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Renomegaly 879.e3

Acute and Chronic Treatment regularly, with frequency of monitoring tailored ADDITIONAL SUGGESTED
• Potassium and sodium citrate 1 mEq/kg to to severity of the metabolic disturbance. READINGS
VetBooks.ir sources for the management of RTA: PROGNOSIS & OUTCOME Cook AK, et al: Renal tubular acidosis associated Diseases and Disorders
> 10 mEq/kg q 24h are the preferred alkali
with zonisamide therapy in a dog. J Vet Intern
○ The dose and ratio of potassium to sodium
Med 25:1454, 2011.
citrate should be titrated to maintain
plasma potassium and bicarbonate within • Prognosis is variable and dependent upon Hooper AN, et al: Fanconi syndrome in four non-
inciting cause and response to therapy.
basenji dogs exposed to chicken jerky treats. J Am
the respective reference ranges. • Animals with acquired RTA (especially toxin Anim Hosp Assoc 47:178, 2011.
○ Once metabolized, 540 mg potassium induced) may have spontaneous resolution. Hostutler RA, et al: Transient proximal renal tubular
−
citrate provides 5 mEq of HCO 3 and Others may develop progressive CKD within acidosis and Fanconi syndrome in a dog. J Am Vet
5 mEq of potassium. a few months of diagnosis. Med Assoc 224:1611, 2004.
○ Generally, proximal RTA requires higher • Animals with complex tubular disorders (i.e., Langlois DK, et al: Acquired proximal renal tubular
alkali dosages than distal RTA. Fanconi syndrome) that have progressed to dysfunction in 9 Labrador Retrievers with copper-
associated hepatitis (2006-2012). J Vet Intern Med
• Bicarbonate 1-10 mEq/kg/day PO titrated the point of showing overt clinical signs 27:491, 2013.
to effect can be used as an alternative alkali generally have a poorer prognosis. Martinez SA, et al: Distal renal tubular acidosis
if potassium and sodium citrate cannot be associated with concurrent leptospirosis in a dog.
used: PEARLS & CONSIDERATIONS J Am Anim Hosp Assoc 50:203, 2014.
○ An 8-oz (227-g) box of baking soda can Shaw DH: Acute response of urine pH following
be added to 3 quarts (2.88 L) of distilled Comments ammonium chloride administration to dogs. Am
water to create a 1-mEq/mL solution of • Renal tubular acidosis is a rare condition in J Vet Res 50:1829, 1989.
bicarbonate, which can be kept refriger- small animals (with the exception of basenji Shearer LR, et al: Distal renal tubular acidosis and
immune-mediated hemolytic anemia in 3 dogs. J
ated up to 2 months. dogs). Vet Intern Med 23:1284, 2009.
○ Sodium bicarbonate can aggravate potas- • Before diagnosis of RTA, other more Thompson MF, et al: Acquired proximal renal
sium wasting, necessitating potassium common causes of metabolic acidosis should tubulopathy in dogs exposed to a common dried
supplementation. Potassium gluconate be definitively ruled out. chicken treat: retrospective study of 108 cases
should be used instead of potassium (2007-2009). Aust Vet J 91:368, 2013.
chloride. Technician Tips Yabuki A, et al: Acquired Fanconi syndrome in two
• Type IV: therapy for hypoaldosteronism or Blood samples for blood pH and bicarbonate dogs following long-term consumption of pet
discontinuation of aldosterone inhibitors analyses should be collected from the jugular jerky treats in Japan: case report. J Vet Med Sci
vein and at the same time as urine collection 79:818, 2017.
Nutrition/Diet for urine pH and bicarbonate evaluation.
Animals with progressive tubular disease and Clients should be warned that administration RELATED CLIENT EDUCATION
associated azotemia should receive a protein- of ammonium chloride could cause vomiting SHEETS
and phosphorus-restricted renal diet. and diarrhea.
Consent to Perform Cystocentesis
Possible Complications SUGGESTED READING How to Collect a Urine Sample
• Inadequate or overzealous administration of DiBartola SP: Metabolic acid-base disorders. In Urolithiasis
alkali or electrolytes can result in metabolic DiBartola SP, editor: Fluid therapy in small AUTHOR: Amy E. DeClue, DVM, MS, DACVIM
disturbances. animal practice, ed 4, St. Louis, 2012, Saunders, EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
• Urolithiasis and osteomalacia are potential pp 253-286.
complications of distal RTA.

Recommended Monitoring
Blood gas analysis, urine pH, and serum
potassium concentrations should be monitored

Renomegaly Client Education
Sheet

BASIC INFORMATION GENETICS, BREED PREDISPOSITION ASSOCIATED DISORDERS
• Polycystic kidney disease is more common Acute kidney injury (AKI [p. 23])
Definition in Persians, Himalayans, and exotic shorthair Chronic kidney disease (CKD [pp. 167
Renomegaly is a condition in which one or breeds. and 169])
both kidneys are abnormally large. It is con- • Miniature schnauzers, Bichon frisé, and shih Clinical Presentation
firmed by abdominal palpation, ultrasound, tzu are breeds predisposed to calcium oxalate
or radiographs. urolithiasis, which may lead to ureteral HISTORY, CHIEF COMPLAINT
obstruction and consequent hydronephrosis. Clinical presentation depends on underlying
Epidemiology cause and damage to renal function. It may
SPECIES, AGE, SEX RISK FACTORS be an incidental finding on physical exam, or
Any dog or cat; older animals more likely to Conditions predisposing to nephrolithiasis signs may include
have renal neoplasia (p. 689)

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