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  Discussion on Death from Kidney Failure
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Posted on Saturday, Dec 9, 2000 - 8:11 pm:

My 12yr old throughbred/quarter horse gelding died Oct. 28 from what the reports describe as Renal tubular Necrosis, acute, severe.

It all started when he was being treated for a foot abcess. He was given TMS and Bute for 4 to 5 days. On 10/27/00 slightly increased HR and RR, fever with swelling periorbitally after initiation of TMS. 10/28/00, mild colic signs slightly decreased manure production. Blood work showed creat @6.55, increased to 6.9 after 47L, 40,000 platelets, pH=7.238, lactate =735, ATIII=87, petechiae. Foot films not remarkable, abscess draining out coronary band - did contrast study. Abdominal ultrasound reported normal except for hyperechoic lef kidney. No fluid, attempts at abdominocentesis normal. Progressively worse with periods of normal comfort level and calmly looking out the window. Very little urine production.

The comments from the autopsy report were as follows: Although the gross and histologic lesions fail to completely explain the clinical scenario, acute renal failure must have contributed to the demise of this horse. The gross changes were impressive. The kidneys were humorrhaic, enlarged and pulpy. Histologically, this change was seen as advanced autolyis with segmental areas of acute mbular necrosis.

My question is: What caused the Kidney failure? The TMS & Bute or was the abscess traveling?

Thanks

Posted on Monday, Dec 11, 2000 - 7:42 am:

My condolences Linn,
Can you tell me the approxiamte weight or the horse, the dosages given, and dates that the horse was on the medications?

Assuming that I have all the pertinent information, I do not believe the foot abscess directly contributed to the renal failure: if the foot abscess had traveled to the kidneys we should have seen evidence of infection. Usually this would be in the form of microabscesses that would have to have affected both kidneys.

Yes, bute can cause these type changes in the kidney but this would be rare at reasonable dosages. There may have been preexisiting but subclinical problems, idiosyncratic reactions, or contributing causes: one thought is the pain of the foot abscess kept the horse from drinking well, leading to dehydration and increased sensitivity to the bute? Anyway let us know the above information and I may be able to help further.
DrO

Posted on Wednesday, Dec 13, 2000 - 8:32 am:

Thank you for your reply. I do not know the Approx weight, but he was 16'3" and used mostly for dressage with a little jumping in between. The abscess started on Oct. 19. He was started on 1 1/2 bute tabs twice a day. After the abscess had not come to a head, he became very lame and was put on 2 bute tabs per day on the night of Oct. 25. On October 26th, the vets came out again and were able to get to abscess to drain. They also found he had spiked a temp of 103. In addition to two bute per day they put him on TMS. It was the night of the Oct 26 when I went to check on him that I noticed swelling in the hollows above the eyes. I called the vet who said she would be out tomorrow. Up to this point he was eating normally. I do not know his water intake as the barn waters 4 to 5 times a day by different people. On Oct 27, you could tell he did not feel good and was not eating and the swelling above his head seemed worse. One of the reports from New Bolton stated "he became quieter, had reduced gastrointestinal motility, as well as decreased manure production. It was noticed that his eyelids were swollen and he became dehydrated." I was cleaning this horse's stall everyday and everything seem normal except for Friday Oct 27. The stall was not as wet as usual. He was walking much better and did not seem to be in much pain. Sat. October 28, we took him to New Bolton as a percaution and were in shock when he went starting failing after being there for a couple of hours. Friday his Blood panel was normal except for some evalutions in what they see from Horses that are started to tie up but not a big increase. I forget the name of that. But on Sat his blood panel show an increase in creatinine that 6.55 mg/dl and well as moderate dehydration, azotemia, lactic acidosis, hypoproteinemia and thrombocytopenia.

Please let me know if you need more info, I guess I'm looking for some sort of closure. This horse was such a family member. It is going to take a long time to get over such a loss.

Thank you again,

Linn

Posted on Wednesday, Dec 13, 2000 - 1:32 pm:

Hello Linn,
The bute dose, though high, but was not exorbidant. I went over to a pharmocology resource and found this under the trimethoprim/sulfa topic:

Drug Interactions - Sulfonamides may displace other highly bound drugs, such
as methotrexate, phenylbutazone, thiazide diuretics, salicylates, probenicid and
phenytoin. Although the clinical significance of these interactions is not entirely clear, patients
should be monitored for enhanced effects of the displaced agents.

Perhaps the antibiotic created a higher than average circulating level of bute, resulting in a toxic interaction. I must say this is not a well known feature of this drug and is used together with bute all the time. Though this increases our understanding of why this may have happened I still believe the horse may have had a sensitivity to the medication. I will include this experience inour newsletter since these two medications are used together all the time.
DrO

Posted on Thursday, Dec 14, 2000 - 6:58 am:

Thanks for your research. The surprising thing about this is that he had been on that Antibiotic a year and one half ago. He had be nicked by the farrier and did not have a reaction. If he was on bute at the same time, maybe it was a smaller dose.

The only other thing my trainer and I had observed that whenever he was hurt, he did seem to take a longer than average time to heal. so it makes me wonder if his immuine system was somehow compromised. I had only had him since June of 99.
Before that he had a career on the West Palm Beach Hunter circuit and was leased out to different people during the season. Just a thought, it also makes me wonder what kind of drugs if any, he may have been given to increase performance. Since I'm don't run in those circles, I'm not quite sure of the morals involved.

Thank you again for your help.

Posted on Tuesday, Jan 9, 2001 - 12:25 pm:

Hi, Linn- very sorry to hear of your loss. I just got my newsletter and read your post. It's very strange a stallion we bred one of our mares to in 1999 had the same problem, he started out with a hoof abcess and later died of kidney failure. I'm not sure of the med's involved but do know he was on antibiotics at one point. I wonder if the same thing happened to this horse? Just thought you might be interested. Again, my condolences on your loss. Melanie.
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