Peritoneal dialysis in dogs and cats: 27 cases (1976-1987)

The records of 25 dogs and 2 cats treated with peritoneal dialysis during an 11-year period were evaluated. The indications for peritoneal dialysis were acute renal failure in 21 animals, chronic renal failure in 5 animals, and azotemia of undetermined cause in 1 animal. Peritoneal dialysis resulted in a significant (P less than 0.05) decrease in serum urea nitrogen concentration in 19 of the dogs and a significant (P less than 0.05) decrease in serum creatinine in 20 dogs. The most common complication of peritoneal dialysis was hypoalbuminemia (11 animals affected). Other common complications were dialysate retention/catheter obstruction (8 animals), peritonitis (6 animals), hypochloremia (6 animals), and subcutaneous leakage of dialysate (6 animals). Twelve dogs and 2 cats died during treatment, 6 dogs were euthanatized, and 1 dog was lost to follow-up evaluation. The remaining 6 dogs survived and were discharged from the hospital after successful peritoneal dialysis. On the basis of the results of this study, the authors concluded that peritoneal dialysis, although associated with a high complication rate, was a successful technique for reducing azotemia in dogs with acute and chronic renal failure. Survival rates were poor because of the severity of the underlying renal diseases.     

Peritoneal dialysis in dogs and cats

The peritoneal dialysis was carried out in dogs for the fist time in 1946. Since then, this method of therapy has been applied more and more frequently in veterinary medicine. The dialysis therapy is mainly recommended in the acute renal failure. Accordingly to the time period over which dialysis is performed and the flow pattern of the dialysate, different types of the peritoneal dialysis are distinguished. In carnivores, intermittent peritoneal dialysis is the most commonly applied method of dialysotherapy. However, despite a considerable effectiveness of this method, complications including uncontrolled transportation of elements and proteins or problems with catheter occur quite often. This article describes indications and contraindications which enable to qualify animal patients for dialysotherapy, and detailed principles of peritoneal dialysis procedure.     

Urinary alkaline phosphatase and 7-glutamyl transferase as indicators of acute renal damage in dogs

Urinary alkaline phosphatase (AP) and 7-glutamyl transferase (GGT) levels were measured in normal dogs, dogs with chronic renal failure, and dogs with acute renal failure, as confirmed by renal histology. The median values for urinary AP were 5–8 iu/litre/mmol creatinine for normal dogs, 6–7 for dogs with chronic renal failure and 49-4 for dogs with acute renal failure. The median values for urinary GGT were 3–4 iu/litre/mmol creatinine for normal dogs, 4–9 for dogs with chronic renal failure and 9-6 for dogs with acute renal failure. The results suggest that urinary AP can be used as an indicator of acute renal damage in the dog. GGT was shown to be less useful. No clear correlations were found between urinary enzyme levels and the extent of morphological kidney damage.     

Hemodialysis

Hemodialysis is a therapeutic procedure that uses the extracorporeal circulation of a patient's blood to ameliorate the azotemia, fluid, electrolyte, and acid-base abnormalities characteristic of the uremic syndrome. Hemodialysis is principally used for the management of acute and chronic renal failure that is refractory to conventional medical therapy. Additional applications include acute intoxications (e.g., ethylene glycol poisoning) and preoperative conditioning of renal transplant recipients. Hemodialysis is a technically demanding procedure that requires an extensive array of sophisticated delivery equipment and specifically trained and dedicated staff to perform, monitor, and ensure the integrity and safety of the procedure in critically ill patients. The advent of neonatal dialysis delivery equipment has ensured that hemodialysis is a feasible, efficacious, safe, and indispensable therapy for dogs and cats with life-threatening renal failure. Increased awareness and acceptance of hemodialysis as an effective renal replacement therapy coupled with increased owner demand guarantee a bright future for hemodialysis as a viable therapeutic modality.     

Peritoneal dialysis in emergency and critical care medicine

Peritoneal dialysis is a technique that has been used to treat acute renal failure in humans since 1923. Peritoneal dialysis is used in people to manage acute and chronic renal failure, as well as to remove dialyzable toxins (ethylene glycol, barbiturates, and ethanol), reduce severe metabolic disturbances, and for the treatment of peritonitis, pancreatitis, uroabdomen, hypothermia, and fluid overload. In veterinary medicine, acute renal failure is the prevailing indication for dialysis. This report will discuss the pathophysiology of peritoneal dialysis, indications, and contraindications. Catheter selection and placement will be reviewed. Types of dialysate solution will be discussed and the protocol established for instituting peritoneal dialysis. The report will conclude with a discussion of potential complications and methods to minimize them.     

