Acute Kidney Injury in Dogs with GDV: A Hidden but Critical Determinant of Survival

Gastric dilatation and volvulus (GDV) is often approached as a surgical emergency requiring immediate decompression and correction. However, what makes GDV truly life-threatening is not just the gastric torsion, but the cascade of systemic complications that follow. Among these, acute kidney injury (AKI) stands out as a clinically significant yet frequently underrecognized contributor to morbidity and mortality¹. 

AKI is defined as an abrupt decline in kidney function, identified through an increase in serum creatinine concentration, a decrease in urine output, or both. Importantly, AKI is not a single disease but a syndrome encompassing multiple etiologies. These include hemodynamic (prerenal), intrinsic renal (such as acute tubular necrosis), and postrenal causes (such as obstruction)¹. In critically ill patients like those with GDV, these mechanisms often overlap, making AKI both complex and difficult to categorize. 

Pathophysiological Cascade in GDV-Associated AKI 

The development of AKI in GDV is deeply rooted in systemic hemodynamic compromise. Dogs with GDV frequently present in shock, which may include a combination of obstructive, hypovolemic, distributive, and cardiogenic components¹. This leads to reduced renal perfusion and oxygen delivery. 

When renal blood flow decreases, the kidneys initially attempt to compensate. However, prolonged hypoperfusion results in ischemia, particularly affecting the renal tubular epithelium. If this state persists, it can progress from reversible hemodynamic AKI to intrinsic renal injury, including acute tubular necrosis². 

Additionally, reperfusion following surgical correction introduces oxidative stress, further damaging renal tissues. At the same time, systemic inflammatory responses triggered by GDV release damage-associated molecular patterns (DAMPs), which amplify cellular injury and contribute to microvascular thrombosis within the kidneys¹. 

Thus, AKI in GDV is not a single event but a multi-phase injury process involving hypoxia, inflammation, and reperfusion damage. 

Re-evaluating AKI Prevalence in GDV 

Earlier studies reported relatively low AKI prevalence rates in GDV patients, ranging from 2.3% to 8%. However, these studies relied on a serum creatinine threshold greater than 2 mg/dL for diagnosis, which excluded early-stage AKI cases¹. 

With the adoption of International Renal Interest Society (IRIS) guidelines, a more sensitive and standardized approach to AKI diagnosis has been implemented. Using these criteria, the present study identified AKI in¹: 

• 17.0% of dogs at presentation  

• 18.9% of dogs during hospitalization  

This significant increase highlights how traditional diagnostic thresholds may underestimate the true burden of kidney injury in GDV. 

AKI as a Prognostic Indicator 

One of the most clinically relevant findings is the strong association between AKI and survival outcomes. Dogs diagnosed with AKI at any time during hospitalization had 9.2 times greater odds of not surviving to discharge¹. 

This finding underscores that AKI is not merely a secondary complication but a major determinant of prognosis. 

Subclinical Kidney Injury: The Missing Link 

A critical insight from recent research is that kidney injury can occur even before measurable changes in creatinine levels. Biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) have shown significant increases following GDV surgery, despite stable or even decreased creatinine levels³. 

This suggests that functional markers (like creatinine) may lag behind structural injury, leading to delayed diagnosis. 

Clinical Implications for Practice 

For veterinarians, these findings emphasize the need for early suspicion and proactive monitoring. Any GDV patient presenting with shock should be considered at high risk for AKI, regardless of initial creatinine levels. 

Monitoring should include: 

• serial creatinine measurements  

• urine output tracking  

• hemodynamic assessment  

• postoperative follow-up  

Early identification and intervention may help mitigate progression and improve outcomes. 

Conclusion 

AKI in dogs with GDV is common, multifactorial, and strongly associated with mortality. The shift toward more sensitive diagnostic criteria has revealed a higher prevalence than previously recognized. Understanding the underlying pathophysiology and maintaining a high index of suspicion are essential for improving clinical outcomes in these critically ill patients. 

References 

1. Suarez-Rodriguez JI, Lourenço BN, Huang JH, Brainard BM, Schmiedt CW. Acute kidney injury is associated with increased mortality in dogs with gastric dilatation and volvulus. Journal of the American Veterinary Medical Association. 2026 Feb 25;1(aop):1-9. https://avmajournals.avma.org/downloadpdf/view/journals/javma/aop/javma.25.11.0716/javma.25.11.0716.pdf 

2. Suarez-Rodriguez JI, Lourenço BN, Huang JH, Brainard BM, Schmiedt CW. Acute kidney injury is associated with increased mortality in dogs with gastric dilatation and volvulus. Journal of the American Veterinary Medical Association. 2026 Feb 25;1(aop):1-9. https://avmajournals.avma.org/downloadpdf/view/journals/javma/aop/javma.25.11.0716/javma.25.11.0716.pdf 
3. Lehmann A, Brunner A, Marti E, Francey T, Steinbach S, Peters LM, Adamik KN. Concentrations and kinetics of renal biomarkers in dogs with gastric dilatation-volvulus with and without 24-h intravenous lidocaine. Frontiers in veterinary science. 2023 Feb 10;10:1115783. https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2023.1115783/pdf