Nephrectomy - how serious is it?

Hi all,

I have a precious female bunny of 5 years of age, who has developed three relatively big stones in her left kidney. The ultrasound confirmed that the cortex of the kidney is distorted because of the stones. Her right one is intact, luckily.

She's been given pain killers and subcutane infusion, her appetite and thirst has decreased. She is syringe fed with Critical Care besides her limited food she eats every day.

I am facing a dilemma whether to perform nephrectomy. I am aware of the risks of anasthesia and I know that such an abdomenal operation has its risks too. I know that her condition can only improve significantly if a successfull surgery is performed, she can happily live with one kidney.

What I'm afraid of is the fact that this operation in Hungary is not a routine one, even if my bunny is treated by a bunny specialist vet. I don't want to put her to unnecessary risk, but want to heal her. We love her so much, like a baby, she is a real family member.

Has anyone gone through a successfull nephrectomy? Does any of you have experience with it?

Thanks for all the opinion and advice.

Hello

I have not had any personal experience with any of my Rabbits, but I know that my Vet has performed the procedure successfully on other Rabbits. I believe that some other members on here have had Rabbits who had a Nephrectomy. I would suggest you drop them a PM. Their usernames on here are :

Bunny Buddy

http://forums.rabbitrehome.org.uk/member.php?10672-Bunny-Buddy

and parsnipbun

http://forums.rabbitrehome.org.uk/member.php?7603-parsnipbun

I hope that all will go well for your Rabbit

Hi,

Thanks for your answer, I'll contact them to learn about their experiences.

One of the bunnies I once fostered went through a very successful nephrectomy following some serious abscesses and that bunny lived happily for another few years. It does seem like a very drastic option, but it is definitely possible for a bunny to live a healthy life with one kidney and actually if the presence of the kidney is causing significant pain and problems, then its removal could make bunny far perkier very quickly, as long as they can get through the GA safely. I guess aside from your concern about the specific expertise to do the op in your country, my concern would be that if it the problem is due to stones, might the stones just continue to form in the other kidney afterwards, depending on their cause?

Good luck with whatever you decide to do for your little one xxx

There are several issues to consider:

Kidney stones are very painful, and when they start to move round or grow or break up she will be in a a LOT of pain - more than metcam can cover - and tbh more than bupronorphine can cover either.

Bits can also break off and start to travel down the tubes and can block them.

The operation is difficult - and it also depends which kidney it is how difficult it is - one is more difficult than the other for a variety of reasons. One also needs more abdominal handling than the other (which is a risk with post surgical adhesions).

However if you can persuade your vet to contact a UK specialist vet in advance for guidance and instruction, and the vet surgeon you have is generally good (and experienced in rabbit aneasthesia generally) then taking a kidney out should be feasible for them.

I should say that rabbits with kidney issues need a diet high in fluids and low in sugars and concentrates - so no dried pellets but lots of fresh foods and forage.

Also low calcium - so if the water you have is high calcium then try bottle low calcium water.

My rabbit that had an ossified kidney was 9 years old and sailed through the op.

I would definitely put another rabbit through the op if there was a decision to be made -

however i do have a specialist rabbit vet/surgeon.

If your vet needs to contact a vet that has done this and does it relatively 'frequently' (relative as its still not common for rabbits) then the contact details for mine are Iain Cope at Cambridge Vet Group 01223 249331.

Artie was the rabbit of mine that had the nephrectomy. He was just short of seven years old when he was diagnosed with kidney stones, thankfully only in the one kidney. His surgery was carried out by Nigel Harcourt-Brown whilst under the care of Frances Harcourt-Brown.

Artie had initially had the stones removed (extremely complex surgery). He had the misfortune (as one of the posts above mentions) of the stone moving into the tube (ureter, from kidney to bladder) and getting wedged therefore blocking the tube and the situation being an emergency. The stones were also removed from the kidney as well as the one blocking the ureter but unfortunately because of the condition of the kidney they formed again less than a month later and the situation with one moving into the ureter reoccurred. At that time the only opinion was to remove the kidney as it was obviously going to keep happening.

From the top of my head it was the left kidney that was removed (one is easier as it isn't nestling amongst the lungs/heart, luckily for Artie it was the one easy to access). When I discussed the surgery with the vet he said, "The surgery itself isn't greatly complex" (the discussion being related to his previous complex surgery and this also is from a very experienced surgeon!) but he said with rabbits the aftercare has to be right, critically the first couple of hours but also the next 24 hours. He said where a lot of vets not particularly experienced with rabbits get it wrong is not the surgery itself but the level of support needed afterwards.

