Use of Renal Replacement Therapy in a Neonatal Foal with Postresuscitation Acute Renal Failure

Abstract

A newborn foal was presented because it was unresponsive and in cardiopulmonary arrest. Aggressive cardiopulmonary cerebral resuscitation was administered to the foal, which revived the foal; however, acute renal failure developed. Fluid retention and azotemia occurred although the foal was alert and able to suckle. A 6-hour renal replacement therapy session using hemodiafiltration and a continuous renal replacement therapy machine was administered to the foal at 3 days of age which lowered the foal's azotemia and facilitated removal of some of the excess body fluid. Despite therapy, the foal developed pulmonary edema and was euthanized. Although the foal in this case did not survive, this report highlights the possibility of developing postresuscitation complications such as acute renal failure and describes the use of renal replacement therapy using hemodiafiltration as a viable option in neonatal foals with acute kidney injury.

Acute kidney injury due toLeptospira interrogansin 4 foals and use of renal replacement therapy with intermittent hemodiafiltration in 1 foal

“…Hemodiafiltration treatment has been documented in a foal with post‐resuscitation renal failure and in healthy adult horses using a continuous RRT machine . Both reports describe successful treatment without major adverse effects in the patients . Hemodiafiltration is a well‐established treatment in dogs, and monitoring protocols used for dogs performed very well for this foal, including regional citrate anticoagulation.…”

“…11 Both reports describe successful treatment without major adverse effects in the patients. 10,11 Hemodiafiltration is a well-established treatment in dogs, and monitoring protocols used for dogs performed very well for this foal, including regional citrate anticoagulation. The main difficulty would have been if further treatment was required, because of development of thrombophlebitis and the necessity to keep a patent large-bore dialysis catheter for the duration of dialysis support.…”

“…Renal replacement therapy (RRT) is recommended in dogs with the severe renal form of leptospirosis . Indications to perform RRT include “oliguria or anuria with subsequent life‐threatening hyperkalemia or severe volume overload and advanced uremia refractory to medical management.” Renal replacement therapy is not considered a routine treatment for foals with acute kidney injury and specific recommendations for its use in horses are not available because of the low number of documented cases . Hemodiafiltration (HDF) has been described in adult horses and in 1 foal with post‐resuscitation acute renal failure, whereas hemodialysis has only once been reported as treatment for oxytetracycline‐induced acute renal failure in a foal .…”

“…8 Renal replacement therapy is not considered a routine treatment for foals with acute kidney injury and specific recommendations for its use in horses are not available because of the low number of documented cases. [9][10][11][12][13][14][15] Hemodiafiltration (HDF) has been described in adult horses 11 and in 1 foal with post-resuscitation acute renal failure, 10 whereas hemodialysis has only once been reported as treatment for oxytetracycline-induced acute renal failure in a foal. 9 The latter foal was treated under general anesthesia on 3 occasions over a 4-day period.…”

Therapeutic plasma exchange to mitigate flunixin meglumine overdose in a cria

“…Although TPE and dialysis modalities are often unavailable to large animal patients due to their inherent large size and the costs associated with such treatments, our current report suggests that TPE can be used in select cases of highly protein‐bound drug toxicosis, including flunixin overdose, especially when no antidote is available. Renal replacement therapy has been performed in large animal neonates for acute kidney injury due to oxytetracycline toxicity 17 or after resuscitation, 18 but TPE as a treatment for drug overdose has not been previously reported in large animal species. Even in the face of congenital defects of the urinary tract, the cria reported here sustained no apparent additional kidney injury or clinically manifesting gastrointestinal ulceration after flunixin meglumine overdose after TPE treatment.…”