Unilateral nephrectomy in dogs is associated with a high rate of intraoperative and postoperative complications

Carley Johnson Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Hunter Piegols Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Janis Lapsley Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Laura E. Selmic Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Abstract

OBJECTIVE

To determine the incidence of complications in the intraoperative and postoperative period for dogs undergoing nephrectomy for renal disease.

ANIMALS

69 dogs.

METHODS

Medical records of dogs undergoing nephrectomies for renal disease were reviewed for signalment, date of surgery, results of blood analyses, and intra- and postoperative complications. Long-term follow-up was obtained via client telephone interview or referring veterinarian medical records. A Fisher exact test was used to assess the relationship between postoperative acute kidney injury and NSAID administration with long-term development of chronic kidney disease.

RESULTS

Complications occurred in 44.9% and 42.6% of dogs in the intraoperative and postoperative periods, respectively. Most of these were lower-grade complications, though a total of 7 dogs died during the postoperative period. An acute kidney injury was diagnosed in 12 dogs postoperatively, with 2 dogs euthanized due to the severity of the injury. Long-term follow-up was available for 53 dogs, with 24 (45.3%) dogs developing chronic kidney disease. Postoperative acute kidney injury (P = .385) and NSAID administration (P = .519) were not statistically associated with the development of chronic kidney disease in this population.

CLINICAL RELEVANCE

Unilateral nephrectomy is associated with high intraoperative and postoperative complication rates in dogs. Chronic kidney disease was diagnosed in almost 50% of the population with available long-term follow-up.

Abstract

OBJECTIVE

To determine the incidence of complications in the intraoperative and postoperative period for dogs undergoing nephrectomy for renal disease.

ANIMALS

69 dogs.

METHODS

Medical records of dogs undergoing nephrectomies for renal disease were reviewed for signalment, date of surgery, results of blood analyses, and intra- and postoperative complications. Long-term follow-up was obtained via client telephone interview or referring veterinarian medical records. A Fisher exact test was used to assess the relationship between postoperative acute kidney injury and NSAID administration with long-term development of chronic kidney disease.

RESULTS

Complications occurred in 44.9% and 42.6% of dogs in the intraoperative and postoperative periods, respectively. Most of these were lower-grade complications, though a total of 7 dogs died during the postoperative period. An acute kidney injury was diagnosed in 12 dogs postoperatively, with 2 dogs euthanized due to the severity of the injury. Long-term follow-up was available for 53 dogs, with 24 (45.3%) dogs developing chronic kidney disease. Postoperative acute kidney injury (P = .385) and NSAID administration (P = .519) were not statistically associated with the development of chronic kidney disease in this population.

CLINICAL RELEVANCE

Unilateral nephrectomy is associated with high intraoperative and postoperative complication rates in dogs. Chronic kidney disease was diagnosed in almost 50% of the population with available long-term follow-up.

Introduction

Unilateral nephrectomy is performed in dogs with renal diseases including renal neoplasia, end-stage hydronephrosis, renal abscessation, and renal dysplasia.13 Unilateral nephrectomy has historically been reported to be well tolerated in healthy renal donor dogs with compensatory renal hypertrophy reported to occur.4,5 Only 1 study6 has assessed complications in 30 dogs with renal disease following unilateral nephrectomy. This study did not assess intraoperative complications associated with the nephrectomy procedure or the development of acute kidney injury (AKI) and chronic kidney disease (CKD) postoperatively.6 No further studies since this report have assessed the development of AKI and CKD following unilateral nephrectomy in dogs with renal disease since the International Renal Interest Society (IRIS) published initial guidelines on the classification of CKD in dogs.7,8 At this time, there is still a large gap in understanding the prognosis associated with unilateral nephrectomy in dogs performed secondary to renal disease.

