Azotaemia post GA (in my own dog)

Re: Azotaemia post GA (in my own dog)

Hannah Wynne Richards — Thu, 30 Oct 2014 10:02:42 GMT

It seems to me that she is one of those dogs who has marginal kidney function, so you might not have seen anytghing on pre-op bloods.

Hope you never need to GA her again

Wynne

Re: Azotaemia post GA (in my own dog)

nikki — Wed, 29 Oct 2014 20:40:54 GMT

USG yesterday was 1.026 and bloods remain WNL. Presumably whatever it was she's getting over it. Don't think I've ever done a USG on her before so no idea what it would normally be.

Re: Azotaemia post GA (in my own dog)

Sean Henney — Wed, 29 Oct 2014 19:31:58 GMT

I certainly wasn't in a panic, just pointing out that your explanation missed a key fact. No, we don't know what its SG was, so it could be a pre-existing problem that has come to light. Your suggestion re 'bucket loads of fluids' doesn't fit the timescale quoted in the original post. I get the feeling that you are suggesting medullary washout by 'physiological response'but that is an unproven concept in canine, as opposed to human, medicine. I think the adice to monitor the situation seems reasonable and perhaps consider GFR measurement-RVC now do it.

Re: Azotaemia post GA (in my own dog)

Martin Atkinson — Wed, 29 Oct 2014 18:56:16 GMT

[quote user="Sean Henney"]But that wouldn't account for the isosthenuria[/quote]Well we don't know what its USG was before it all started and its been PU (possibly because it was pyrexic or psychogenic) plus it had bucketloads of fluids so this may just have been a physiological response to that. Its too early to draw conclusions but I wouldn't be panicking yet albeit a cautious prognosis is sensible.

Re: Azotaemia post GA (in my own dog)

Sean Henney — Wed, 29 Oct 2014 16:10:12 GMT

[quote user="Martin Atkinson"]

Hmmm.... with that neutrophilia and left shift my take on this is that dog suffered a post-op infection, the mild azotaemia reflects this. Probably this was resistant to cephalexin but not to pot. amox. Seems the simple explanation to me.

[/quote]

But that wouldn't account for the isosthenuria

Re: Azotaemia post GA (in my own dog)

Martin Atkinson — Fri, 24 Oct 2014 16:55:12 GMT

Re: Azotaemia post GA (in my own dog)

Alex Allen — Fri, 24 Oct 2014 16:36:34 GMT

Ref FDA website info - Ah I see...be careful these are just observations and not verified or necessarily linked to renal effects. This may have been an owner just being over zealous with their recording of their dog's drinking or due to fluid loss following a GIT upset.

Cefalexin has been used for decades and no renal toxicity has ever been noted. Also remember Crea levels can be influenced by muscle turnover and there is a recent significant musculoskeletal procedure here.

Good news about the latest bloods but agree with above re monitoring.

Re: Azotaemia post GA (in my own dog)

Andrew Kent — Fri, 24 Oct 2014 14:36:26 GMT

[quote user="nikki"]Repeated bloods again today and her urea/creat/phos now all within normal limits (urea:4.8, creat:149, phos:1.56), but USG still 1.015. Trace protein, pH:8.0. Ultrasound of urinary tract was unremarkable[/quote]

Excellent - sounds promising - I would get a sediment/culture on this urine again and otherwise keep an eye on what happens to it over the next few weeks.

Andy

Re: Azotaemia post GA (in my own dog)

Michael Woodhouse — Fri, 24 Oct 2014 14:27:36 GMT

Nicola - your dog is as fine as a boxer is ever going to be!

Have you thought of an easier breed next time, flat coat retriever, st Bernard, Westie.......

Re: Azotaemia post GA (in my own dog)

nikki — Fri, 24 Oct 2014 11:33:58 GMT

I found this online - 2 dogs reported polydipsia as an adverse reaction. Decided if any dog was going to have a weird adverse reaction it would be mine, plus she'd already had a week of treatment at this point so I stopped them.

http://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/UCM318614.pdf

Repeated bloods again today and her urea/creat/phos now all within normal limits (urea:4.8, creat:149, phos:1.56), but USG still 1.015. Trace protein, pH:8.0. Ultrasound of urinary tract was unremarkable.

Re: Azotaemia post GA (in my own dog)

Alex Allen — Fri, 24 Oct 2014 09:45:24 GMT

"Took her off the Rilexine as read on data sheet of occasional reports of PUPD."....

I'm little concerned where you saw this as cefalexin is neither nephrotoxic or likely to cause PU/PD. It's not on the SPC/Datasheets/package inserts so if you've seen this somewhere else it's incorrect.

Re: Azotaemia post GA (in my own dog)

Andrew Kent — Fri, 24 Oct 2014 01:13:22 GMT

Hi Nikki,

Sorry to hear about this, its always difficult with our own pets.

It is also difficult to know the significance of a GA in these situations or whether these are longer standing problems exacerbated by the GA. Probably the description would be unusual for an acute kidney injury post GA. Equally, being a boxer, an underlying renal dysplasia is possible, perhaps complicated by a urinary tract infection.

I think your plan sounds very sensible, I would also ultrasound the urinary tract to see whether there are any structural changes that help you determine the chronicity of the problem (i.e. a dysplastic kidney), with the leukocytosis I would also collect another urine sample (preferably by cystocentesis) and submit for culture but also sediment cytology and a UPC. Its easy to miss UTI's if relying on culture alone as they are often falsely negative. What was the urine pH? Any sign of anaemia?

Do let us know what you find on the ultrasound etc.

Andy

Re: Azotaemia post GA (in my own dog)

An On MRCVS — Thu, 23 Oct 2014 22:52:15 GMT

Anonymous because is a bit personal.

She may be fine if what happened to her is similar to my personal experience with orthopedic surgery.

I had a hip replacement 2 years ago, and the first 36 hours I was basically anuric, then became very PUPD. To the despair of nursing staff who accelerated my ability to reach the toilet by myself! It lasted a few days, nobody seemed to worry, and no bloods were taken, and it normalised by itself. I thought it might have been that the kidneys were a bit overflushed at somepoint and lost their concentrating gradient for a while.

As for their health at the moment; I have just passed all the checks and tests to be allowed to donate a kidney, so they di not suffer in the least!

Hope and wish the same will be the case for your dog.

Best wishes