Successful hemodialysis treatment of a Quarter Horse mare with silver maple leaf toxicity and acute kidney injury.
Authors: Pinnell Erin F, Her Jiwoong, Gordon Daniel, Kinsella Hannah M, Langston Catherine E, Toribio Ramiro E
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Hemodialysis as a Treatment Option for Equine Acute Kidney Injury Silver maple leaf toxicity caused acute intravascular haemolysis and subsequent renal failure in an adult Quarter Horse mare that presented with pigmenturia and lethargy; despite aggressive conventional management including blood transfusion, intravenous fluid therapy, antimicrobials and supportive care, azotaemia persisted as an indicator of non-recovering kidney function. The clinical team implemented two intermittent haemodialysis sessions over three days—a treatment modality rarely reported in equine practice—which successfully reversed the azotaemia, resolved clinical signs, and allowed safe discharge from the hospital. At six-month follow-up, the mare's blood urea nitrogen, creatinine and serum electrolyte concentrations remained within normal ranges, demonstrating sustained renal recovery. Whilst haemodialysis requires specialised equipment and operator expertise typically available only at referral centres, this case demonstrates its viability as a life-saving intervention when conventional therapies fail to restore renal function in horses, suggesting that equine practitioners should consider referral for this treatment when managing cases of acute kidney injury unresponsive to standard management protocols.
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Practical Takeaways
- •Hemodialysis should be considered as a treatment option for horses with acute kidney injury when conventional medical management fails, if equipment and expertise are available
- •Silver maple leaf toxicity causes hemolysis and acute kidney injury in horses and requires aggressive treatment including possible dialysis support
- •Early recognition of pigmenturia and lethargy in horses with potential toxic exposure warrants investigation for hemolytic disease and acute renal failure
Key Findings
- •A Quarter Horse mare with silver maple leaf toxicity and acute kidney injury was successfully treated with 2 hemodialysis sessions over 3 days
- •Azotemia that persisted despite conventional medical management (fluids, transfusion, antibiotics, oxygen) was resolved with hemodialysis
- •Clinical signs improved and biochemical parameters (BUN, creatinine, electrolytes) remained normal 6 months post-treatment