Complications associated with unilateral nephrectomy in humans have been more widely reported, with up to 13% and 40% of patients experiencing a complication in the intraoperative and postoperative periods, respectively.9,10 These complications are commonly less severe in nature, with low mortality rates in humans but may result in longer hospitalization and recovery periods.9,10 Complications following nephrectomy in dogs have not been well documented, but it is important to be aware of the complications associated with unilateral nephrectomies in the perioperative and long-term periods in dogs when nephrectomy is the treatment of choice for a renal disease. Understanding perioperative complications can help set owner and clinician expectations associated with the procedure and postoperative period and can help guide clinician selection and management of cases. This may include measuring GFR prior to any nephrectomy to better assess renal function of the contralateral kidney and strict blood pressure monitoring and management perioperatively to prevent ischemic renal injury. Knowledge of long-term complications, especially those associated with the development of CKD, can help structure recommended rechecks of renal values and ensure that CKD is diagnosed promptly to start appropriate treatment. The objective of this study was to assess the perioperative and long-term complication rate associated with unilateral nephrectomies in dogs with renal disease and assess for factors that may increase the risk of CKD development, such as a postoperative AKI and NSAID usage. The authors hypothesized that histological diagnosis would not affect the risk of CKD development and that dogs that developed a postoperative AKI and received NSAIDs would have a higher risk of developing CKD.

Methods

The electronic medical records from The Ohio State University Veterinary Medical Center (OSU-VMC) were searched for billing triggers associated with a unilateral nephrectomy procedure between September 1, 2013, and September 1, 2023. Dogs were included in the study if a unilateral nephrectomy was performed due to unilateral renal disease, including intraoperative damage to a kidney resulting in nephrectomy. Long-term follow-up was collected from the medical records or via medical records from the referring veterinarian if there was no documented examination or bloodwork at the OSU-VMC following surgery. Owner follow-up via phone was attempted if no further follow-up information was available from the referring veterinarian. Dogs were excluded from long-term follow-up if a record of euthanasia or most recent veterinary visit were not available, the owner could not be reached for further follow-up, or bloodwork was not available following surgery.

Data collected from the medical records included the signalment, reason for presentation for nephrectomy, preoperative creatinine and BUN levels, whether GFR was evaluated preoperatively and the results if performed, and any preexisting medical or health conditions. The anesthesia records were reviewed for any intraoperative complications and interventions performed for those complications. The anesthesia record was also used to calculate the length of the anesthetic event as the time between induction of anesthesia and extubation. The surgery reports were reviewed for the level of training of the primary surgeon, other procedures that were performed under the same anesthetic event, any intraoperative surgical complications that occurred, and any interventions performed for those complications. Treatment sheets from the postoperative hospitalization period were reviewed for complications and any required interventions along with NSAID usage. Initial postoperative creatinine and BUN levels were reported if available. Medical records from the OSU-VMC and referring veterinarians were reviewed to determine the last available follow-up on dogs undergoing unilateral nephrectomies. Most recent creatinine and BUN levels were reported, if available. If the dog was deceased at the time of study follow-up, the date of death, cause of death, or suspected cause of death or reason for humane euthanasia were collected. For dogs that were still alive at the time of study follow-up, the date of the last available follow-up was recorded.

Creatinine values were assessed preoperatively within 24 hours of surgery, postoperatively within 24 hours of surgery, and at the most recent recheck if still alive or at the last recheck before death to assess for the development of a postoperative AKI and/or the development of CKD. Dogs were staged for both AKI and CKD on the basis of IRIS guidelines.8,11 Acute kidney injury staging ranged from stage 1 (nonazotemic but a > 0.3-mg/dL increase in creatinine in < 48 hours) to stage 5 (creatinine > 10 mg/dL). Chronic kidney disease staging ranged from stage 1 (creatinine < 1.4 mg/dL) to stage 4 (creatinine > 5.0 mg/dL).

