Azotemia in horses refers to an elevated concentration of nitrogenous waste products, such as urea and creatinine, in the blood. This condition is typically indicative of impaired kidney function or reduced renal perfusion. Azotemia can be classified into three types: prerenal, renal, and postrenal, each associated with different underlying causes. Prerenal azotemia often results from dehydration or decreased blood flow to the kidneys, while renal azotemia is due to intrinsic kidney damage. Postrenal azotemia arises from obstructions in the urinary tract. Understanding the type and cause of azotemia is essential for effective management and treatment. This page collates peer-reviewed research studies and scholarly articles that explore the pathophysiology, diagnosis, and treatment strategies for azotemia in equine patients.
Pinnell EF, Her J, Gordon D, Kinsella HM, Langston CE, Toribio RE.An adult American Quarter Horse mare presented for pigmenturia and lethargy of 12 hours' duration and was diagnosed with silver maple leaf toxicity. The mare had intravascular hemolysis and azotemia. The mare was treated with a transfusion of whole blood, fluids administered IV, antibiotics, oxygen insufflation, and supportive care. The azotemia persisted despite conventional medical management and hemodialysis was elected. After 2 intermittent hemodialysis treatments over 3 days, the azotemia almost resolved, clinical signs improved, and the mare was discharged. The blood urea nitrogen, c...
Ford MG, Nelson BB, Ford TS, Souza CRS, Easley JT, Hackett ES.Surgical repair is frequently effective at resolving uroperitoneum in foals, though complications occur. Despite their occurrence, management strategies used to address these complications, and their impact on survival are not clearly defined. To better describe the complications following surgical correction of uroperitoneum and to document treatment strategies and outcomes after intervention, a multi-center retrospective case series was performed. Medical record data of foals undergoing surgical treatment for uroperitoneum were retrieved from three surgical centers, and cases identified with...
Bernick A, Nieth J, Wehrend A.Uroperitoneum is a typical disease in newborn foals. An accumulation of urine develops in the abdominal cavity in consequence to a congenital or acquired leakage in the urinary tract. Colts are more frequently affected than fillies. The most common cause of uroperitoneum is a rupture of the dorsal urinary bladder wall. The urinary bladder is affected in 73.1 %, the urachus in 21.6 % and the ureter in 5.2 % of cases. Typical clinical signs occur 2-5 days postpartum, and encompass reduced general condition, abdominal distention, mild colic symptoms and unphysiologic micturition. Ultrasou...
Bayless RL, Moore AR, Hassel DM, Byer BJ, Landolt GA, Nout-Lomas YS.Detection of equine acute kidney injury (AKI) is hindered by limited markers of early renal damage in horses. N-acetyl-β-D-glucosaminidase (NAG), a lysosomal enzyme in renal tubular epithelium released into urine during tubular insult, has shown promise for early identification of AKI in humans and other species. We validated an assay for NAG in equine urine and measured urinary NAG in 7 azotemic and 7 non-azotemic client-owned adult horses. The enzymatic NAG assay was validated using within- and between-run coefficients of variation (CVs), recovery following standard addition, and linearity ...
Wong DM, Ruby RE, Eatroff A, Yaeger MJ.A newborn foal was presented because it was unresponsive and in cardiopulmonary arrest. Aggressive cardiopulmonary cerebral resuscitation was administered to the foal, which revived the foal; however, acute renal failure developed. Fluid retention and azotemia occurred although the foal was alert and able to suckle. A 6-hour renal replacement therapy session using hemodiafiltration and a continuous renal replacement therapy machine was administered to the foal at 3 days of age which lowered the foal's azotemia and facilitated removal of some of the excess body fluid. Despite therapy, the foal ...
Hardefeldt LY.Four neonatal foals were presented, over a 2-year period, (2011-2012) with aimlessly walking, head pressing, 'chewing gum' seizures and ataxia. The neurological lesion was consistent with increased intracranial pressure in all cases. All foals had severe hyponatraemia and azotaemia identified on biochemistry. Hyponatraemia was transient in 3/4 cases, with the foal in the final case requiring long-term sodium supplementation. Three foals survived to hospital discharge; one was euthanased because of anuric renal failure and one of the surviving foals was euthanased with septic osteomyelitis 2 we...
Thompson JA, Mirza MH, Barker SA, Morgan TW, Bauer RW, McConnico RS.3 Quarter Horse racehorses were examined for suspected clenbuterol overdose 12 to 24 hours after administration by mouth of a compounded clenbuterol product. Results: All horses developed sinus tachycardia, muscle tremors, hyperhidrosis, and colic. Abnormalities on serum biochemical analysis included hyperglycemia, azotemia, and high creatine kinase activity. The presence of clenbuterol in the serum of all 3 horses and in the product administered was confirmed and quantified by use of liquid chromatography-electrospray tandem mass spectrometry. Results: Propranolol (0.01 mg/kg [0.005 mg/lb], I...
Dickinson CE, Gould DH, Davidson AH, Avery PR, Legare ME, Hyatt DR, DebRoy C.A postpartum mare and foal were presented for evaluation of fever and lethargy in the mare. The mare was diagnosed with endometritis and initially responded well to treatment. On the second day of hospitalization, the mare developed renal insufficiency characterized by oliguria, azotemia, hemolysis, and thrombocytopenia. Concurrently, the foal developed rapidly progressive central nervous system signs culminating in refractory seizures. Both animals failed to respond to treatment and were euthanized. Thrombotic microangiopathy involving glomeruli was evident on microscopic examination of the m...
Norman TE, Chaffin MK, Johnson MC, Spangler EA, Weeks BR, Knight R.Five horses were evaluated because of severe cutaneous burn injuries following a barn fire. Gross hemolysis and morphologic changes in RBCs consistent with oxidative damage were detected in all of the horses. Of these horses, 4 became azotemic. The overall goals of treatment included wound care, correction of dehydration and provision of diuresis, control of inflammation, pain management, and prophylaxis against sepsis. After treatment, 2 horses survived and were discharged from the hospital. Red blood cell damage and hemolysis following cutaneous burn injury have been investigated in other sp...
Gallatin LL, Couëtil LL, Ash SR.A 15-year-old Paso Fino gelding was evaluated because of acute renal failure following an episode of exertional rhabdomyolysis. The horse was azotemic and treated conservatively at another referral practice with no improvement in the azotemia. With conservative treatment and intermittent peritoneal dialysis, the horse had minimal improvement. Continuous-flow peritoneal dialysis (CFPD) was instituted on day 7 and continued for 3 consecutive days. Dramatic changes in the horse's attitude and serum creatinine concentration were detected within the first 24 hours of CFPD treatment. The horse remai...
Magdesian KG, Hirsh DC, Jang SS, Hansen LM, Madigan JE.To determine molecular characteristics of Clostridium difficile isolates from foals with diarrhea and identify clinical abnormalities in affected foals. Methods: Retrospective study. Methods: 28 foals with C difficile-associated diarrhea. Methods: Toxigenicity, molecular fingerprinting, and antibiotic susceptibility patterns were determined. Information on signalment, clinical findings, results of clinicopathologic testing, whether antimicrobials had been administered prior to development of diarrhea, and outcome was obtained from the medical records. Results: Twenty-three (82%) foals survived...
Toribio RE, Bain FT, Mrad DR, Messer NT, Sellers RS, Hinchcliff KW.Three weak, recumbent neonatal foals with skin lesions, including a thin wooly coat, were born to mares being treated for equine protozoal myeloencephalitis. Mares received sulfadiazine or sulfamethoxazole-trimethoprim, pyrimethamine, folic acid, and vitamin E orally. Foals were anemic, leukopenic, azotemic, hyponatremic, and hyperkalemic. Serum folate concentrations in the 3 foals and 2 mares were lower than those reported in the literature for clinically normal brood mares. Treatment was unsuccessful. For each foal, necropsy revealed lobulated kidneys with thin cortices and a pale medulla, a...
Rodger LD, Carlson GP, Moran ME, Yarbrough TB, Pascoe JR, Reynolds JA.A 3-year-old Thoroughbred colt was presented for evaluation of azotemia and anorexia. Physical examination revealed a ureterolith in the left ureter, approximately 10 cm from the bladder, which was thought to obstruct urine flow by approximately 90% when viewed cystoscopically. Ultrasonographic examination of both kidneys revealed indistinct corticomedullary junctions, and the right kidney was more hyperechoic. A percutaneous biopsy of the right kidney revealed chronic interstitial nephritis with marked interstitial medullary fibrosis. Medical therapy consisting of IV fluids, sodium chloride P...
Green SL, Conlon PD, Mama K, Baird JD.The effects of hypoxia and azotaemia on the pharmacokinetics of amikacin were evaluated in 20 full-term neonatal critically ill foals which required 24-h supportive care, antibiotics and dextrose-supplemented polyionic fluids given intravenously, nasal insufflation with oxygen and nutritional supplementation. There was no association between sepsis score or survival and pharmacokinetic parameters. Concurrent hypoxia and azotaemia were associated with significantly decreased clearance and increased peak and trough serum concentrations of amikacin; however, peaks or troughs did not exceed toxic ...
Byars TD, Simpson JS, Divers TJ, Shiner KA, Rantanen NW.Percutaneous nephrostomy was used to provide urine output in a 3-year-old Thoroughbred filly with azotemia and obstructive ureterolithiasis. Previous left ureteral surgery had failed to provide clinical improvement, and the filly became more azotemic. Nephrostomy was performed in the standing patient, with ultrasonographic guidance and local anesthesia. Continuing IV fluid therapy and diuresis through the nephrostomy tube resulted in a decrease in clinical signs of azotemia. However, the filly developed a cecal impaction, which ruptured during surgery because of colic, and was euthanatized.
Divers TJ, Byars TD, Spirito M.Bilateral ureteral defects were diagnosed as the cause of depression and azotemia in an 8-day-old Thoroughbred filly. The azotemia resulted from accumulation of urine in the retroperitoneal area. A ventral midline laparotomy was performed, and defects found in both the left and right ureter were repaired. Uroperitoneum and abdominal distention, presumably from urine leakage at the left ureteral surgery site, were detected on the fourth postoperative day and necessitated abdominal drainage. Thirty-six hours later, the leakage stopped spontaneously, and the foal recovered normally. This report s...
Morris CF, Robertson JL, Mann PC, Clark S, Divers TJ.A syndrome characterized clinically by oliguria, progressive severe azotemia, and edema of the abdomen and groin was seen in 2 horses. Treatment with fluids, diuretics, and corticosteroids administered intravenously was ineffective, and the horses were euthanatized. Microscopically, there was severe necrotizing angiopathy with profuse fibrin deposition in renal glomeruli and sinusoids of peripheral lymph nodes. The signs observed in the horses resembled hemolytic-uremic syndrome in human beings.
Roberts MC, Seawright AA, Ng JC, Norman PD.Chronic mercuric chloride intoxication in an aged horse given 0.8 mg Hg/kg/day for 14 weeks was manifest by signs of progressive respiratory difficulty and renal disease. The effects were not self-limiting after mercury was withdrawn, and the animal was destroyed six weeks later. Renal function changes included heavy glycosuria, modest proteinuria, phosphaturia, reduced urine osmolality, gradually increasing urine production, reduced glomerular filtration rate, and terminally, azotemia. The condition bore similarities to the Fanconi syndrome in man. Urinary gamma-glutamyl transpeptidase, alkal...