Ultrasonography of the parathyroid glands in dogs--a review

The purpose of the study was to give an overview over the usefulness of ultrasonographic examination of parathyroid glands in dogs. By means of a 10 MHz high-resolution linear transducer it was possible to visualize parathyroid glands in healthy dogs. There was a positive correlation between body weight and size of the parathyroid glands, additionally the likelihood to detect 4 glands increased with an increase in body weight. Dogs with chronic renal failure had significantly larger parathyroid glands than healthy dogs and dogs with acute renal failure. In dogs with hypercalcemia of malignancy either none or parathyroids which were small in relation to body weight were detected. In contrast visualisation of parathyroid masses in dogs with primary hyperparathyroidism was easy due to their increased size and anechoic appearance. In dogs with severe azotemia the ultrasonographic examination of the parathyroid glands is helpful to differentiate between acute and chronic renal failure, in dogs with hypercalcemia to differentiate between hypercalcemia of malignancy and hypercalcemia due to primary hyperparathyroidism.     

Results of clinical renal transplantation in 15 dogs using triple drug immunosuppressive therapy

OBJECTIVE: To evaluate outcome of renal transplantation in dogs administered cyclosporine, azathioprine, and prednisolone immunosuppression. STUDY DESIGN: Prospective clinical study. ANIMALS: Fifteen dogs with chronic renal failure. RESULTS: Nine dogs died within 1 month of surgery; 5 died from complications associated with generalized thromboembolism. Three dogs survived for 6-25 months. Three dogs alive at the time of this report have survived 22-48 months; however, all 3 dogs have had bacterial infections that responded to antibiotic therapy. There was no biochemical evidence of acute allograft rejection in any dog. Perioperative use of enoxaparin may have prevented thromboembolism in 5 dogs. CONCLUSIONS: Triple drug immunosuppressive therapy used in this study prevented acute renal allograft rejection in 6 dogs that survived >4 weeks; however, immunosuppression was excessive, resulting in an unacceptable frequency of infection and other drug-related complications. Perioperative anticoagulation therapy seem to be warranted. CLINICAL RELEVANCE: Survival time and quality of life for this group of dogs was poor; however, there was no evidence of acute rejection in the dogs surviving >4 weeks. This protocol should only be used if the degree of immunosuppression is reduced, and early evidence of allograft rejection is monitored by renal biopsy or markers of lymphocyte activation.     

Urinary tract manifestations of protothecosis in dogs

Records of 13 dogs with systemic infection with Prototheca sp. from 3 veterinary teaching hospitals were reviewed. Acute renal failure secondary to disseminated infection with Prototheca zopfii was diagnosed in 2 dogs. In 1 dog, acute renal failure developed during administration of immunosuppressive drugs for treatment of anterior uveitis. During diagnostic evaluation of this dog, Prototheca sp. organisms were noted in urine sediment and renal biopsy specimens. In the 2nd dog, acute renal failure was diagnosed after treatment for bacterial cystitis. After diagnosis of protothecosis, organisms were successfully isolated by aerobic urine culture. Both dogs with acute renal failure did not respond to conventional medical therapy. In total, Prototheca sp. was noted in urine sediment in 4 of 8 dogs and successfully cultured from urine in 5 of 7 dogs. Four of 5 dogs had organisms noted in the kidneys on histopathologic examination. In all dogs, the species identified was P zopfii. Sensitivity testing of 3 isolates revealed wide differences in in vitro drug resistance. Examination and culture of urine is recommended as a practical method for diagnosis of systemic infection with Prototheca sp.     

Ultrasonographic quantitative evaluation of acute and chronic renal disease using the renal cortical thickness to aorta ratio in dogs

The renal cortical thickness (RCT) has been correlated with renal function. Previous studies have also reported that the RCT:Abdominal aorta(Ao) ratio is constant in normal dogs with various physical factors. This multi-center, retrospective, analytical study aimed to determine if there are differences between actual RCT and predicted value of RCT considering physical factors in dogs with acute or chronic renal disease. We also aimed to demonstrate whether the RCT and Ao ratio index would be useful for evaluating renal pathology. A total of 54 dogs with acute or chronic renal disease and 30 normal healthy dogs were included in this study. The RCT was measured at the center of the renal pyramid as the shortest distance perpendicular to the renal capsule from the base of the renal medullary pyramid at three points. The diameter of the Ao was measured just caudal to the branch of the left renal artery in the sagittal plane in systole. The RCT:Ao ratio of chronic kidney disease (CKD) patients was 0.50 ± 0.11 (mean ± standard deviation). The RCT:Ao ratio in normal dogs was 0.67 ± 0.07. The RCT:Ao ratio in patients with acute kidney injury (AKI) was 0.83 ± 0.05. There was a statistically significant difference between normal dogs and dogs with CKD (P < 0.001) and between normal dogs and dogs with AKI (P < 0.001). In conclusion, findings from the current study supported using the RCT:Ao ratio as a non-invasive quantitative method for characterizing kidney pathology in dogs with acute or chronic renal disease.     