Complications were considered any adverse event that occurred during the intraoperative or postoperative period. Intraoperative complications were considered those that occurred between initial skin incision and skin closure. Postoperative complications were those that occurred following skin closure and up to 14 days postoperatively. This included the development of a postoperative AKI. Intraoperative complications were graded by use of the Classification of Intraoperative Complication System from 1 (no treatment needed) to 4 (death).12 Postoperative complications were graded by the Contracted Accordion Severity Classification System from 1 (mild complication) to 4 (death).13

Statistical analysis

Descriptive statistics were calculated to summarize dog signalment data. Continuous variables were assessed for normality using a Shapiro-Wilk test. Data with a normal distribution were reported as mean ± SD and nonnormal distribution as median and IQR. The duration of follow-up was calculated as the number of days between the last available follow-up and the date of surgery. If GFR was evaluated preoperatively, results were compared to the development of a postoperative AKI and diagnosis of CKD using Fisher exact tests. Histological diagnosis, diagnosis of postoperative AKI, and postoperative NSAID usage were each compared to the diagnosis of CKD using Fisher exact tests. A P value < .05 was considered significant for all results. A Kaplan-Meier survival plot was created to show survival rates for all dogs with long-term follow-up compared to those with long-term follow-up with neoplastic versus benign renal lesions based on histopathology. All analyses were conducted using commercial software (SPSS Statistics for Windows, version 29.0; IBM Corp).

Results

A total of 69 dogs had a unilateral nephrectomy performed during the given period with perioperative information available. Long-term follow-up was available for 53 dogs, with 51 dogs having veterinary records available and only 2 requiring owner phone interviews to retrieve records. Dog signalment and baseline presentation information is presented in Table 1. The median age of these dogs was 7.9 years (range, 0.4 to 14.9 years). Of the dogs, 27 were castrated males, 6 were intact males, 29 were spayed females, and 7 were intact females. Mixed-breed dogs were the most common in this population (n = 18). The most common pure breeds consisted of Labrador Retriever (n = 6), Golden Retriever (5), Yorkshire Terrier (4), Bichon Frise (3), and pit bull–type breed (3). Preoperative creatinine levels showed a median of 0.9 mg/dL (range, 0.3 to 3.39 mg/dL; reference interval, 0.1 to 1.3 mg/dL). Creatinine and BUN levels from the preoperative, immediate postoperative, and long-term follow-up bloodwork are presented in Figures 1 and 2. Glomerular filtration rate was assessed in 9 (13%) dogs, with only 2 (16.7%) dogs having abnormal GFR of their contralateral kidney. Dogs were presented primarily for unilateral nephrectomy for treatment of neoplastic renal lesions (n = 37), benign lesions (30), and trauma (2). All surgeries were performed by a board-certified surgeon or a resident or fellow under the supervision of a surgeon. The median time under anesthesia was 184 minutes (range, 80 to 330 minutes). Additional surgical procedures were performed in 47 (68%) dogs, consisting of liver biopsy (n = 10), cystotomy (9), ipsilateral adrenalectomy (9), splenectomy (9), ovariohysterectomy (6), lymphadenectomy (5), castration (3), gastropexy (2), small intestinal resection and anastomosis (2), partial pancreatectomy (1), diaphragmatic mass excision (1), and retroperitoneal mass excision (1). Histological diagnosis was available for 64 dogs. Neoplastic lesions were present in 37 (53.6%) dogs and benign lesions in 32 (46.4%) dogs. Neoplastic lesions consisted of renal carcinoma (n = 18), hemangiosarcoma (7), invasive pheochromocytoma (3), spindle cell sarcoma (2), ureteral leiomyosarcoma (2), nephroblastoma (1), osteosarcoma (1), and fibrosarcoma (1). Benign lesions consisted of hydronephrosis (n = 13), pyelonephritis (10), renal dysplasia (4), renal artery thrombosis (1), and renal pelvic diverticulum (1). Of the 5 dogs that did not have histopathology available, nephrectomy was performed secondary to trauma (n = 2), suspected neoplasia (2), and hydronephrosis (1). All surgeries were performed by a board-certified surgeon or a resident or fellow under surgeon supervision. The median time under anesthesia was 184 minutes (range, 80 to 330 minutes). Intraoperative surgical complications occurred in 31 (44.9%) dogs (Table 2). These consisted of grade 1 in 7 (10.1%) dogs, grade 2 in 16 (23.2%) dogs, grade 3 in 7 (10.1%) dogs, and grade 4 in 1 (1.4%) dog. Grade 1 complications were associated with mild hypotension that did not require treatment (n = 3), mild hemorrhage that did not require intervention (3), and accidental premature laceration of the ureter associated with the nephrectomized kidney (1). Grade 2 complications consisted of moderate hypotension requiring treatment (n = 13) and moderate hemorrhage that did not require blood transfusion (3). Grade 3 complications consisted of severe hypotension that required intervention (n = 1) and severe intraoperative hemorrhage that required blood transfusion (6). Grade 4 complications occurred in 1 dog that was in septic shock before anesthesia following a dog attack. The dog experienced cardiopulmonary arrest during the procedure. Cardiopulmonary resuscitation was performed on this dog, and it experienced a return of spontaneous circulation intraoperatively. This dog experienced cardiopulmonary arrest again during the immediate postoperative period and did not experience return of spontaneous circulation.

Table 1

Dog signalment including median age (median [IQR]) and sex, lateralization of the nephrectomized kidney, and histologic diagnosis for 69 dogs undergoing unilateral nephrectomy.

Variable Total
Age (y)a 7.9 (5.4)
Sex
  Intact male 6
  Castrated male 27
  Intact female 7
  Spayed female 29
Kidney removed
  Right 30
  Left 39
Lesion type
  Neoplasia 35
  Renal cell carcinoma 18
  Hemangiosarcoma 7
  Invasive pheochromocytoma 3
  Spindle cell sarcoma 2
  Nephroblastoma 1
  Osteosarcoma 1
  Fibrosarcoma 1
  Ureteral leiomyosarcoma 2
  Benign 29
  Hydronephrosis 13
  Pyelonephritis 10
  Renal dysplasia 4
  Renal artery thrombosis 1
  Renal pelvic diverticulum 1

aData are presented as median (IQR).

Figure 1
Figure 1

Preoperative, immediate postoperative, and long-term follow-up creatinine values in 69 dogs undergoing unilateral nephrectomy. One extreme outlier was excluded from the figure. The preoperative and postoperative reference interval was 0.1 to 1.3 mg/dL. Circles are outliers within 1.5 to 3 times the IQR, and triangles are outliers outside of 3 times the IQR.

Citation: Journal of the American Veterinary Medical Association 262, 6; 10.2460/javma.24.01.0005

Figure 2
Figure 2

Preoperative, immediate postoperative, and long-term follow-up BUN values in 69 dogs undergoing unilateral nephrectomy. One extreme outlier was excluded from the figure. The preoperative and postoperative reference interval was 10 to 27 mg/dL. Circles are outliers within 1.5 to 3 times the IQR, and triangles are outliers outside of 3 times the IQR.

Citation: Journal of the American Veterinary Medical Association 262, 6; 10.2460/javma.24.01.0005

Table 2

Proportion of dogs that developed intraoperative and postoperative complications, including diagnosis of acute kidney injury and chronic kidney disease, in 69 dogs undergoing unilateral nephrectomy.

Variable Total Percentage
Intraoperative complications 31 44.9%
  Grade 1 7 10.1%
  Grade 2 16 23.2%
  Grade 3 7 10.1%
  Grade 4 1 1.4%
Postoperative complications 29 42.6%
  Grade 1 12 17.6%
  Grade 2 10 14.7%
  Grade 3 0 0%
  Grade 4 7 10.3%
Acute kidney injury 12 17.4%
  Stage 1 7 10.1%
  Stage 2 3 4.3%
  Stage 3 2 2.9%
Chronic kidney disease 24 34.8%
  Stage 1 3 4.3%
  Stage 2 18 26.0%
  Stage 3 2 2.9%
  Stage 4 1 1.4%