Artie's kidney was damaged by EC, he tested with a very high titre for it at the time of his first surgery, one of the highest they've seen. I've no understanding of how this could happen but the other kidney was not affected. The other kidney kept Artie going another 22 months which is far longer than I could ever have hoped for at the time of surgery. He was very happy during that time and blatantly well.

I'd definitely recommend having it performed if your vet is confident to do it and you are confident in your vet. The idea of a rabbit being in such pain is horrible but the part that really worried me is the thought of the kidney stones moving and blocking the tubes.

It could well be worth contacting my rabbits' vet for advice too.
https://www.harcourt-brown.co.uk/consulting

Good luck, whatever you decide. Knowing there is a good kidney is hugely good news for the prognosis.

Thanks to all three of you for your responses.

To begin with, my vet is an experienced exotic pet specialist with lots of experience in rabbit anasthesia. That part I am not worried about. However, I am not sure if he has ever done this kind of surgery before. He had consulted with his colleagues and then said the operation - though risky - is feasible. The left kidney is impacted, as I understood from your answers that is the easier one to remove.

What I would like to avoid at all cost is to leave my beloved one in constant pain. Taking pain killers daily cannot be the permanent solution. The surgery is scheduled for the first week of January, 2015.

I have contacted Dr. Esther vaan Prag, a bunny specialist, owner of medirabbit.com who was very kind to support me with my questions. She even dropped e-mails to Uk specialist, one of them being Dr. Richard Saunders, the name can be more telling to you than to me.

I have concerns with pain management too. My vet prescribed Meloxycam, however dr. vaan Prag suggested that there is a better drug widely spread in UK vet practices, namely Tramadol. This is given to humans to soothe kidney related severe pain, and this is non-toxic for a rabbit's kidney.

When I asked my pet whether to use this instead of Meloxycam, he did not support the idea saying that it can easily cause intestinal stasis in rabbits.

So now I am in a situation where I have a vet whom I need to rely on, but receive other information from different international sources which may contradict my vet's position. This is awkward, at the end of the day he is the vet not me, how dare I tell him what kind of medication to use?

Not easy...

Tramadol or Ketamin will both not harm the other kidney. Constant metacam/meloxivet will. But Tramadol can also have some side effects (as it does in humans ) and may make bun look (and poss feel as we cannot know) depressed and nauseous. I prefer to use ketamin but others disagree (I am an owner not a vet by the way but my vet will use ketamin and bup. as well as tramadol).

Richard Saunders is excellent.

Hi All, it's been for a while. My rabbit since then had recovered, and was free of symptoms and back to normal from New Year's Eve up until 3 weeks ago. Then the whole thing just started over. Loss of appetite, inactivity, abnormal dumps, showing the exact symptoms of GI stasis, pain. Poor girl has even dropped weight, even though she is fed with Critical Care three times a week.

As she has not improved, or even her symptoms worsened, I have an appointment again with my vet tonight (had visited him several times in the past three weeks). Ultrasound, blood test etc.

It seems we came to the point where I need to make maybe one of the most difficult decisions of my life: operation or other cure. As I do not really beleive in other cure at this point, I will have no choice but take the risk.

Now what matters is HER, this is the point where I have to give up being selfish. I have done my best to care her, there is no more I can do.

She will either die painless during the operation or will recover, and live a "healthy" few more years with one kidney.

Please keep your fingers crossed for her, she is my everything! I'm just dread to think of a life without her.

I really hope that the surgery will be successful and that she will make a full recovery xx

I hope things go well for your little one. We never ever regretted going through the kidney removal with our bun - and neither did he! You could tell that from the spring in his step!!

I hope everything will go well for your bunny. We will keep our fingers and paws crossed for her.

I have a rabbit with only one kidney, she's only ever had one kidney and she is 7 years old now.

Victorius said:

Hi All, it's been for a while. My rabbit since then had recovered, and was free of symptoms and back to normal from New Year's Eve up until 3 weeks ago. Then the whole thing just started over. Loss of appetite, inactivity, abnormal dumps, showing the exact symptoms of GI stasis, pain. Poor girl has even dropped weight, even though she is fed with Critical Care three times a week.

As she has not improved, or even her symptoms worsened, I have an appointment again with my vet tonight (had visited him several times in the past three weeks). Ultrasound, blood test etc.

It seems we came to the point where I need to make maybe one of the most difficult decisions of my life: operation or other cure. As I do not really beleive in other cure at this point, I will have no choice but take the risk.

Now what matters is HER, this is the point where I have to give up being selfish. I have done my best to care her, there is no more I can do.

She will either die painless during the operation or will recover, and live a "healthy" few more years with one kidney.

Please keep your fingers crossed for her, she is my everything! I'm just dread to think of a life without her.

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I am keeping my fingers and toes crossed for her and for you, and wish you all the luck in the world :wave: