduced in protein, phosphorus, and sodium content. These and other dietary modifications are designed to prevent or ameliorate clinical signs of uremia, minimize disturbances associated with excesses or losses of electrolytes and minerals, arrest or retard progression of renal failure, and maintain adequate nutrition.     

Intermittent peritoneal dialysis for the treatment of acute renal failure in two horses

Acute renal failure (ARF) in the horse is most commonly due to decreased renal perfusion or a nephrotoxic insult. Conventional therapy includes the administration of i.v. fluids, frusemide, mannitol and/or dopamine, as well as general supportive care. However, not all horses with ARF will respond to these treatments. In these cases, peritoneal dialysis is a viable therapeutic option. This case report describes 2 horses with ARF that was refractory to conventional therapy. Intermittent peritoneal dialysis was used effectively in both cases for treatment of the ARF. Dialysis was easy to perform and associated only with minor complications. To the authors' knowledge, this is the first report describing the successful use of intermittent peritoneal dialysis in the treatment of ARF in the horse.     

Early diagnosis of renal disease and renal failure.

The main goal of early diagnosis of renal disease and renal failure in dogs and cats is to enable timely application of therapeutic interventions that may slow or halt disease progression. Strategies for early diagnosis of renal disease use urine tests that detect proteinuria that is a manifestation of altered glomerular permselectivity or impaired urine-concentrating ability as well blood tests to evaluate plasma creatinine concentration. Animals with progressive renal disease should be carefully investigated and treated appropriately.Animals with mild, possibly nonprogressive, renal disease should be monitored adequately to detect any worsening trends,which should lead to further investigation and treatment even if the increments of change are small.     

Utilization of continuous renal replacement therapy in a case of feline acute renal failure

Objective: To introduce and investigate the application, efficacy, and potential clinical complications of a continuous renal replacement therapy (CRRT) in a feline acute renal failure (ARF) patient. Case summary: A domestic short‐haired cat presented for continued management of ARF of a presumed toxic etiology. Severe azotemia and uremic complications had been identified on initial presentation to a local urgent care facility, and the cat had been referred for renal replacement therapy following approximately 9 hours of conservative management. Continuous venovenous hemodiafiltration was performed over an approximately 25‐hour period, and a significant resolution of the cat's uremic derangements was obtained. Major complications included significant hypothermia and a single episode of hypocalcemia associated with utilization of citrate anticoagulation. All complications identified were readily managed. Following hospital discharge, long‐term medical support was not required, and no evidence of significant illness was noted 6 months following therapy. New or unique information provided: CRRT represents a collection of extracorporeal blood purification techniques that utilize extended treatment periods for gradual, physiologically balanced correction of uremic toxicity. These therapies demonstrate significant promise in the treatment of ARF cats with actual or potential hemodynamic compromise, and prior advances in therapeutic administration have made these techniques readily accessible within the intensive care unit setting.     

Evaluation of parameters for the differentiation of acute from chronic renal failure in the dog

The differentiation of acute (ARF) from chronic (CRF) renal failure is important for therapeutic and prognostic reasons and should be established as soon as possible. In practice this differentiation is often based on history, physical examination and laboratory results. In this retrospective study the diagnostic accuracy of parameters to differentiate ARF from CRF was tested in 19 dogs with ARF and 49 dogs with CRF. The diagnostic accuracy of body condition was 65%, of the hematocrit 78%, of serum potassium levels 28%, of total CO2 48%, of urinary casts 77%, of glucosuria 90% and of the urine protein-to-urine creatinine ratio 43%. Of all the parameters evaluated only glucosuria revealed an acceptable discriminating quality with a sensitivity of 92% and a specificity of 89%. A limitation of this factor is, that glucosuria depends on the cause of ARF. The single parameters tested are not very useful and the diagnosis of ARF or CRF is based on a combination of parameters from history, physical examination, laboratory results and diagnostic imaging. If a diagnosis can't be established immediately, treatment for ARF is recommended. With an immediate, aggressive treatment the possibility of total recovery from ARF is increased.     

A reproducible means of studying acute renal failure in the horse

Acute renal failure was produced in 5 ponies which had received mercuric chloride (0.25 mg/kg) and potassium dichromate (3 mg/kg) intravenously each day for 5 days. Failure was due to acute nephrosis. This was indicated clinically by daily monitoring of the urine output, and B-mode ultrasonography of both kidneys after administering the fifth dose of the chemical agents. Euthanasia was performed after days 14, 9, 5, 8 and 5 respectively in each of the ponies, and the presence of renal disease confirmed by gross and microscopic post mortem examination. The nature of the kidney lesions observed in each animal was consistent, indicating that the induction of renal disease in this manner was reproducible and represented a means by which the pathophysiologic and biochemical development of equine acute renal failure might be studied.     

Renal transplantation for treatment of end-stage renal failure in cats.

Renal transplantation was performed as treatment of end-stage renal failure in 23 cats. Twenty-two cats had chronic renal disease and 1 cat had acute renal disease associated with ethylene glycol-induced toxicosis. Sixteen cats were discharged from the hospital. Nine survived a mean of 8.4 +/- 6.5 months, and 7 cats continue to survive at the time of this report (mean 12.6 months). Seven cats died within 2 weeks of surgery. All renal allografts were obtained from unrelated blood-crossmatch-compatible donors. No deaths were attributable to acute renal allograft rejection, demonstrating the successful maintenance of renal allografts by use of cyclosporine and prednisolone immunosuppression in cats.