Hemolytic Uremic Syndrome in Dogs

A disease syndrome similar to the hemolytic uremic syndrome of people is described in three dogs with acute renal failure. In each dog, hemorrhagic gastroenteritis preceded the onset of anuric acute renal failure. Evidence of microangiopathic hemolytic anemia (schizocytes, thrombocytopenia, and increased concentrations of fibrin split products) was present in the three dogs. Serum chemistry results showed increased concentrations of blood urea nitrogen, creatinine, and phosphorus. Ultrasound examination performed in one dog revealed increased echogenicity of the renal cortices. Treatment for anuric acute renal failure using a continuous dopamine and furosemide infusion established urine production in one of three dogs. Microscopic examination of tissue from the two dogs that underwent necropsy showed occlusion of the renal vasculature by fibrin thrombi consistent with microangiopathic arteriolar thrombosis. The pathophysiology and current knowledge of human hemolytic uremic syndrome is compared with hemolytic uremic syndrome in these dogs. (Journal of Veterinary Internal Medicine 1993; 7:220–227. Copyright © 1993 by the American College of Veterinary Internal Medicine.)     

Microemulsified cyclosporine-based immunosuppression for the prevention of acute renal allograft rejection in unrelated dogs: preliminary experimental study

OBJECTIVES: To determine whether the microemulsified formulation of cyclosporine (MCsA; Neoral; Novartis A.G.), combined with azathioprine (Imuran; Glaxo Wellcome), and prednisolone (Delta-Cortef; Upjohn), would be effective in preventing acute renal allograft rejection in unrelated mongrel dogs. To document any toxic effects associated with this drug combination. STUDY DESIGN: rospective, pilot study. ANIMALS: Four healthy, adult, mongrel, canine renal allograft recipients. METHODS: Heterotopic renal transplantation, with bilateral nephrectomy, was performed in 4 dogs. Allografts were harvested from 2 unrelated dogs that were to be euthanatized for reasons unrelated to this study. The dogs were treated for 100 days or until signs of illness or allograft rejection required euthanasia. Microemulsified cyclosporine (20 mg/kg/day), azathioprine (5 mg/kg every other day), and prednisolone (1 mg/kg/day) were administered for the prevention of acute rejection. Body weight, serum biochemistry profiles, complete blood counts, and trough whole-blood cyclosporine concentrations were measured throughout the study. Cyclosporine dose was adjusted to maintain a trough concentration of 400-500 ng/mL. Azathioprine dose was decreased if evidence of hepatotoxicity developed or if the total blood white cell count was <4,000 cells/micro L. The prednisolone was tapered by 0.25 mg/kg increments every 3 weeks and discontinued 14 days before the end of the study in the surviving dogs. Complications were recorded. A complete necropsy and histopathologic examination were performed in each recipient. RESULTS: Two of the 4 dogs survived the 100-day period. One dog was euthanatized at 8 days because of an intestinal intussusception. One dog was euthanatized at 64 days because of a severe upper respiratory infection. At the time of death, these 2 dogs had plasma creatinine concentrations of 1.5 and 2.6 mg/dL, respectively, with no histopathologic evidence of allograft rejection. All dogs had transient weight loss (range, 4.6%-17.7% of preoperative body weight) between days 7 and 14. Two dogs had evidence of hepatotoxicity. The 2 dogs surviving to 100 days had normal serum creatinine concentrations and no clinical signs of rejection. One of these dogs had evidence of a grade IIa acute/active rejection based on the modified BANFF 97 histopathologic classification. The second dog had no evidence of rejection or inflammation within the allograft. CONCLUSIONS: This preliminary experimental study shows that immunosuppression using MCsA, combined with azathioprine and prednisolone, may be effective in preventing acute renal allograft rejection in unrelated mongrel dogs for 100 days. Complications included ileocolic intussusception, upper respiratory infection, weight loss, and transient hepatotoxicity. CLINICAL RELEVANCE: Immunosuppression using MCsA, azathioprine, and prednisolone may be effective in preventing acute renal allograft rejection in unrelated, mongrel dogs. This triple drug protocol is cost-effective and was easy to administer. Further investigation is warranted to minimize toxic effects and to determine the efficacy of prophylactic renal biopsies to detect and treat subclinical acute/active rejection.     

