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- Carlos Martinez

In this second part we will cover the key aspects during the peri- and postoperative period in a functional adrenalectomy in dogs.

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Peri-operative medical management in dogs with hypercortisolemia:

• Constant blood pressure monitoring and electrocardiogram.

• Start dexamethasone infusion as soon as the adrenal mass has been removed/sectioned:

  • Dose: 0.1 mg/kg infusion over 6 hours (0.017 mg/kg/h).

• Electrolyte and glucose measurement at the end of surgery.

• Sufficient but not excessive peri- and post-operative analgesia, since the patient must be able to walk/be ambulatory no later than 4 hours after surgery.

  • This is pursued to try to reduce the risk of thrombus formation.

Post-operative medical management:

• MONITORING

  • Electrocardiogram (ideally constant).

  • Blood pressure (2 - 3 measurements per day).

  • Hematocrit/total protein (at least 1 time per day).

  • Glucose 4 - 6 hours after surgery and the morning after surgery.

    • From that moment on, 24 hours or depending on needs.

  • Electrolytes 4 - 6 h after surgery and the morning after surgery.

    • From that moment on, 24 hours or depending on needs.

  • Short, frequent walks (q 1 - 2 hours initially) to promote blood circulation and minimize the risk of thrombus formation.

  • Important! Remove sutures later than usual (3 weeks after surgery) as healing may be slower.

    

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In this series of publications (two in total) we will review the key aspects surrounding functional adrenalectomy in dogs.

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Following diagnosis

Our main objective in a dog with hypercortisolemia will be to normalise the cortisol concentration.

• We will administer trilostane but…

  • Be careful! since these tumors are generally very sensitive to treatment and we can easily induce hypocortisolemia

    • Initial dose of trilostane (0.2 - 1 mg/kg q 12h)

WHAT are we pursuing with medical treatment prior to adrenalectomy associated with hypercortisolemia?

• Resolve:

  • Clinical signs

  • Laboratory alterations

  • Reduce surgical complications

HOW LONG is it necessary to administer medical treatment prior to surgery in dogs with hypercortisolemia?

• In general terms, a treatment of 1 to 2 months is necessary

After 10 - 14 days we will perform ACTH stimulation, what THERAPEUTIC RANGE are we pursuing?

• Obtain a post-ACTH [cortisol] 1.5 - 5 ug/dL (4-6 hours post-stimulation)

What RISKS does prior treatment with trilostane MINIMIZE in dogs with hypercortisolemia?

• Delayed wound healing.

• Immunosuppression.

• Arterial hypertension.

• Hypercoagulability.

In the second part (for Premium subscribers) we will cover everything you need to know during the peri- and post-adrenalectomy period 🤓

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Chronic kidney disease (CKD) in dogs and cats is defined as:

• “Presence of structural and/or functional abnormalities lasting more than 3 months”

  • These changes are generally irreversible.

It is estimated that the prevalence of CKD in dogs and cats is around 0.5-1% and 1-3%, respectively, mainly affecting geriatric animals.

Although the etiology of CKD remains unknown, multiple studies have shown how normal kidney tissue is progressively replaced by fibrous and inflammatory tissue, resulting in the development of tubulointerstitial nephritis in the vast majority of cases.

• Other processes (less frequently) include glomerulonephropathies and amyloidosis.

How to recognize chronic kidney disease in dogs and cats?

• The retention and/or loss of certain compounds and elements is the trigger for the clinical manifestations that we usually observe.

  • Generally, dogs and cats with a history (> 3 months) of CKD present one or more of the following clinical signs at the time of consultation:

    • Polyuria-polydipsia.

    • Hyporexia.

    • Vomiting.

    • Diarrhea.

    • Weight loss.

  • In the physical examination, it is common to detect:

    • Decreased body condition.

    • Muscle atrophy.

    • Halitosis.

    • Stomatitis associated with uremia (sometimes oral ulcerations).

    • Unkempt coat.

    • Decreased renal silhouette on abdominal palpation.

  

  • Laboratory abnormalities:

    • Hematology may reveal the presence of moderate to severe anemia (< 20-15%) of the normocytic-normochromic type.

    • Biochemistry mainly shows:

      • Azotemia (increased creatinine and urea concentration).

      • Electrolyte imbalances:

        • Hyperphosphatemia.

        • Hyper/hypokalemia.

        • Hypo/hypercalcemia.

      • Hypoalbuminemia.

      • Metabolic acidosis.

    • Measurement of the serum concentration of symmetrical dimethylarginine (SDMA) is particularly interesting in dogs and cats with suspected CKD in the early stages of the disease.

      • In a recent study carried out in cats with CKD, it was shown that SDMA values ​​increased on average 17 months before creatinine values, allowing earlier recognition of the disease and therefore premature initiation of renoprotective interventions.

    • Urinalysis can reveal a wide constellation of abnormalities:

      • Decreased ability to concentrate/dilute urine.

      • Proteinuria.

      • Pyuria associated with infection.

      • Cylindruria.

      • Hematuria.

      • Inappropriate pH.

      • Inappropriate glucosuria.

      • Cystinuria.

Review of chronic kidney disease in dogs and cats using “Therapeutic Keys”

• When addressing the management of a dog or cat with suspected CKD, it is essential to determine an accurate diagnosis of the disease, as well as perform a complete staging.

• In order to adequately assess serum creatinine and SDMA concentrations, it is essential that the animal is correctly hydrated at the time of the analysis.

• In dogs and cats with suspected proteinuria of renal origin, we must rule out the presence of pre- and post-renal diseases before proceeding to quantify them.

• To minimize intra- and inter-day variability in the amount of protein eliminated in urine, we will take urine samples from 3 consecutive days (free catch sample) and perform the measurement on a “pooled sample” (combining equal volumes of all three samples).

• Evaluate systemic blood pressure using Doppler or oscillometric methods.

From: http://www.iris-kidney.com/guidelines/staging.html

The treatment of CKD in dogs and cats should focus on:

1- Correct the presence of both renal and extra-renal imbalances

2- Delay disease progression

To cover these objectives we can use of a simple but useful mnemonic rule: NEPHRONS

In the second part (for Premium subscribers) we will address how, by using this mnemonic term, we can cover all the fundamental aspects of the disease 🙂

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- Carlos Martinez

In the first part we will cover some generalities of hepatic vascular anomalies and how to approach unstable patients 🤓

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In general terms, surgery is the treatment of choice in dogs and cats with congenital macrovascular porto-systemic vascular anomalies, resulting in greater survival and a lower frequency of clinical signs compared to medical management.

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