Specialist: Dr Adam Mugford BVetMed MVetMed DACVECC MRCVS, Board-Certified Emergency and Critical Care Specialist
Buffy initially presented at the Village Vet Highgate branch with only a 48 hour history of illness. Unfortunately, initial investigations confirmed severe acute kidney injury. Samples revealed a urea of 71 mmol/l, creatinine, 1556 umol/l and potassium, 6.6 mmol/l.
Caused by a severe pyelonephritis. Buffy’s condition carried an extremely guarded prognosis, therefore the owners requested referral. Luckily for Buffy and much to the owners’ relief, London Vet Specialists offered Central London’s most advanced 24 hour critical care service and its Board-Certified Emergency and Critical Care Specialist, Dr Adam Mugford had particular expertise in acute kidney injury. Following admission a pyometra was also confirmed, which meant that if Buffy’s kidney injury could be stabilised, she would potentially require surgery.
Initial stabilisation included central line placement allowing repeat blood sampling and central venous blood pressure measurement to guide fluid therapy. In addition, in-dwelling urinary catheter placement confirmed a marked polyuria (urine output of 16ml/kg/hr). As a result, the azotaemia and hyperkalaemia had worsened despite initial therapy. The hyperkalaemia was managed with administration of insulin, dextrose and terbutaline therapy. Continuous ECG and serial blood pressure measurement aided intensive care and with appropriate high volume fluid therapy, her azotaemia then began to improve rapidly.
Subsequent marked free water loss during recovery led to a rapid change in serum sodium levels resulting in generalised seizure activity . Immediate intervention was performed with the correction of the free water deficit (via administration of dextrose 5 % water ), and phenobarbitone treatment was instigated which controlled the progressive seizure activity.
After 1 week the sodium levels had stabilised and the azotaemia had resolved. Unfortunately medical management for the concurrent pyometra had failed and therefore surgery was recommended. Due to the development of severe anaemia prior to surgery, a fresh whole blood transfusion was required. Buffy was then anaesthetised and maintained using a fentanyl continuous rate infusion to protect renal perfusion. Whilst she had been fed via a naso-oesphageal feeding tube placed prior to surgery, an oesophageal feeding tube was put in following her ovario-hysterectomy. Although Buffy had minor post-operative oliguria, her renal function remained stable .
Buffy was discharged following 12 days of intensive care. At the time of discharge both her urea and creatinine had returned to within reference range. The LVS nursing team performed home visits to assist the owners with tube feeding. Eight months later, Buffy’s body condition had returned to normal, and she continues to maintain adequate renal function.
With specialist intensive care, survival rates from acute renal injury can approach 40%. Blood creatinine on admission is not a predictor of long term renal function. London Vet Specialists is happy to accept referral of any case with or at risk of acute kidney injury.