Case-control study of the association between intraoperative administration of nafcillin and acute postoperative development of azotemia

Abstract

Objective. To describe 7 cases of acute postoperative azotemia in dogs and to examine by use of a case-control study the possible association between this complication and administration of nafcillin. Design. Retrospective and case-control study. Animals. 7 case dogs and 28 matched control dogs. Procedure. Cases of acute renal failure or acute renal insufficiency were identified by retrospective study of records of dogs treated between July 1, 1992, and Feb 28, 1995, and from information received rom a practitioner. A random sample of records of dogs undergoing invasive procedures between Dec 1, 1992, and Nov 30, 1993, was examined to determine the prevalence of nafcillin use. Each case dog was matched with 4 control dogs, and data were subjected to logistic regression analysis, employing exact conditional inference on the parameter estimates. Results. Case dogs were between 1 and 9 years old and weighed between 21 and 60 kg. Preoperatively, none of the dogs had a history of renal disease, and BUN concentrations, hematocrit, and plasma protein concentrations were within reference ranges. Postoperatively, each dog became azotemic and had clinical signs consistent with uremia. Hyponatremia was recorded in 6 case dogs. One dog did not respond to treatment and was euthanatized. Two dogs had persistent isosthenuria, and 4 dogs recovered. Nafcillin was used in approximately 502 of 2,184 (23%) dogs that underwent invasive procedures between Dec 1, 1992, and Nov 30, 1993. The use of nafcillin ceased on Nov 30, 1993, and no further cases were recorded in the following 15 months. In the case-control study, the only factor that was significantly associated with the occurrence of acute postoperative azotemia was administration of nafcillin. Clinical Implications. Intraoperative use of nafcillin may be associated with development of acute postoperative azotemia in dogs.