Brobst DF, Lee HA, Spencer GR.An 11-year-old mare with polyuria, polydipsia, and azotemia was found to be hypercalcemic and hypophosphatemic. The concentration of calcium in a single collection of urine was within normal limits, although urinary inorganic phosphate concentration was lower than normal. After a brief period of supportive treatment, the mare died. At necropsy, the kidneys were found to be shrunken and fibrous. Histologically, the lesions were those of glomerulonephritis.
Magdesian KG, Hirsh DC, Jang SS, Hansen LM, Madigan JE.To determine molecular characteristics of Clostridium difficile isolates from foals with diarrhea and identify clinical abnormalities in affected foals. Methods: Retrospective study. Methods: 28 foals with C difficile-associated diarrhea. Methods: Toxigenicity, molecular fingerprinting, and antibiotic susceptibility patterns were determined. Information on signalment, clinical findings, results of clinicopathologic testing, whether antimicrobials had been administered prior to development of diarrhea, and outcome was obtained from the medical records. Results: Twenty-three (82%) foals survived...
Bayless RL, Moore AR, Hassel DM, Byer BJ, Landolt GA, Nout-Lomas YS.Detection of equine acute kidney injury (AKI) is hindered by limited markers of early renal damage in horses. N-acetyl-β-D-glucosaminidase (NAG), a lysosomal enzyme in renal tubular epithelium released into urine during tubular insult, has shown promise for early identification of AKI in humans and other species. We validated an assay for NAG in equine urine and measured urinary NAG in 7 azotemic and 7 non-azotemic client-owned adult horses. The enzymatic NAG assay was validated using within- and between-run coefficients of variation (CVs), recovery following standard addition, and linearity ...
Green SL, Conlon PD, Mama K, Baird JD.The effects of hypoxia and azotaemia on the pharmacokinetics of amikacin were evaluated in 20 full-term neonatal critically ill foals which required 24-h supportive care, antibiotics and dextrose-supplemented polyionic fluids given intravenously, nasal insufflation with oxygen and nutritional supplementation. There was no association between sepsis score or survival and pharmacokinetic parameters. Concurrent hypoxia and azotaemia were associated with significantly decreased clearance and increased peak and trough serum concentrations of amikacin; however, peaks or troughs did not exceed toxic ...
Morris CF, Robertson JL, Mann PC, Clark S, Divers TJ.A syndrome characterized clinically by oliguria, progressive severe azotemia, and edema of the abdomen and groin was seen in 2 horses. Treatment with fluids, diuretics, and corticosteroids administered intravenously was ineffective, and the horses were euthanatized. Microscopically, there was severe necrotizing angiopathy with profuse fibrin deposition in renal glomeruli and sinusoids of peripheral lymph nodes. The signs observed in the horses resembled hemolytic-uremic syndrome in human beings.
Dickinson CE, Gould DH, Davidson AH, Avery PR, Legare ME, Hyatt DR, DebRoy C.A postpartum mare and foal were presented for evaluation of fever and lethargy in the mare. The mare was diagnosed with endometritis and initially responded well to treatment. On the second day of hospitalization, the mare developed renal insufficiency characterized by oliguria, azotemia, hemolysis, and thrombocytopenia. Concurrently, the foal developed rapidly progressive central nervous system signs culminating in refractory seizures. Both animals failed to respond to treatment and were euthanized. Thrombotic microangiopathy involving glomeruli was evident on microscopic examination of the m...
Rodger LD, Carlson GP, Moran ME, Yarbrough TB, Pascoe JR, Reynolds JA.A 3-year-old Thoroughbred colt was presented for evaluation of azotemia and anorexia. Physical examination revealed a ureterolith in the left ureter, approximately 10 cm from the bladder, which was thought to obstruct urine flow by approximately 90% when viewed cystoscopically. Ultrasonographic examination of both kidneys revealed indistinct corticomedullary junctions, and the right kidney was more hyperechoic. A percutaneous biopsy of the right kidney revealed chronic interstitial nephritis with marked interstitial medullary fibrosis. Medical therapy consisting of IV fluids, sodium chloride P...
Roberts MC, Seawright AA, Ng JC, Norman PD.Chronic mercuric chloride intoxication in an aged horse given 0.8 mg Hg/kg/day for 14 weeks was manifest by signs of progressive respiratory difficulty and renal disease. The effects were not self-limiting after mercury was withdrawn, and the animal was destroyed six weeks later. Renal function changes included heavy glycosuria, modest proteinuria, phosphaturia, reduced urine osmolality, gradually increasing urine production, reduced glomerular filtration rate, and terminally, azotemia. The condition bore similarities to the Fanconi syndrome in man. Urinary gamma-glutamyl transpeptidase, alkal...
Toribio RE, Bain FT, Mrad DR, Messer NT, Sellers RS, Hinchcliff KW.Three weak, recumbent neonatal foals with skin lesions, including a thin wooly coat, were born to mares being treated for equine protozoal myeloencephalitis. Mares received sulfadiazine or sulfamethoxazole-trimethoprim, pyrimethamine, folic acid, and vitamin E orally. Foals were anemic, leukopenic, azotemic, hyponatremic, and hyperkalemic. Serum folate concentrations in the 3 foals and 2 mares were lower than those reported in the literature for clinically normal brood mares. Treatment was unsuccessful. For each foal, necropsy revealed lobulated kidneys with thin cortices and a pale medulla, a...
Wong DM, Ruby RE, Eatroff A, Yaeger MJ.A newborn foal was presented because it was unresponsive and in cardiopulmonary arrest. Aggressive cardiopulmonary cerebral resuscitation was administered to the foal, which revived the foal; however, acute renal failure developed. Fluid retention and azotemia occurred although the foal was alert and able to suckle. A 6-hour renal replacement therapy session using hemodiafiltration and a continuous renal replacement therapy machine was administered to the foal at 3 days of age which lowered the foal's azotemia and facilitated removal of some of the excess body fluid. Despite therapy, the foal ...
Hardefeldt LY.Four neonatal foals were presented, over a 2-year period, (2011-2012) with aimlessly walking, head pressing, 'chewing gum' seizures and ataxia. The neurological lesion was consistent with increased intracranial pressure in all cases. All foals had severe hyponatraemia and azotaemia identified on biochemistry. Hyponatraemia was transient in 3/4 cases, with the foal in the final case requiring long-term sodium supplementation. Three foals survived to hospital discharge; one was euthanased because of anuric renal failure and one of the surviving foals was euthanased with septic osteomyelitis 2 we...
Byars TD, Simpson JS, Divers TJ, Shiner KA, Rantanen NW.Percutaneous nephrostomy was used to provide urine output in a 3-year-old Thoroughbred filly with azotemia and obstructive ureterolithiasis. Previous left ureteral surgery had failed to provide clinical improvement, and the filly became more azotemic. Nephrostomy was performed in the standing patient, with ultrasonographic guidance and local anesthesia. Continuing IV fluid therapy and diuresis through the nephrostomy tube resulted in a decrease in clinical signs of azotemia. However, the filly developed a cecal impaction, which ruptured during surgery because of colic, and was euthanatized.
Pinnell EF, Her J, Gordon D, Kinsella HM, Langston CE, Toribio RE.An adult American Quarter Horse mare presented for pigmenturia and lethargy of 12 hours' duration and was diagnosed with silver maple leaf toxicity. The mare had intravascular hemolysis and azotemia. The mare was treated with a transfusion of whole blood, fluids administered IV, antibiotics, oxygen insufflation, and supportive care. The azotemia persisted despite conventional medical management and hemodialysis was elected. After 2 intermittent hemodialysis treatments over 3 days, the azotemia almost resolved, clinical signs improved, and the mare was discharged. The blood urea nitrogen, c...
