Treatment of acute kidney injury associated with cyclosporine overdose in a dog using hemodialysis and charcoal hemoperfusion

Segev, Gil; Cowgill, Larry D

doi:10.1111/vec.12694

Cited by 6 publications

(3 citation statements)

References 23 publications

(59 reference statements)

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“…Severe adverse events, such as AKI, hepatotoxicity, or lymphoma have an uncertain association with CsA use. Only a single case of nephrotoxicity has been reported with CsA overdose and 1 case of multicentric lymphoma has been associated with CsA administration . Experimentally, CsA is reported to cause liver injury in rats .…”

Section: Discussionmentioning

confidence: 99%

Retrospective evaluation of cyclosporine in the treatment of presumed idiopathic chronic hepatitis in dogs

Ullal

Ambrosini

Rao

et al. 2019

Veterinary Internal Medicne

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Background The etiology of idiopathic chronic hepatitis (ICH) in dogs is poorly understood, but evidence supports an immune‐mediated pathogenesis in some dogs. Objectives To describe a case series of dogs with presumed ICH treated with cyclosporine (CsA) with or without concurrent medications and to document the incidence of biochemical remission and factors associated with failure to attain remission. Animals Forty‐eight client‐owned dogs diagnosed with presumed ICH, treatment of which included CsA. Methods Two‐institution, retrospective case series of dogs between 2010 and 2017. All dogs were treated with CsA with or without concurrent medications for ≥2 weeks. Data were collected from medical records. Results Biochemical remission (<1.1 times the upper limit of normal for alanine aminotransferase activity) was attained in 79% of dogs (38/48). Median dose of CsA at remission was 7.9 mg/kg/d (range, 2.5‐12.7 mg/kg/d) and median time to remission was 2.5 months (range, 0.75‐18 months). Concurrent hepatoprotectant treatment was not associated with likelihood of remission. Clinical score, ascites, hypoalbuminemia, hyperbilirubinemia, prolonged coagulation times, dose, and duration of treatment were not associated with the probability of remission or time to remission. Common adverse effects of CsA were gastrointestinal signs in 38% (18/48) and gingival hyperplasia in 25% (12/48) of treated dogs. Conclusion and Clinical Importance A treatment regimen including CsA and frequent hepatoprotectant use resulted in biochemical remission of ICH in most dogs. None of the evaluated factors, including hepatoprotectant use, were significantly associated with likelihood of remission. Future prospective studies are indicated to evaluate CsA monotherapy in ICH dogs.

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Section: Discussionmentioning

confidence: 99%

Retrospective evaluation of cyclosporine in the treatment of presumed idiopathic chronic hepatitis in dogs

Ullal

Ambrosini

Rao

et al. 2019

Veterinary Internal Medicne

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“…These events occurred at least 2 years after the initiation of CsA making it difficult to establish causality. There is only one report of nephrotoxicity associated with CsA overdose in a clinical 59 setting and one report of multicentric lymphoma associated with CsA administration. 60 No cases of hepatotoxicity were identified in this study although experimentally, CsA can cause liver injury.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Evaluation of Cyclosporine in the Treatment of Chronic Hepatitis in Dogs: 2010-2017

Tarini

Yoko

Sangeeta

et al. 2018

Preprint

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BackgroundIdiopathic chronic hepatitis (CH) in dogs is a prevalent hepatic disorder. The etiology is poorly understood; however, there is evidence to support an immune-mediated pathogenesis. No literature exists investigating the efficacy of cyclosporine (CsA) therapy for CH in dogs.ObjectivesTo retrospectively evaluate the efficacy and adverse side effects of CsA in the treatment of CH in dogs, and to identify factors that impact response to CsA therapy.Animals48 client-owned dogs diagnosed with CH treated with CsA for at least 2 weeks.MethodsRetrospective review of medical records between the years 2010-2017.ResultsTwenty-two breeds of dogs were included of which 54% were spayed females, 42% neutered males and 4% intact males. Median age was 8.5 years (range, 0.7-14 years). Complete remission (normalization of alanine aminotransferase [ALT]) in response to CsA was attained in 79% of dogs (38/48). Median dose of CsA at the time of remission was 7.9 mg/kg/day (range, 2.5-12.7mg/kg/day) and median time to remission was 2.5 months (range, 0.75-18 months). None of the factors evaluated including clinical score, presence of ascites, hypoalbuminemia, hyperbilirubinemia, prolonged coagulation times, dose, or duration of therapy influenced remission. Common side effects were gastrointestinal signs in 38% (18/48) and gingival hyperplasia in 25% (12/48) of dogs.Conclusion and Clinical ImportanceCsA proved to be a tolerated and effective medication in attaining remission in dogs with idiopathic CH based on normalization of serum ALT. None of the evaluated factors were shown to negatively impact response to CsA or remission of disease.

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“…Charcoal hemoperfusion often used to treat toxicities with an appropriate pharmacokinetic profile. [37][38][39][40][41][42][43][44] The first veterinary-specific extracorporeal platform is a hemoperfusion machine (Aimalojic); it may be used by many emergency hospitals that do not have an extracorporeal therapies service, thus increasing the availability of ECTR throughout the United States.…”

Section: Specialty Procedures Extracorporeal Therapies-renal Replacem...mentioning

confidence: 99%

Nephrology in Veterinary Medicine

Foster

2023

Kidney360

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Veterinary nephrology is a specialized field of veterinary medicine providing a high level of care for animals with all types of kidney disease. Veterinarians complete extensive training to become board certified in veterinary nephrology-urology. Companion animal nephrology is the most advanced field; however, all species are afflicted by a variety of renal disorders. Most naturally occurring animal renal diseases have similar disorders found in people; where veterinary research is lacking clinical management is often modified from standard of care in people. Veterinarians have become adept at scaling down procedures to safely perform them on dogs and cats weighing only a few kilograms. Advanced diagnostics (renal biopsy, cystoscopy, fluoroscopic studies, etc.) and therapeutics (renal replacement therapy, interventional endourology, etc.) are commonly performed within the practice of veterinary nephrology-urology. Collaboration between veterinary and human nephrologists may advance both disciplines and improve care for people and animals alike.

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Treatment of acute kidney injury associated with cyclosporine overdose in a dog using hemodialysis and charcoal hemoperfusion

Abstract: Combined hemodialysis and charcoal hemoperfusion treatment can significantly reduce blood cyclosporine concentrations following acute intoxication or overdosage, and should be considered as an option for decontamination in such cases.

Cited by 6 publications

References 23 publications

Retrospective evaluation of cyclosporine in the treatment of presumed idiopathic chronic hepatitis in dogs

Retrospective evaluation of cyclosporine in the treatment of presumed idiopathic chronic hepatitis in dogs

Retrospective Evaluation of Cyclosporine in the Treatment of Chronic Hepatitis in Dogs: 2010-2017

Nephrology in Veterinary Medicine

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