NEPHROTOXICANT TABLE
TOXIN SOURCE vetgirlontherun.com
MECHANISM OF ACTION
CLINICAL SIGNS
CLIN PATH FINDINGS
TOX TEST
TREATMENT
PROGNOSIS
Aggressive gastrointestinal decontamination: • emesis induction (even delayed several hours post-ingestion) • single dose of activated charcoal Aggressive IV fluid therapy for up to 72h post-ingestion Anti-emetics BP and UOP monitoring Serial BW monitoring (q12-24h) Asymptomatic patients monitor BW q24h then 48-72h post- ingestion Hemodialysis or peritoneal dialysis in severe cases Aggressive decontamination: • emesis • activated charcoal X 1 GI support: • antiemetics • H 2 blockers or proton pump inhibitors if azotemic IV fluid therapy Clin path monitoring q24h x 2-3d UOP monitoring for 48h Hemodialysis if anuric Symptomatic & supportive care
N/A
• Excellent – no signs of AKI • Fair to poor – with AKI
Vomiting, inappetence, diarrhea, lethargy, anorexia, abdominal pain, uremic breath, and subsequent oliguria and anuria (48-72h post-ingestion)
Clinpath changes consistent w/ AKI: • hypercalcemia and hyperphosphatemia initially • azotemia may develop in 24h
Vitis spp. NOT grapeseed extract
Grapes and Raisins
Mechanism of toxicity is not known at this time and possibly idiosyncratic Hypotheses: • individual inability to metabolize tannins or high monosaccharide content • mycotoxin/pesticide residue on fruit • salicylate-like chemicals w/in grapes/raisins
• Fair to good, if tx is early and aggressive • Grave, if anuric or oliguric kidney injury
Vomiting, depression, anorexia Anuric AKI in 1-3d
N/A
Severe azotemia Urinalysis: • epithelial casts (12-18h post ingestion)
CATS only Ingestion of leaves, petals, pollen or vase water
Lilium spp. (Easter lily, stargazer lily, tiger lily and other Asiatic hybrid lilies) Hemerocallis spp. (some species of day lilies) Peace, Peruvian, Calla lilies, lily of the valley are not “true” lilies are therefore, not nephrotoxic
True Lilies
• proteinuria • glucosuria
NOTE: When in doubt, all drug dosages and treatment advice should be confirmed and cross-referenced with a reference guide such as Plumb’s Veterinary Drug Handbook or a veterinary toxicology resource. When in doubt, the ASPCA Animal Poison Control Center at (888) 426-4435 should be consulted as needed. Abbreviations: AC: Activated charcoal; AKI: Acute kidney injury; BW: blood work; CNS: central nervous system; GI: gastrointestinal; OTC: over-the-counter; UOP: urine output
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