Acute renal failure associated with contrast medium administration in a dog.

Intravenous administration of an ionic radiographic contrast medium was believed to have caused acute oliguric renal failure in a young dog. Intravenous pyelography was done on a healthy 14-month-old female Lhasa Apso prior to reconstructive surgery for pseudohermaphroditism. Within 24 hours of the radiographic procedure, acute oliguric renal failure developed. Cause for the renal failure was not found other than the recent IV administration of radiographic contrast medium. Treatment with fluids, furosemide, and dopamine was successful in returning renal function to normal. Various adverse reactions to IV administration of contrast media in human beings and animals have been reported; however, to our knowledge, acute renal dysfunction induced by IV administration of contrast material has not been reported in dogs.     

Cisplatin for treatment of transitional cell and squamous cell carcinomas in dogs

Thirteen dogs with tumors were treated with monthly infusions of cisplatin. Complete responses were not observed. Of 8 dogs with urinary tract transitional cell carcinomas, 1 (12.5%) had a partial response of 31 weeks' duration, and 4 (50%) had stable disease for 12, 30, 32, and 34 weeks. Three (60%) of 5 dogs with head and neck squamous cell carcinomas had partial responses for 2, 10, and 15 weeks. All 13 dogs were evaluated for signs of toxicosis. Transient episodes of vomiting were recorded for 7 dogs (54%), and 2 dogs (15%) had mild thrombocytopenia. Although renal function gradually decreased in 2 dogs (15%), none of the dogs had an episode of acute renal failure attributable to cisplatin. These findings suggest that cisplatin may be a safe and potentially effective agent for treatment of transitional cell and squamous cell carcinomas in dogs.     

Use of capillary electrophoresis to quantitate carbamylated hemoglobin concentrations in dogs with renal failure

OBJECTIVE: To evaluate quantification of the amount of carbamylated hemoglobin (CarbHb), using capillary electrophoresis (CE) and a new dynamic capillary coating system to separate hemoglobin derivatives, and to assess the use of CarbHb amounts to evaluate long-term urea exposure and differential diagnoses of azotemia in dogs. ANIMALS: 8 dogs with renal failure, 2 dogs with diabetes mellitus, and 7 control dogs. PROCEDURE: Optimal analytic conditions for separation of CarbHb and other hemoglobin derivatives in blood samples obtained from dogs were determined, using a commercial analysis system developed for the detection of glycohemoglobin Hb A1c (GlycHb) in human blood samples. Relative content of hemoglobin derivatives in blood from 10 dogs with renal failure or endocrine diseases were compared with values for 7 dogs without renal or endocrine diseases. RESULTS: Satisfactory resolution of hemoglobin derivatives was obtained, which permitted identification and quantitation of the amount of CarbHb as a percentage of the total amount of hemoglobin. Normal or increased amounts of GlycHb did not interfere with CarbHb analysis. Dogs with chronic renal failure had considerably higher peak amounts of CarbHb than dogs with acute renal failure, a dog with chronic renal failure that was treated by use of hemodialysis, or dogs without renal disease. CONCLUSIONS AND CLINICAL RELEVANCE: Amounts of CarbHb in blood samples obtained from dogs can be readily quantified by use of capillary electrophoresis. Assessment of the amount of CarbHb can be used to facilitate evaluation of the cause of azotemia in dogs.     

Mastocytemia in dogs with acute inflammatory diseases

Nineteen dogs were identified that had mastocytemia (mast cells in venous blood samples) not associated with mast cell neoplasia. The first 10 dogs were identified by examination of blood films from dogs with suspected parvovirus enteritis (8), fibrinous pericarditis and pleuritis secondary to thoracic lacerations (1), and renal insufficiency of unknown cause (1). Because of the apparent association with acute enteritis, blood films from 52 suspected canine parvovirus cases were examined retrospectively and 8 mastocytemic dogs were found. An additional 52 canine blood films were randomly selected from the same retrospective time period and 1 mastocytemic dog was found that had pneumothorax, pelvic fractures, and hemorrhagic septic abdominal effusion secondary to renal hemorrhage and traumatized intestines. All mastocytemic dogs had acute inflammatory leukograms the day that mast cells were first detected: neutropenia with toxic neutrophils (4), neutropenia with a left shift (8), total neutrophil count within reference interval but with a left shift (5), or neutrophilia with a left shift (2). All dogs except the renal insufficiency case had circulating toxic neutrophils. Five dogs were mastocytemic on more than 1 day. The pathogenesis of the mastocytemia associated with the acute inflammatory disease was not determined.     