Postoperative complications occurred in 29 (42%) dogs (Table 2). These consisted of grade 1 in 12 dogs, grade 2 in 10 dogs, and grade 4 in 7 dogs. Grade 1 postoperative complications consisted of hematuria (n = 7), stranguria (4), abdominal pain (3), and anorexia (2). One reported case of hematuria had a concurrent partial cystectomy, and the remaining 6 were not associated with surgery of the urinary bladder. Grade 2 complications consisted of fluid-responsive AKI (n = 8), urethral obstruction (1), pancreatitis (1), and cardiac arrhythmias (3). Grade 4 complications consisted of euthanasia (n = 5) and cardiopulmonary arrest (2). Euthanasia was performed secondary to severe anuric AKI (n = 2), extensive suspected metastatic disease found intraoperatively (1), necrotizing pancreatitis (1), and the development of pleural effusion (1). Postoperative creatinine levels had a median of 0.9 mg/dL (range, 0.1 to 4.8 mg/dL; reference interval, 0.1 to 1.3 mg/dL; Figures 1 and 2). Twelve dogs with postoperative complications were associated with the development of an AKI. International Renal Interest Society staging for these dogs consisted of 7 with stage 1, 3 with stage 2, and 2 with stage 3 AKI. Creatinine and BUN normalized or plateaued for all dogs before they were discharged, apart from 2 dogs that were euthanized secondary to severe anuric AKI.

Long-term follow-up was available for 53 dogs, with a median of 2 years (range, 0.04 to 9.9 years) available postoperatively. Twenty-one (39.6%) of these dogs were alive and 32 (60.4%) were deceased at the time of the last follow-up (Figure 3). For dogs still alive, the median age at the time of last follow-up was 7.5 years (range, 1.4 to 14.3 years). For deceased dogs, the median age at the time of death was 12.5 years (range, 5.1 to 16.9 years). The median time since surgery and last follow-up for alive and deceased dogs was 1.24 years (range, 0.1 to 9.9 years) and 2.11 years (range, 0.1 to 9.5 years), respectively. Creatinine levels at the time of last follow-up had a median of 1.2 mg/dL (range, 0.4 to 11.1 mg/dL; Figures 1 and 2). Of these dogs, 24 (45.3%) developed CKD. The median time from surgery to diagnosis of CKD was 108 days (range, 13 to 2,764 days). Reasons for nephrectomy in these dogs included neoplasia (n = 13), pyelonephritis (5), hydronephrosis (5), and thrombosis of the renal artery (1). Histological diagnosis of the nephrectomized kidney was not associated with the risk of CKD development in this population (P = .433). International Renal Interest Society staging for these dogs consisted of stage 1 (n = 3), stage 2 (18), stage 3 (2), and stage 4 (1). Of those that developed CKD, 8 (33.3%) dogs were euthanized secondary to the progression of their CKD.

Figure 3
Figure 3

Kaplan-Meier survival plot showing survival rates for 53 dogs with long-term follow-up available following unilateral nephrectomy and stratified by benign (n = 24) versus neoplastic (29) histological diagnosis.

Citation: Journal of the American Veterinary Medical Association 262, 6; 10.2460/javma.24.01.0005

Of the 53 dogs with long-term follow-up, 8 dogs (15.1%) had the GFR of the contralateral kidney assessed prior to surgery. Two of these dogs had abnormal contralateral kidney function, with one of these dogs developing CKD. Preoperative assessment of the GFR of the contralateral kidney was independent of CKD development in this population (P = .653). Six (11.3%) dogs with long-term follow-up had an AKI diagnosed following surgery. Four (66.7%) dogs diagnosed with an AKI postoperatively developed CKD based on long-term follow-up as opposed to 20 (37.7%) dogs that were not diagnosed with an AKI. Development of an AKI postoperatively was not found to be associated with the development of CKD in this population (P = .385). Of dogs with long-term follow-up, 12 (22.6%) dogs received an NSAID postoperatively. Of those that received an NSAID, 4 (33.3%) dogs developed CKD as opposed to 20 (37.7%) dogs that did not receive an NSAID. Postoperative NSAID administration was not found to be associated with the development of CKD in this population of dogs (P = .519).

