Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Exploring the Challenges of Unilateral Nephrectomy in Dogs
Curious about the real challenges of performing a unilateral nephrectomy in dogs? Join us for an enlightening conversation with Dr. Laura Selmic and Carley Johnson. Carly delves into the findings from a recent JAVMA article, revealing the high rate of complications during and after this surgical procedure. From renal neoplasia to end-stage hydronephrosis and severe renal infections, discover the complex conditions that often necessitate nephrectomy and the intricate balance veterinarians must maintain to ensure a successful outcome.
Gain insights into the most common intraoperative and postoperative hurdles, such as low blood pressure, hemorrhage, and acute kidney injuries. Learn how, despite these risks, most dogs ultimately recover well. Laura discusses the pressing need for long-term data to better guide veterinary professionals and pet owners. Don't miss this chance to elevate your understanding of this surgical procedure.
JAVMA article: https://doi.org/10.2460/javma.24.01.0005
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Speaker 2:You're listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode, we chat about unilateral nephrectomy in dogs with our guests Laura Selmick and Carly Johnson. Laura and Carly, thank you so much for being here today.
Speaker 3:Thank you for the invite.
Speaker 2:All right, let's dive right in. So, carly, your JAVMA article discusses how unilateral nephrectomy in dogs is associated with a high rate of intraoperative and postoperative complications. Please share with our listeners the background on this study.
Speaker 4:So unilateral nephrectomy can be performed in dogs for kind of a variety of reasons. Big things that we think of would be things like renal neoplasia, end-stage hydronephrosis, renal dysplasia, renal infection like pyelonephritis or renal abscessation, and a lot of times, you know, we may not have other options for these dogs other than removing the affected kidney. Despite kind of the multitude of reasons why we perform nephrectomy, there's really been kind of a lack of research that's really evaluated kind of the complications associated with nephrectomy, especially in kind of the longer term period we're looking at in these dogs. There was one study in 1996 that did look at nephrectomy in about 30 dogs. That did kind of evaluate what the kind of immediate post-operative complications looked like. But they really only followed these dogs up for about six months and unfortunately it was before. We had a lot of things like iris staging guidelines for things like acute kidney injuries and chronic kidney disease. So a lot of that aspect of you know what did the kidney function of these dogs look like? Is kind of absent from that paper.
Speaker 4:More recently there's been kind of a focus on nephrectomy for renal donors and things like that and there was a more recent study that did find in you know two follow up of healthy dogs that they did have a decent outcome. But you know our dogs and our population aren't necessarily the picture of health when they come in for surgery. So I'm really trying to get an idea of you know when nephrectomies need to be our best treatment option for these dogs. You know what are things that we can help use to guide owners as far as what this treatment option is going to look like and you know what are these complications going to be and what is the long-term period going to look like for these dogs?
Speaker 2:Yeah, thank you for sharing this information with Javma. I think it's going to be really important and hopefully interesting to you for our readers. Now, carly, what were some of the pivotal findings from this study?
Speaker 4:So what we found was that nephrectomy the procedure itself was associated with a fairly large amount of intraoperative complications, with the most common being low blood pressure, hypotension and hemorrhage, but, that being said, most of them were fairly minor and most of the dogs went on to make a full recovery from the surgery itself. Similarly, postoperative complications were also fairly common in this population of dogs, but most of the complications, similarly, were fairly minor, with most of them actually being associated with acute kidney injuries in 12 out of the 69 dogs. And then the second most common was hematuria, but most of these dogs went on to make a fairly full recovery from surgery, and Laura what sparked your research interest in nephrectomy?
Speaker 3:Yeah, we got interested in this because you can use nephrectomy for various conditions, but actually we realized that we didn't have very much data, very much in the literature, regarding how they do long-term. And this is really important for both the clients, the owners of the animals, and also for ourselves and veterinarians that are following up the cases so that we know what to look out for and what might happen in the long term. And so, while there might not be another treatment option, it is important because we might be able to try and mitigate some of the types of complications that could occur both intraoperatively and then also in the longer term.
Speaker 2:Yeah, this knowledge is going to be really important, I think, for future clinicians moving forward. And, laura, selfishly, why did you choose to submit this manuscript to JAVMA?
Speaker 3:Yeah, so we had picked JAVMA because we wanted to get this information to clinicians, to veterinarians, who would most benefit from this information, and so this is a common procedure that's performed in general practice, in specialty practice, and a variety of general practitioners and specialists will treat these cases even after nephrectomy. So it's good that we really understand the sequelae and the types of complications from the procedure.
Speaker 2:We appreciate you sharing this manuscript with us. We strive for a fast and fair peer review process and currently we have less than 100 days from submission of publication for both Shavam and AJVR. You have a really fantastic team, so we hope to see more manuscripts from your group, and I asked Carly earlier about the pivotal findings from the study. But, laura, what were some of the most surprising findings from the study?
Speaker 3:I think probably what surprised us the most really was when we looked at the patients. In the long term, it does make sense that we might see more decline in renal function over time as a factor of aging dogs, but also as a factor of having less remaining functional nephrons than if the dog had two kidneys, and so it was very interesting finding out how many of these dogs did in the end develop some form of chronic renal insufficiency. So that was surprising.
Speaker 2:finally, and for our listeners just joining us, we're discussing unilateral nephrectomy in dogs with our guests Laura Selmick and Carly Johnson. So now, kind of moving to the more personal side of things, carly, how did your advanced training prepare you to write this manuscript?
Speaker 4:I think, at least as far as my training side of it goes, I've actually had the opportunity to be a part of multiple nephrectomies which I think kind of not only like spurred my interest in it but also kind of helped me relate to like what the procedure looks like and why the interoperative complications that we see in these dogs really do make sense. And I've been able to see or be a part of part of some of the kind of long term complication side of these things with these dogs as far as in that postoperative period and what that looks like. So I think kind of having that baseline really helped me write that manuscript yeah having that firsthand clinical experience can be super helpful.
Speaker 2:And, laura, how did your advanced training prepare you to help mentor Carly to write this manuscript?
Speaker 3:That's a good question. So, yeah, throughout my time as a faculty member, I have definitely enjoyed mentoring students, interns, residents, fellows towards publication and completion of research projects, perspective and also retrospective ones like this. I think it's definitely key, like Khalid said, that we're answering some of the important clinical questions, but also these clinical questions are inspiring to the students and interns and residents that are looking at these questions, and so this one was one that was particularly relevant, and so I think that it was straightforward to mentor Carly on this project because it was an inspiring one.
Speaker 2:Now this next set of questions is going to be very important for our listeners. Carly, what is one piece of information the veterinarian should know before discussing unilateral nephrectomy with a client?
Speaker 4:I think the biggest thing would truly be the need for long-term follow-up in these dogs and especially fairly close monitoring of renal values. Almost 50% of the dogs that we did have long-term follow-up in this population did go on to develop chronic kidney disease, which, while that may or may not be secondary to the nephrectomy itself, these dogs will have 50% less nephrons than a dog that has both kidneys. So really making sure that we're monitoring these dogs closely in that long-term period to make sure you know if they are going to develop chronic kidney disease, can we diagnose that quickly so potentially we could intervene in these dogs and continue to help them live a good quality of life.
Speaker 2:And on the other side of the relationship, what's one thing clients should consider around a unilateral nephrectomy for their pet.
Speaker 4:I think from the client standpoint, similarly to the clinician standpoint, kind of what the long-term follow-up period would look like. But if they're looking kind of at the immediate surgery period itself, I think you know, being aware that there are complications, that they can happen and they do happen fairly frequently, but also being aware that most of them were minor and most of these dogs did make it out of hospital and do very well post-operatively, is something that's going to be really important for these clients.
Speaker 2:Thank you. Client communication is so key, so I feel like this manuscript, too, will hopefully help clinicians in that regard as well. And now we get to move on to the fun part. These questions are also just kind of something interesting, so our listeners can learn more about you, carly. What is the oldest or most interesting item on your desk or in your desk drawer?
Speaker 4:So I sit at a shared desk that typically belongs to a surgical oncology fellow, and while I was going through the drawers, when I first kind of moved in here, there was just a bag of these little like fingertip hands, little plastic hands. I think they're supposed to be for children, like they definitely don't fit on my hands, but that's probably the most interesting thing that I have on my desk right now.
Speaker 2:That's too funny. Were you able to ask, like, what what they're for, how they got there?
Speaker 4:I have not cause. I unfortunately found them after after this fellow left um, but I would be very interested to know why they did have them we haven't had that answer before, so that's too funny.
Speaker 2:And, laura, what is your favorite animal fact?
Speaker 3:well, I guess my favorite would be, um, that the mantis shrimp has, uh, really cool very, very sensitive eyes. So it has six focal points, so it's got three focal points in each eye. It also has up to 16 photoreceptors, so they see UV light, visible light and polarized light, and so I got to learn a bit more about mantis shrimps when I was working on a research project with an engineer that was modeling the cameras to detect near-infrared fluorescent imaging agents, with a camera that had this many focal points, because the mantis shrimp eye was the model.
Speaker 2:Very cool. Yeah, I think crustaceans are so interesting. So thank you for sharing that, and just thank you again. Laura and Carly Really appreciate you being here and for sharing your manuscript with Javma.
Speaker 4:Absolutely. Thank you for having us.
Speaker 3:Thank you very much for inviting me to be part of this podcast.
Speaker 2:And to our listeners. You can read Laura and Carly's article and print Javma or online using your favorite search engine. I'm Sarah Wright. I want to thank each of you for joining us on this episode of the Veterinary Vertex podcast. We love sharing cutting edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