Renal amyloidosis in related English foxhounds

Renal amyloidosis was diagnosed in six related English foxhounds from two separate hunting kennels. There was no apparent age or sex predilection. All the dogs had clinical and laboratory findings compatible with renal disease. The onset of clinical signs was acute in all cases with death or euthanasia in five of the six affected dogs occurring within one week of presentation. The remaining dog was treated with diuresis which produced a temporary improvement. Histological examination of renal tissue from affected dogs identified the presence of both glomerular and interstitial amyloid, which was confirmed by immunohistochemical staining to be of the reactive type (amyloid A). There were occasional sclerosed glomeruli or glomeruli with thickened Bowman's capsules, in addition to interstitial and periglomerular infiltration with a predominance of plasma cells and lymphocytes and secondary changes including tubular eosinophilic casts. Renal papillary necrosis was identified in three dogs. One hound had concurrent multicentric lymphoma. Pedigree analysis of the affected dogs revealed that four individuals shared a common great grandsire and that the same dog was the grand-sire of a further case. Pedigree analysis of five additional dogs from one of the kennels, all of which had clinical signs of acute renal failure but from which renal tissue was not available, revealed a close relationship to those foxhounds with confirmed renal amyloidosis.     

Applications and Outcome of Hemodialysis in Cats: A Review of 29 Cases

Hemodialysis (HO) has been used in the management of renal failure in dogs, but its feasibility has not been reported for uremic cats. Therefore, we investigated the technical possibility, efficacy, and complications of intermittent HD in cats with severe uremia. A total of 160 HD treatments were performed on 29 cats with acute renal failure (ARF) (n = 15), chronic renal failure (CRF) (n = 6), or acute on CRF (n =8) between November 1993 and June 1996. Hemodialysis treatments were performed with transcutaneous dialysis catheters using a bicarbonate-based delivery system, sodium modeling, and volumetric-controlled ultrafiltration. Presenting serum chemistries (mean ± SD) for all cats were creatinine, 16.4 ± 7.5 mg/dL; blood urea nitrogen (BUN), 229 ± 87 mg/dL; phosphate, 15.4 ± 5.4 mg/dL; potassium, 6.0 ±1.6 mEq/L; and HCO^-₃, 16.0 ± 4.4 mEq/L. For intensive HD treatments, pre-HD versus post-HD creatinine changed from 10.3 ± 4.4 to 1.6 ± 0.9 mg/dL and BUN from 105 ± 33 to 8 ±10 mg/dL. One or more adverse events occurred during 111 (69%) treatments. Dialysis-related events included hypotension, dialysis dysequilibrium, clotting, and bleeding. Nine of 15 (60%) cats with ARF and 1 cat with CRF recovered sufficiently to survive without ongoing need for HD. For the remaining cats, the proximate causes of death were dialysis related in 9 cats, uremia related in 6 cats, and iatrogenic or unknown in 4 cats. Hemodialysis is technically feasible and effectively controls the biochemical disturbances of uremic cats. It is especially valuable for the management of severe ARF, permitting recovery in a large number of cats refractory to conventional therapy. Technical complications and chronic debility, however, may limit its usefulness for cats with advanced CRF.     

Use of continuous-flow peritoneal dialysis for the treatment of acute renal failure in an adult horse

A 15-year-old Paso Fino gelding was evaluated because of acute renal failure following an episode of exertional rhabdomyolysis. The horse was azotemic and treated conservatively at another referral practice with no improvement in the azotemia. With conservative treatment and intermittent peritoneal dialysis, the horse had minimal improvement. Continuous-flow peritoneal dialysis (CFPD) was instituted on day 7 and continued for 3 consecutive days. Dramatic changes in the horse's attitude and serum creatinine concentration were detected within the first 24 hours of CFPD treatment. The horse remained hospitalized for 23 days; within 3 months of discharge, serum BUN and creatinine concentrations had returned to within the reference ranges and the horse had resumed normal activity. In adult horses, it appears that CFPD can be used to successfully treat acute renal failure that is refractory to conventional treatments.