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Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)2023; 33(6); 685-695; doi: 10.1111/vec.13324

Retrospective evaluation of acute kidney injury in horses treated with nonnitrogenous bisphosphonates (2013-2020): 8 cases.

Abstract: To describe a population of horses with acute kidney injury (AKI) following administration of bisphosphonates including clinical signs, clinicopathologic data, treatment, and outcome. Methods: Retrospective study from August 2013 to July 2020. Methods: Veterinary university teaching hospital. Methods: Eight adult horses with AKI following administration of nonnitrogenous bisphosphonates. Methods: None. Results: Five horses received intramuscular clodronate (5/8; 62.5%) and 3 horses received intravenous tiludronate (3/8; 37.5%). Six horses (6/8; 75%) received concurrent nonsteroidal anti-inflammatory drugs. The most common initial presenting complaint was poor appetite (6/8; 75%), followed by abnormal urination (2/8; 25%). At the time of initial evaluation, the mean serum or plasma creatinine was 451.72 ± 190.06 μmol/L (5.11 ± 2.15 mg/dL) and BUN was 18.84 ± 8.85 mmol/L (52.75 ± 24.77 mg/dL). Five horses (5/6; 83.3%) had either an increased number of red blood cells (n = 4) or hemoprotein (n = 1) in the urine. All horses were treated with IV isotonic, balanced crystalloids either as a bolus, continuous rate infusion, or a combination of the 2. Seven horses (7/8; 87.5%) survived the initial episode of AKI and 1 horse (1/8; 12.5%) was euthanized. Of the 7 surviving horses, 2 horses (2/7; 28.5%) went on to develop chronic renal dysfunction. Warmblood breeds were overrepresented in the AKI group (P = 0.008; odds ratio: 11.5, 95% confidence interval: 1.8-72.1), when compared to horses that received bisphosphonates during the study period and did not develop AKI. Conclusions: Bisphosphonate administration, with or without concurrent nonsteroidal anti-inflammatory drugs, can be associated with AKI in horses. Serum creatinine should be monitored prior to and following bisphosphonate treatment to minimize this risk. Further evaluation of renal function is warranted in horses that develop clinical signs of poor appetite, lethargy, or altered urination in the days following bisphosphonate treatment.
© Veterinary Emergency and Critical Care Society 2023.
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Publication Date: 2023-09-11 PubMed ID: 37695208DOI: 10.1111/vec.13324Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research article focuses on the study of acute kidney injury (AKI) in horses as a result of bisphosphonate treatment, analyzing the various symptoms, treatments, and outcomes.

Study Overview

The conducted research is a retrospective study that was carried out from August 2013 to July 2020. In the study, the researchers evaluated eight horses that had experienced AKI following the administration of nonnitrogenous bisphosphonates.

  • There were two categories of bisphosphonates that were administered to the horses: intramuscular clodronate that was given to five horses and intravenous tiludronate that was given to three horses.
  • Six out of the eight horses were also concurrently administered with nonsteroidal anti-inflammatory drugs.

Key Findings

  • Common initial symptoms of AKI included poor appetite and abnormal urination.
  • At the time of initial evaluation, the mean serum or plasma creatinine and BUN were on a higher side indicating a potential kidney problem.
  • Five out of the six examined horses had an increased number of red blood cells or hemoprotein in their urine.
  • All the horses were given IV isotonic, balanced crystalloids as a treatment, either as a bolus, continuous rate infusion, or a combination of the two.
  • Seven out of the eight horses survived the initial episode of AKI while one was euthanized.
  • Of the surviving seven horses, two went on to develop chronic renal dysfunction.
  • Warmblood breeds were more susceptible to AKI compared to other horses that were administered bisphosphonates during the study period and did not develop AKI.

Conclusions

The research concluded that the administration of bisphosphonates can lead to AKI in horses, irrespective of whether or not the horses are concurrently administered nonsteroidal anti-inflammatory drugs as well.

This implies that it is essential to monitor the serum creatinine of horses both before and after the treatment with bisphosphonates, in order to minimize the risk of AKI. Further, if the horses show clinical signs of poor appetite, lethargy, or unusual urination after bisphosphonate treatment, it is advised to thoroughly evaluate their renal function.

Cite This Article

APA
Edwards L, Magdesian KG. (2023). Retrospective evaluation of acute kidney injury in horses treated with nonnitrogenous bisphosphonates (2013-2020): 8 cases. J Vet Emerg Crit Care (San Antonio), 33(6), 685-695. https://doi.org/10.1111/vec.13324

Publication

Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)
ISSN: 1476-4431
NlmUniqueID: 101152804
Country: United States
Language: English
Volume: 33
Issue: 6
Pages: 685-695

Researcher Affiliations

Edwards, Lisa
  • William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, Davis, California, USA.
Magdesian, K Gary
  • Department of Medicine and Epidemiology, University of California, Davis, Davis, California, USA.

MeSH Terms

  • Humans
  • Horses
  • Animals
  • Retrospective Studies
  • Diphosphonates / adverse effects
  • Clodronic Acid / therapeutic use
  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / veterinary
  • Acute Kidney Injury / drug therapy
  • Anti-Inflammatory Agents / therapeutic use
  • Creatinine
  • Horse Diseases / chemically induced
  • Horse Diseases / drug therapy

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Citations

This article has been cited 4 times.
  1. Silverstein AL, Calulot CM, McLouth CJ, Gensel JC, Alilain WJ. Liposome-encapsulated clodronate and COX-2 inhibitor treatment impair ventilatory recovery but improve compensatory locomotor function following cervical spinal cord injury in rats. Exp Neurol 2026 Feb;396:115522.
    doi: 10.1016/j.expneurol.2025.115522pubmed: 41130383google scholar: lookup
  2. Conrad MB, Leatherwood JL, Paris BL, George JM, Martinez RE, Vergara-Hernandez FB, Nielsen BD, Colbath AC, Arnold CE, Glass KG, Welsh TH Jr, Bradbery AN. Effects of clodronate disodium on endocrine regulators of calcium in yearling horses. J Anim Sci 2025 Jan 4;103.
    doi: 10.1093/jas/skaf132pubmed: 40259552google scholar: lookup
  3. Tippen SP, Metzger CE, Sacks SA, Allen MR, Mitchell CF, McNulty MA. Clinically relevant doses of tiludronate do not affect bone remodelling in pasture-exercised horses. Equine Vet J 2025 Mar;57(2):513-521.
    doi: 10.1111/evj.14119pubmed: 38924597google scholar: lookup
  4. van Galen G, Divers TJ, Savage V, Schott HC 2nd, Siwinska N. ECEIM consensus statement on equine kidney disease. J Vet Intern Med 2024 Jul-Aug;38(4):2008-2025.
    doi: 10.1111/jvim.17101pubmed: 38801172google scholar: lookup
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