Discussion

This study found that intraoperative and postoperative complications were high following unilateral nephrectomy in dogs, with many developing perioperative AKI and CKD during long-term follow-up. Few dogs in this population had GFR measured preoperatively, and an abnormal GFR was not associated with increased risk of CKD development long-term. This may have been secondary to the low number of dogs that had GFR measured preoperatively and that 83.3% of those that did have GFR assessed had a normal GFR of the contralateral kidney. Postoperative AKI and NSAID administration in the postoperative period were not associated with increased risk of CKD development long-term in this population. This may have been secondary to the small number of dogs that received postoperative NSAIDs or may represent that appropriate NSAID dosages are safe to use in these dogs following nephrectomy.

Intraoperative complications occurred in 44.9% of the dogs in this population, with complications divided almost evenly into low and high grades and only 1 reported intraoperative death. Twelve of the 31 (40%) dogs in this study had complications secondary to hemorrhage associated with renal dissection. Severe hemorrhage, considered as loss of > 15% of blood volume, was noted in 6 (8.7%) dogs, with all receiving an intraoperative blood transfusion. Twenty-three of the 31 (74.2%) dogs that experienced an intraoperative complication were grades 1 and 2. The previous study6 in dogs reported an intraoperative complication rate of approximately 26.7%, with 8 of 30 dogs having an intraoperative complication. These consisted of hypotension in 6 dogs and damage to surrounding structures in 2 dogs.6 In humans undergoing unilateral nephrectomies, intraoperative complications have been reported between 1.2% and 13.3%, with most complications related to hemorrhage from associated vessels or surrounding organs.10,14,15 These complications are reported to be split almost equally between severe and nonsevere complications, with no reported intraoperative mortality.10 Hemorrhage during nephrectomy in human patients has been reported to be severe, with 15.4% and 24.1% of patients losing > 1 L of blood and requiring transfusion, respectively.14

Postoperative complications occurred in 42.6% of the dogs in this study. Most of these complications were low in grade, with 76% being grade 1 and 2. The postoperative mortality rate in this population of dogs was 10.3%, with 5 of the 7 dogs being humanely euthanized due to the severity of their complication. A previous study6 in dogs reported 32 postoperative complications in 30 dogs, with the most frequent consisting of abdominal pain, vomiting, and oliguria. There was no postoperative mortality reported in this previous study.6 In humans, postoperative complications have been reported in approximately 10% to 40% of nephrectomies, with 2 larger retrospective studies reporting complications in closer to 40% of the population.9,14,1618 These complications are reported to be overall lower in severity, with a study finding higher-grade complications in only 22% of human patients.16 Postoperative mortality in humans has been reported to occur in 1.8% of patients.14 Overall incidence of postoperative complications is similar between both dogs and humans, with a higher incidence of low-grade complications. The higher mortality rate found in dogs in this study may be secondary to decreased availability of treatments such as dialysis for dogs as compared to human patients or the ability to perform humane euthanasia in veterinary species.

Twelve (17.6%) dogs in this study developed an AKI following surgery. Ten of these dogs recovered renal function with treatment, and 2 (16.7%) dogs were euthanized secondary to severe anuric AKI. Dialysis was attempted in 1 dog with anuric AKI, but the dog had severe complications secondary to treatment, so it had to be discontinued. Previous studies in dogs have not reported the frequency of AKI following nephrectomy but have noted increases in creatinine postoperatively in healthy kidney donor dogs, with the mean value changing from 1.22 to 1.66 mg/dL.5 Gookin et al6 did not comment on kidney function postoperatively but did find a mean postoperative creatinine of 2.2 mg/dL, with 5 dogs noted to be oliguric following surgery. Unilateral nephrectomy has been reported to cause postoperative AKI in approximately 21% to 34% of human patients.19,20 One study20 of 941 human patients found that the development of an AKI was associated with a < 1% mortality rate in the immediate postoperative period. While AKI may be reported more frequently in humans following nephrectomy, the mortality rate in dogs was much higher in this study. This was likely secondary to the increased availability and feasibility of advanced treatment options such as dialysis in human patients to facilitate renal recovery.

