Abstract

Meloxicam is a widely used, nonsteroidal anti-inflammatory drug that inhibits cyclooxygenase mediated prostaglandin formation to treat both acute and chronic pain and inflammation.^1,2 In veterinary species, hematologic, gastrointestinal, hepatic, and renal adverse effects are reported.^2,3 In cetaceans, however, only gastrointestinal adverse effects are reported.^1,4

Here, we report a 19-year-old bottlenose dolphin (Tursiops truncatus) with acute renal failure following meloxicam administration. Initial presentation showed leukocytosis, decreased serum iron, and no serum biochemical abnormalities. Due to suspected pulmonary inflammation, treatment was initiated with oral antimicrobials and single dose oral meloxicam (0.1 mg/kg). Two days following meloxicam administration, the dolphin exhibited acute onset lethargy, anorexia, severe azotemia, metabolic acidosis, glucosuria, and proteinuria. Urine sediment evaluation revealed sheets of caudate and renal tubular epithelial cells consistent with renal pelvis and tubular damage. No evidence of nephrolith obstruction was apparent on ultrasound evaluation.^5,6 Treatment entailed enteral and parenteral fluid therapy to promote diuresis, pharmacokinetic-directed antimicrobial therapy to account for reduced renal clearance, and supportive care. Consideration was given to hemodialysis and peritoneal dialysis. However, due to continual improvement in azotemia over four weeks, dialysis was not pursued.^7,8 Diagnostics failed to elucidate an infectious, nutritional, or other toxic cause, leading to a presumptive diagnosis of idiosyncratic acute kidney injury secondary to single-dose meloxicam administration.

To the authors’ knowledge, this is the first report of idiosyncratic acute kidney injury in a cetacean following meloxicam administration. Future efforts should include large-scale, multi-dose pharmacokinetic studies, as well as evaluation of hemodialysis techniques for treatment of nephrotoxicity in dolphins.

Acknowledgments

The authors thank the involvement of U.S. Navy Marine Mammal Program animals, biotechnicians, and managers, and the National Marine Mammal Foundation and Science Applications International Corp. trainers, veterinary and medical records staff who facilitated this effort, as well as Dr. Travis Lanaux, University of Florida, College of Veterinary Medicine, for his consultation on this case.

Literature Cited

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2.  Papich, MG. 2020. Papich Handbook of Veterinary Drugs. St. Louis: Saunders. p. 565–568.

3.  Rivera-Velez SM, Broughton-Neiswanger LE, Suarez MA, Slovak JE, Hwang JK, Navas J, Leung AWS, Pineyro PE, Villarino NF. 2019. Understanding the effect of repeated administration of meloxicam on feline renal cortex and medulla: A lipidomics and metabolomics approach. J Vet Pharmacol Ther 42(4):476–86.

4.  Van Bonn W. 2003. Perforation of the gastrointestinal tract in bottlenose dolphins (Tursiops truncatus). IAAAM 34th Annual Conference Proceedings, Waikoloa, HI.

5.  Smith CR, Venn-Watson S, Wells RS, Johnson SP, Maffeo N, Balmer BC, Jensen ED, Townsend FI, Sakhaee K. 2013. Comparison of nephrolithiasis prevalence in two bottlenose dolphin (Tursiops truncatus) populations. Frontiers in Endocrinology 4(145).

6.  Le-Bert CR, Smith CR, Poindexter J, Ardente A, Meegan JM, Wells RS, Ven-Watson S, Jensen ED, Sakhaee K. 2018. Comparison of potential dietary and urinary risk factors for ammonium urate nephrolithiasis in two bottlenose dolphin (Tursiops truncatus) populations. Am J Physiol Renal Physiol 315: F231–F237.

7.  Tuttle AD, Erlacher-Reid C, Dunn JL, Kaplan AA. 2011. Intestinal dialysis in a beluga whale (Delphinapterus leucas) with acute renal failure. IAAAM 42nd Annual Conference Proceedings, Las Vegas, NV.

8.  Schmitt TL, McBain J, Yochem PK, Smith C, Johnson S, Jensen E, Kashkouli A, Sanchez AP, Ward DM. 2010. Treatment of acute renal insufficiency in an Atlantic bottlenose dolphin (Tursiops truncatus) with peritoneal dialysis. IAAAM 41st Annual Conference Proceedings, Vancouver, BC.