Renal function tests

RE: Renal function tests

Andrew Kent — Wed, 12 Oct 2016 13:01:42 GMT

Hi Robin,

ive replied in that thread :-)

Andy

RE: Renal function tests

Robin Grimmer — Tue, 11 Oct 2016 20:31:14 GMT

Hi Andy,

What's your opinion of the SMDA test for renal function generally? (I don't mean to do with this case). See the thread lower down on SMDA testing.

RE: Renal function tests

Andrew Kent — Tue, 11 Oct 2016 18:53:03 GMT

[quote user="Nicola M"]

Many thanks for the info. Is there a way of determining if a kidney is 'too far gone' or for obstruction would stenting always be preferable to see if function recovers?

[/quote]

Hi Nicola,

That does become a matter of opinion to some degree, if the kidney just looks like a bag of fluid on ultrasound with no internal structure then it seems unlikely that there will be significant improvement (although I have seen almost unbelievable recovery in a couple of cases) with intervention but anything less than that I would definitely try.

Sometimes it does come down to owner preference and cost as nephrectomy means one procedure rather than the potential for more than one if an intervention doesn't work.

Andy

RE: Renal function tests

Nicola Cole — Tue, 11 Oct 2016 18:47:48 GMT

Many thanks for the info. Is there a way of determining if a kidney is 'too far gone' or for obstruction would stenting always be preferable to see if function recovers?

RE: Renal function tests

Andrew Kent — Mon, 10 Oct 2016 13:55:02 GMT

[quote user="Anthony Dennison"]Dog is still being monitored by the referral centre, and may still need a nephrectomy.[/quote]

Difficult to comment too much on cases I don't know a lot about but nephrectomy should be the absolute last resort for post-renal disease and there are some very good options available at a number of places (for example ureteral stenting) which would be preferable.

Stone forming dogs have a tendency to form more stones and we tend to regret nephrectomy at the time the other kidney obstructs...

Andy

RE: Renal function tests

Anthony Dennison — Mon, 10 Oct 2016 12:35:54 GMT

The dog was in such pain with renal colic (screaming even with methadone on board) and the ureters were so dilated I thought there was only one option! Have learnt now though.

Dog is still being monitored by the referral centre, and may still need a nephrectomy.

RE: Renal function tests

Andrew Kent — Mon, 10 Oct 2016 11:56:08 GMT

[quote user="Anthony Dennison"]I recently referred a dog with hydronephrosis and a massively dilated ureter (2cm diameter in some places) for nephrectomy, and it was treated medically instead with a view to try and wait for the stones causing the semi-obstruction to pass.[/quote]

So stones are a great example where medical management can be a good option. I would typically place a ureteral stent (temporary) to relieve the acute obstruction as the success of recovery is dependent on duration of obstruction. Then medical therapy to dissolve the stones.

Andy

RE: Renal function tests

Anthony Dennison — Mon, 10 Oct 2016 10:20:24 GMT

I recently referred a dog with hydronephrosis and a massively dilated ureter (2cm diameter in some places) for nephrectomy, and it was treated medically instead with a view to try and wait for the stones causing the semi-obstruction to pass.

RE: Renal function tests

Andrew Kent — Sun, 09 Oct 2016 22:49:04 GMT

Sorry to hear that Nicola, but sounds sensible in the circumstances.

In a case like that if not azotaemic then it's reasonable to assume the normal kidney is functioning ok and would likely be safe to remove the abnormal kidney.

Having said that I would still try to avoid removal if possible by resolving the post-renal disease (in this case perhaps ureterocoele or other cause of ureteral obstruction) as we see some amazing recovery of hydronephrotic kidneys sometimes even when they look beyond help.

Andy

RE: Renal function tests

Nicola Cole — Sun, 09 Oct 2016 21:42:59 GMT

Yes, sorry-didn't want to ramble with lots of history!

3 month old puppy (GSD)presented with inappetance. Palpably very enlarged left kidney (approx 2.5-3 times length of right kidney) and some discomfort on palpation. On further questioning, owners had had for a week, drinks a lot (significantly more than any other dog they've had)-not measured but will drink a cat bowl whenever water put in front of pup, and urinates at least 20 times a day, temp 40C.

Biochem normal, haematology anaemia (mild-moderate, haven't got figures to hand) and think moderate neutrophilia (I can check tomorrow if needed).

Scanned kidneys-left consistent with hydronephrosis, right kidney normal architecture and size. Started I/v fluids, opioids, antibiotics but financial constraints so on balance was unfortunately pts.

RE: Renal function tests

Andrew Kent — Sun, 09 Oct 2016 20:53:22 GMT

Hi Nicola,

There is, sadly, no good answer to this. It is possible to use renal scintigraphy to assess the individual contribution of each kidney but this is rarely practical to do!

There are other ways that we sometimes use depending on the circumstances and reason for removal (for example looking at excretion on an IVU, looking at resistive index etc) but the measures these give are very crude so removing a kidney is always something of a leap of faith!

Can you give us more details about the reasons for removal then I may have a more practical solution!

Andy