Today we talk to Stefano Cortellini, lecturer in emergency and critical care here at the RVC about the process and indications for Continuous Renal Replacement Therapy (CRRT) and Therapeutic Plasma Exchange (TPE). Further information about this therapy can be found here http://www.rvc.ac.uk/small-animal-referrals/advanced-techniques-and-specialist-procedures/continuous-renal-replacement-therapy

Information on acute kidney injury (AKI) and grading can be found on the website of the International Renal Interest Society (IRiS) here http://www.iris-kidney.com/guidelines/grading.html

The indications for considering treating patients with AKI are; metabolic acidosis, electrolyte imbalance (especially refractory hyperkalaemia), and uraemia. The patients we see, have a potential reversible cause, are often anuric and we can successfully catheterise.  tend to be most affected are those that are anuric. Some toxins can be removed by dialysis when different filters are used. TPE has been used for immune mediated diseases (IMHA, polyradiculoneuritis), and cutaneous and renal glomerular vasculopathy.

If you are in the UK and have a patient that you might think benefit from this therapy, then do not hesitate to contact the RVC http://www.rvc.ac.uk/small-animal-referrals/

Suggested reading.

Review of CRRT and blood purification http://onlinelibrary.wiley.com/doi/10.1111/vec.12028/abstract

Single pass lipid dialysis for ivermectin toxicosis http://onlinelibrary.wiley.com/doi/10.1111/vec.12581/abstract

Therapeutic plasmapheresis in IMHA http://onlinelibrary.wiley.com/doi/10.1111/j.1476-4431.2009.00431.x/abstract  

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