Chronic kidney disease developed in 45.3% of the dogs in this study, with 8 of these dogs euthanized secondary to the progressive nature of their CKD at the time of last follow-up. Methods to evaluate for increased risk of CKD development, such as assessing GFR preoperatively, were not associated with risk of CKD development in this study. Only 9 dogs had a GFR assessed, with 1 dog with a low GFR of the contralateral kidney developing CKD and 2 dogs with a normal contralateral GFR developing CKD. No previous study has assessed the frequency of CKD following nephrectomy in dogs.6 CKD is reported to develop in 31% to 43.4% of humans following nephrectomy.2123 Nephrectomy in humans has been associated with increased risk of CKD development, with a statistically higher risk of developing CKD following nephrectomy for renal donation when compared to patients that did not donate a kidney.24 Factors in humans related to increased risk of CKD development include a postoperative AKI and abnormal GFR of the contralateral kidney preoperatively.19,22 Postoperative AKI has also been associated with an increased likelihood of developing CKD in human patients, with 1 study19 reporting CKD in 50% of patients 5 years after postoperative AKI. There was not a significant difference in the development of CKD in this population of dogs associated with postoperative AKI. This may have been secondary to the small population size, a shorter follow-up time, or lack of bloodwork at the time of long-term follow-up in this population, therefore not diagnosing CKD in a subset of dogs.

Kidney injuries are most commonly reported secondary to ischemic and inflammatory lesions, renal infections, and exposure to nephrotoxic substances.25 While we could not assess the risk of CKD due to unilateral nephrectomy on the basis of this study design, it is suspected that these animals may be more susceptible to CKD due to the reduction of functional nephrons.

Nonsteroidal anti-inflammatory drug use was reported in 22.6% of the dogs in this population and was not found to be associated with the development of CKD. No previous studies have assessed the use of NSAIDs following unilateral nephrectomy in veterinary species; however, NSAID use is reported in human patients following nephrectomy.26 Han et al26 found that postoperative NSAID usage was not associated with a significantly different GFR when compared to humans who received opioid pain medication. This study also found that NSAIDs did not result in significantly lower postoperative pain scores but did reduce the length of hospitalization in patients following nephrectomy.26 Previous studies in dogs have found that NSAID administration is not associated with severe changes in renal function, with carprofen having the least effect on renal function.27 With no adverse effects seen with NSAID use in humans following nephrectomy and the lack of association in this study with NSAID use and the development of CKD in this population, postoperative treatment with NSAIDs may be considered when dosed appropriately in dogs following nephrectomy.

This study should be read in light of its limitations. Only 69 dogs were identified for inclusion in this study, with multiple indications for nephrectomy. A larger population would have increased the statistical power of this study. The retrospective nature of this study made it susceptible to inaccurate or incomplete medical record–keeping. Postoperative follow-up in these dogs was also performed most frequently with referring veterinarians; follow-up bloodwork would have been performed on different analyzers in these cases, which could be a potential cause of differences in renal values. Several dogs did not have bloodwork repeated following surgery, potentially leading to an underestimation of the number of dogs that developed CKD in this population.

In conclusion, unilateral nephrectomy is associated with a high complication rate in dogs with known disease of the nephrectomized kidney. Over one-third of this population developed CKD per IRIS guidelines despite not having preoperative evidence of renal insufficiency, and one-third of those dogs were euthanized secondary to the progression of their CKD. Understanding perioperative and long-term complications can help owners and clinicians set postoperative expectations and structure further rechecking of renal values postoperatively. Further prospective research is needed to assess the impact of different indications for nephrectomy, postoperative AKI, and NSAID administration in dogs following nephrectomy and the role they might play in the development of CKD.

Acknowledgments

None reported.

Disclosures

The authors have nothing to disclose. No AI-assisted technologies were used in the generation of this manuscript.

Funding

The authors have nothing to disclose.

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