Page 5 - Clinical Connections - Summer 2023

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Page 5 - Clinical Connections - Summer 2023
P. 5

Advancements

        A DECADE OF EXTRACORPOREAL THERAPY

        Rosanne Jepson and Stefano Cortellini, Co-Directors of the Renal Replacement Therapy Service

          t is ten years since we began delivering   died, despite expert veterinary care. Alba’s   Without this treatment, his body would
          extracorporeal therapies for cats and   condition continued to worsen during   have taken several days to remove this
        I dogs with kidney injury, immune-  hospitalisation and her urine production   drug. Jonah continued to improve, became
        mediated disease and certain toxicities.   started to decrease – a sign that the kidneys   progressively  more  alert  and  was  soon
        More  than  50  patients  have  received  the   were shutting down.     ambulatory. He was discharged fully
        advanced treatments, most of which would   Plasmapheresis   had   never   been   recovered two days later.
        have died without it.               attempted as a treatment for a dog with
          ºÚÁÏÉç  Small  Animal Referrals  is  the   CRGV, but her owners were keen that all
        only  veterinary  centre  in  the  UK  to  have   treatments were considered. Using the
        extracorporeal therapy. The equipment was   evidence-base  from  human  medicine,
        funded by the ºÚÁÏÉç’s registered charity, the   where similar conditions can be helped
        Animal Care Trust.                  by  TPE, Alba  was  treated  with  this  novel
          The machine uses different filters, which   therapy.
        allow  removal  of  different  sizes  and  types   She made a good recovery and went on
        of  molecules.  These  molecules  could  be   to become an active adult dog. She returned
        undesirable substances, such as toxins   to the ºÚÁÏÉç in 2016 for an event marking the
        or drugs, excessive water or toxins that   30th birthday of the Queen Mother Hospital
        accumulate  in  acute  kidney  failure,  or   for Animals.
        specific antibodies which can cause various   The ºÚÁÏÉç is one of the few centres in the   Marty, who had three cycles of dialysis at ºÚÁÏÉç
        auto-immune diseases.               UK  researching  into  trying  to  identify  the   Small Animal Referrals
          The treatment is called renal replacement   cause or a cure for CRGV, as these are
        therapy (a form of dialysis) when we treat   currently unknown.         Marty’s case
        patients with acute kidney failure, and                                 A more recent patient was 10-week-old
        plasmapheresis or therapeutic plasma   Jonah’s case                     Labrador  Marty,  who  was  referred  earlier
        exchange (TPE) when we treat patients with   Several animals that had swallowed specific   this year. He presented with a bacterial
        immune-mediated  disease. Both dialysis   toxins (such as raisins) or either eaten or   infection (leptospirosis) causing both acute
        and plasmapheresis can be used for the   received inadvertent overdoses of drugs   kidney failure and liver damage.
        removal of toxins and drugs.        have been successfully treated in the   Despite  starting  antibiotic  treatment  and
                                            same way at the ºÚÁÏÉç. One such case was   supportive therapy, including diuretics to try
                                            Jonah, a one-year-old cocker spaniel, who   to improve Marty’s urinary production, his
                                            was referred in 2020 following suspected   kidneys completely stopped producing urine
                                            phenobarbitone intoxication.        (anuria) and we were concerned he would
                                              On arrival Jonah was comatose, had   develop life-threatening complications.
                                            breathing difficulties and required immediate   Dialysis  was  discussed  with  Marty’s
                                            intubation.  Mechanical  ventilation  was   owners and three dialysis sessions were
                                            started, and dialysis performed to remove   performed over the following days. During
                                            the excessive phenobarbitone. Jonah   those sessions Marty required two packed
                                            responded well to dialysis, recovering from   red blood cell transfusions for development
                                            his coma within three  hours of starting   of anaemia.
                                            treatment.                           Marty started producing urine after
                                                                                the  final  session,  which  was  a  fabulous
                                                                                outcome for the team looking after him.
         Extracorporeal  therapies  can  treat  a  broad
         range of conditions                                                    His kidney values gradually returned to
                                                                                normal over several days and, by the time
        'Alabama rot' and Alba                                                  of discharge, he had returned to his usual
        In 2014 the team and equipment enabled a                                excitable temperament.
        breakthrough in the treatment of cutaneous                               Extracorporeal  therapy  has  become
        renal glomerular vasculopathy (CRGV),                                   an integral part of the management of
        dubbed 'Alabama rot' and ‘New Forest                                    critical dogs and cats at the ºÚÁÏÉç, either in
        syndrome’.  A Labrador puppy called  Alba                               treating severe cases of acute kidney injury,
        started developing wounds over her body                                 immune-mediated diseases or in treating
        and acute kidney injury. She was referred                               drug overdoses or toxin ingestion.
        to  the  ºÚÁÏÉç  Emergency  and  Critical  Care
        clinicians, who became concerned she was
        suffering from CRGV.                                                           For small animal referrals, please call:
          There were no documented cases of                                          01707 666399
        dogs with this condition and severe renal   Jonah was comatose upon arrival at the ºÚÁÏÉç     Email:
                                                                                     qmhreception@rvc.ac.uk
        failure  surviving  and  dozens  of  dogs  had   but quickly recovered
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