Department of Emergency and Critical Care, Cornell University Veterinary Specialists, Stamford, Connecticut, USA.
Department of Internal Medicine, Cornell University Veterinary Specialists, Stamford, Connecticut, USA.
J Vet Emerg Crit Care (San Antonio). 2020 Sep;30(5):574-580. doi: 10.1111/vec.12976. Epub 2020 Jul 11.
To describe 2 dogs with acute kidney injury secondary to type III hypersensitivity reaction to 25% human serum albumin (HSA).
Two dogs were presented with evidence of septic peritonitis. The dogs were hospitalized following definitive surgical correction of a jejunal laceration following routine ovariohysterectomy, and removal of a jejunal foreign body. In the postoperative period, both dogs developed hypoalbuminemia and received 25% HSA. At the time of initial discharge, both dogs were doing well clinically and had normal renal parameters. Eleven and 18 days after HSA infusion, respectively, both dogs were re-presented with clinical signs of inappetence, vomiting, and lameness that progressed to urticaria, peripheral and angioedema, and petechiae, consistent with a delayed type III hypersensitivity reaction. Treatment for the type III hypersensitivity reaction to HSA included administration of diphenhydramine and glucocorticoids. Despite partial resolution of edema and joint swelling, both dogs developed progressive azotemia together with hypoalbuminemia and proteinuria. One dog developed an anuric acute kidney injury (AKI). Both dogs were humanely euthanized. Histopathology of the kidneys of both dogs was consistent with immune complex deposition and vasculitis.
Severe type III hypersensitivity reactions have been documented in healthy dogs and clinical patients following the administration of HSA. This report describes the first documented delayed type III hypersensitivity reaction in 2 dogs with septic peritonitis that resulted in AKI, glomerulonephritis, and oligo- to anuria in clinical patients following administration of 25% HSA.
描述 2 只因对 25%人血清白蛋白（HSA）的 3 型超敏反应而继发急性肾损伤的犬。
2 只犬表现出败血性腹膜炎的证据。在常规卵巢子宫切除术和小肠异物取出术后，对 1 只犬的空肠裂伤进行了明确的手术修复后，该犬被住院治疗。在术后期间，2 只犬均出现低白蛋白血症，并接受了 25%的 HSA。在最初出院时，2 只犬的临床状况均良好，肾功能参数正常。在 HSA 输注后分别 11 天和 18 天，2 只犬均出现食欲不振、呕吐和跛行的临床症状，进展为荨麻疹、外周和血管性水肿和瘀点，符合迟发型 3 型超敏反应。针对 HSA 的 3 型超敏反应的治疗包括给予苯海拉明和糖皮质激素。尽管水肿和关节肿胀部分缓解，但 2 只犬均出现进行性氮质血症、低白蛋白血症和蛋白尿。其中 1 只犬出现无尿急性肾损伤（AKI）。2 只犬均被人道安乐死。2 只犬的肾脏组织病理学检查均符合免疫复合物沉积和血管炎。
在接受 HSA 治疗后，健康犬和临床患者中已记录到严重的 3 型超敏反应。本报告描述了首份关于 2 只患有败血性腹膜炎的犬在接受 25%HSA 治疗后发生 AKI、肾小球肾炎和寡尿至无尿的迟发型 3 型超敏反应的记录。
