Page 5 - Clinical Connections - Summer 2023

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
RVC 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 RVC’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 RVC 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 RVC is one of the few centres in the Marty, who had three cycles of dialysis at RVC
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 RVC. 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 RVC, 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 RVC 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 RVC Email:
qmhreception@rvc.ac.uk
failure surviving and dozens of dogs had but quickly recovered
Summer 2023 5