Ford MG, Nelson BB, Ford TS, Souza CRS, Easley JT, Hackett ES.Surgical repair is frequently effective at resolving uroperitoneum in foals, though complications occur. Despite their occurrence, management strategies used to address these complications, and their impact on survival are not clearly defined. To better describe the complications following surgical correction of uroperitoneum and to document treatment strategies and outcomes after intervention, a multi-center retrospective case series was performed. Medical record data of foals undergoing surgical treatment for uroperitoneum were retrieved from three surgical centers, and cases identified with...
Brobst DF, Lee HA, Spencer GR.An 11-year-old mare with polyuria, polydipsia, and azotemia was found to be hypercalcemic and hypophosphatemic. The concentration of calcium in a single collection of urine was within normal limits, although urinary inorganic phosphate concentration was lower than normal. After a brief period of supportive treatment, the mare died. At necropsy, the kidneys were found to be shrunken and fibrous. Histologically, the lesions were those of glomerulonephritis.
Bernick A, Nieth J, Wehrend A.Uroperitoneum is a typical disease in newborn foals. An accumulation of urine develops in the abdominal cavity in consequence to a congenital or acquired leakage in the urinary tract. Colts are more frequently affected than fillies. The most common cause of uroperitoneum is a rupture of the dorsal urinary bladder wall. The urinary bladder is affected in 73.1 %, the urachus in 21.6 % and the ureter in 5.2 % of cases. Typical clinical signs occur 2-5 days postpartum, and encompass reduced general condition, abdominal distention, mild colic symptoms and unphysiologic micturition. Ultrasou...
Gallatin LL, Couëtil LL, Ash SR.A 15-year-old Paso Fino gelding was evaluated because of acute renal failure following an episode of exertional rhabdomyolysis. The horse was azotemic and treated conservatively at another referral practice with no improvement in the azotemia. With conservative treatment and intermittent peritoneal dialysis, the horse had minimal improvement. Continuous-flow peritoneal dialysis (CFPD) was instituted on day 7 and continued for 3 consecutive days. Dramatic changes in the horse's attitude and serum creatinine concentration were detected within the first 24 hours of CFPD treatment. The horse remai...
Norman TE, Chaffin MK, Johnson MC, Spangler EA, Weeks BR, Knight R.Five horses were evaluated because of severe cutaneous burn injuries following a barn fire. Gross hemolysis and morphologic changes in RBCs consistent with oxidative damage were detected in all of the horses. Of these horses, 4 became azotemic. The overall goals of treatment included wound care, correction of dehydration and provision of diuresis, control of inflammation, pain management, and prophylaxis against sepsis. After treatment, 2 horses survived and were discharged from the hospital. Red blood cell damage and hemolysis following cutaneous burn injury have been investigated in other sp...
Thompson JA, Mirza MH, Barker SA, Morgan TW, Bauer RW, McConnico RS.3 Quarter Horse racehorses were examined for suspected clenbuterol overdose 12 to 24 hours after administration by mouth of a compounded clenbuterol product. Results: All horses developed sinus tachycardia, muscle tremors, hyperhidrosis, and colic. Abnormalities on serum biochemical analysis included hyperglycemia, azotemia, and high creatine kinase activity. The presence of clenbuterol in the serum of all 3 horses and in the product administered was confirmed and quantified by use of liquid chromatography-electrospray tandem mass spectrometry. Results: Propranolol (0.01 mg/kg [0.005 mg/lb], I...
Divers TJ, Byars TD, Spirito M.Bilateral ureteral defects were diagnosed as the cause of depression and azotemia in an 8-day-old Thoroughbred filly. The azotemia resulted from accumulation of urine in the retroperitoneal area. A ventral midline laparotomy was performed, and defects found in both the left and right ureter were repaired. Uroperitoneum and abdominal distention, presumably from urine leakage at the left ureteral surgery site, were detected on the fourth postoperative day and necessitated abdominal drainage. Thirty-six hours later, the leakage stopped spontaneously, and the foal recovered normally. This report s...
