A retrospective evaluation of contrast-induced kidney injury in dogs (2006-2012).

OBJECTIVE: To evaluate a population of dogs for evidence of contrast-induced nephropathy (CIN). DESIGN: A retrospective case review between 2006 and 2012. SETTING: A university teaching hospital. ANIMALS: A total of 1,217 client-owned dogs that were administered intravenous iodinated contrast agents were reviewed for evidence of CIN. Inclusion required a measured serum creatinine within 1 week prior as well as within 1 week following administration of contrast. Eighty-six dogs with 92 contrast administrations qualified for inclusion. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: CIN was defined as an increase in >44.2 µmol/L (0.5 mg/dL) from baseline creatinine concentration within 1 week following administration of an intravenous iodinated contrast agent. A total of 7.6% of contrast administrations (7/92) fulfilled the definition of CIN. The creatinine postcontrast administration as well as the change in creatinine concentration was significantly higher in the CIN group than in the non-CIN group (median postcreatinine 150 µmol/L [1.7 mg/dL] versus 70.7 µmol/L [0.8 mg/dL], median change in creatinine 53 µmol/L [0.6 mg/dL] versus 0 µmol/L). Patient signalment, initial creatinine, number of total contrast administrations, dose of contrast received, duration of anesthesia, IV fluid administration, administration of nephrotoxic agents, and use or vasopressor therapy were not significantly different between groups. CONCLUSIONS: The temporal association between contrast administration and renal injury in these cases highlights the potential for CIN in dogs. Due to the retrospective nature of this study, a causal association between contrast administration and renal injury cannot be determined. A prospective study is needed to further evaluate CIN in dogs.

Axillary artery tumor embolism secondary to mitral valve myxosarcoma in a dog.

OBJECTIVE: To describe the clinical presentation, treatment, and outcome of a dog with an arterial tumor embolism. CASE SUMMARY: An 11-year-old, neutered male Irish Setter presented with acute right forelimb lameness. The dog was unable to bear weight on the right forelimb, which was cool to the touch with no palpable pulses. Diagnosis of thromboembolism was confirmed using angiography, revealing a lack of blood flow to the right axillary artery. Balloon angioplasty, thrombosuction, and infusion of the thromboembolism with tissue plasminogen activator were used to achieve increased, but not complete, blood flow through the vasculature. Echocardiogram revealed vegetative mitral valve lesions consistent with endocarditis, thrombus, neoplasia, or a combination thereof. At the time of discharge, there was improvement in the temperature and motor function of the proximal limb but no conscious proprioception or deep pain sensation in the distal limb. Histopathologic analysis of the sample retrieved with thrombosuction was consistent with a diagnosis of myxosarcoma. A series of 3 rechecks showed continued improvement in neuromuscular function. Treatment for suspected mitral valve myxosarcoma was declined. The patient was lost to follow up until being presented for necropsy 16 months later. Necropsy confirmed myxosarcoma of the mitral valve with tumor emboli to the coronary arteries, lungs, and the right axillary artery. UNIQUE INFORMATION PROVIDED: To the authors' knowledge, there is no report of myxosarcoma originating on the mitral valve in dogs, although it has been reported in the human literature. To the authors' knowledge, there are also no reports of tumor embolism of the axillary artery in a dog. This case demonstrates a unique presentation of a dog that had a myxosarcoma tumor embolism. It also describes the use of angiography for diagnosis and localization of the vascular obstruction and a variety of interventional techniques for the treatment of thromboembolism.