Dog with kidney injury and lung swelling improves after dialysis

Abstract

A 7-year-old, 3.44-kg, spayed female Poodle was referred for acute kidney injury following firocoxib administration. Initial diagnostics revealed severe uraemia, oliguria and elevated C-reactive protein levels. Despite fluid resuscitation and diuretic therapy, oliguria persisted, necessitating haemodialysis. On Day 2, post-haemodialysis, the patient developed progressive pulmonary infiltration. The acute onset of tachypnoea, in the absence of cardiac disease or fluid overload, suggested noncardiogenic pulmonary oedema. Differential diagnoses included uraemic pneumonitis, acute respiratory distress syndrome and transfusion-related acute lung injury. After three haemodialysis sessions, urine output increased to polyuria; however, respiratory symptoms and radiographic abnormalities persisted. By Day 7, pulmonary infiltration had significantly decreased on radiographs, although tachypnoea remained. As polyuria continued, uraemia and radiographic findings progressively improved and tachypnoea resolved by Day 12. The patient was discharged, and by Day 18, follow-up radiographs confirmed complete resolution of pulmonary changes. In this case report, we documented the serial progression and resolution of severe noncardiogenic pulmonary oedema, successfully managed with haemodialysis and supportive care, highlighting the therapeutic importance of addressing the primary uraemic insult.