Concentrations and kinetics of renal biomarkers in dogs with gastric dilatation-volvulus with and without 24-h intravenous lidocaine

Background: Gastric dilatation volvulus (GDV) can lead to organ failure including acute kidney injury (AKI). Due to its cytoprotective, antioxidant and anti-inflammatory effects, lidocaine has a potential to prevent AKI in dogs with GDV.

Design and setting: Prospective, observational cohort study in client-owned dogs with GDV.

Objective: To determine concentrations of renal biomarkers for AKI in dogs with GDV with and without intravenous (IV) lidocaine therapy.

Methods: Thirty-two dogs were randomized to receive either IV lidocaine (2 mg/kg, followed by a lidocaine constant rate infusion at a dose of 50 μg/kg/min over 24 h; n = 17) or no lidocaine (n = 15). Blood and urine samples were taken at admission (T ₀) (only blood), during or immediately after surgery (T ₁), and 24 (T ₂₄) and 48 (T ₄₈) h after surgery. Plasma creatinine (pCr), plasma neutrophil gelatinase-associated lipocalin (pNGAL), urinary NGAL (uNGAL), uNGAL to creatinine ratio (UNCR), and urinary gamma-glutamyl transferase to creatinine ratio (uGGT/uCr) were evaluated. Biomarker concentrations were compared between dogs with and without IV lidocaine and the course of each marker was determined in comparison to its admission value.

Results: In the entire population, a significantly higher pCr at T ₀ (median, 95 μmol/L, interquartile range, 82-105) compared with T ₁ (69 μmol/L, 60-78), T ₂₄ (63 μmol/L, 52-78), and T ₄₈ (78 μmol/L, 65-87) (P < 0.001) was found. Plasma NGAL increased significantly between T ₀ (5.66 ng/mL, 3.58-7.43) and T ₂₄ (7.50 ng/mL, 4.01-11.89) (P = 0.006) and T ₄₈ (9.86 ng/mL, 5.52-13.92) (P < 0.001), respectively. Urinary NGAL increased significantly between T ₁ (0.61 ng/mL, 0.30-2.59) and T ₂₄ (2.62 ng/mL, 1.86-10.92) (P = 0.001) and T ₄₈ (4.79 ng/mL, 1.96-34.97 (P < 0.001), respectively. UNCR increased significantly between T ₁ (0.15 μg/mmol, 0.09-0.54) and T ₂₄ (1.14 μg/mmol, 0.41-3.58) (P = 0.0015) and T ₄₈ (1.34 μg/mmol, 0.30-7.42) (P < 0.001), respectively. Concentrations of uGGT/uCr increased significantly from T ₀ highest at T ₂₄ (6.20 U/mmol, 3.90-9.90) and significantly decreased at T ₄₈ (3.76 U/mmol, 2.84-6.22) (P < 0.001). No significant differences in any renal biomarker concentration were found between dogs with and without IV lidocaine therapy.

Conclusion and clinical relevance: Plasma NGAL, uNGAL and UNCR remained increased up to 48 h post-surgery. No evidence of lidocaine-associated renoprotection was found.