b'ARTICLEThe most recentable to return for follow-up appointments and testing if required? What is their studies show thatcomfort level with home care versus both the prevalencehospitalisation? The most appropriate of acute kidneytreatment plan is the one that balances injury (1.16.7%) andmedical risk with practical reality.overall mortalityWhat we might say to the client is:For the unwell dog, the conversation is (1%) are low in dogsusually clear:with confirmedYour dog is already showing signs grape or raisinthat concern us, such as vomiting, ingestion, especiallyMore recent thinking challenges thisinappetence or changes on their blood when promptprotocol-driven approach and insteadtests. That tells us the kidneys may focuses on proportional individualisedalready be under stress. At this stage, the decontaminationsafest option is to admit them so we can care grounded in the principle of is performed andprimum non nocere - first, do no harm.provide supportive care with intravenous the dog remainsHospitalising every dog to protectfluids, closely monitor urine output and the small minority who may developblood values and respond quickly if things clinically well in thedeteriorate.first 2448 hours. kidney injury risks overtreating the many, particularly when fluid therapyFor the asymptomatic patient, the itself carries potential complicationsdiscussion is different and more nuanced:and its ability to prevent acute kidneyAt the moment, your dog is bright and injury in this scenario remains unproven.well, and weve removed as much of The emphasis instead shifts to clinicalthe toxin as we can. Well take a quick precision: prompt decontamination,blood sample to check how the kidneys baseline assessment and escalation onlyare coping right now. If those results are if clinical signs or biochemical changesnormal, managing your dog at home is a are present or emerge. reasonable option and is less stressful for Confidence here lies in the data. Thedogs than being hospitalised, provided most recent studies show that bothyoure able to keep a close eye on them.the prevalence of acute kidney injuryAt this stage, hospitalisation and (1.1 - 6.7%) and overall mortality (1%) areintravenous fluids have not been shown low in dogs with confirmed grape orto reduce the risk of developing acute raisin ingestion, especially when promptkidney injury, although they may become decontamination is performed and thenecessary if anything changes. The dog remains clinically well in the first 24 reassuring thing is that most dogs in this 48 hours. The case for a less aggressivesituation do not go on to develop kidney approach is further bolstered by a largeproblems, and overall survival is reported retrospective UK study of 606 dogs withat over 99%.confirmed ingestion of Vitis vinifera fruit.At home, wed ask you to watch appetite, Nearly half of these dogs were treated asdrinking, urination and energy levels and outpatients, only one dog developed mildto look out for any vomiting or diarrhoea. AKI (IRIS Grade I) and all dogs survivedIf you notice any change, wed want to to discharge supporting the safety ofsee your dog promptly so we can reassess outpatient care in carefully selected low- and escalate care if needed. Does that risk cases.sound like something youd be able to This isnt about choosing one approachdo?over the other. Its about knowing whenAnother important part of contextualised each applies. Understanding this allowscare is recognising the emotional toll us to move beyond rigid rules and offeruncertainty can place on owners. Even considered responsive care. when a dog remains clinically well, some What else matters? owners find the wait and see period Clinical risk matters but so do the widerdeeply stressful, worrying constantly considerations of care. Can the ownerabout the possibility of hidden kidney monitor their dog closely? Will they bedamage. In these cases, offering a repeat 22www.inspiredvet.co.uk'