Acute Kidney Failure and Acute Kidney Injury Flashcards
Define acute kidney failure
Sudden onset of excretory failure leading to accumulation of metabolic/uraemic toxins
How are GFR and creatinine related?
As GFR increase, creatinine decreases
Define acute kidney injury. How does this differ from acute renal failure?
Abrupt reduction in kidney function - increase of creatinine or decreased urine output
Patients may not be azotaemic
What is the typical history for acute kidney failure?
- Non-specific - lethargy, weakness, anorexia, V/D
- Known toxin ingestion
- Altered urine output
- Signs of concurrent disease
What are the clinical signs of acute renal failure?
Dehydration Oral ulceration, halitosis Hypothermia Brady/tachycardia Swollen, painful or normal kidneys
How should a newly documented azotaemic patient be refined?
Acute or chronic?
Pre-, renal or post-renal?
What differentiates acute from chronic renal disease?
History PE - renal size Non-regenerative anaemia Renal US CKD-mineral bone disorder
Does hyperphosphataemia occur with acute or chronic renal disease?
Both, cannot use it to decide.
Use presence of CKD-mineral bone disorder instead
What is rubber jaw? How is it caused?
Softening of the lower jaw caused by secondary renal hyperparathyroidism
What can cause azotaemia?
High production of nitrogenous waste
Low GFR
Reabsorbed urine leaking from UT
Which diagnostic test should always be performed when evaluating renal function?
Urinanalysis
What USG values indicate prerenal and renal azotaemia?
Pre-renal
Dog: >1.030
Cat: >1.035
Renal
Dog: <1.030
Cat: <1.035
What results can you expect on UA with renal azotaemia?
Glucosuria
Casts
Calcium oxalate
Which type of azotaemia can be greatly improved with IVFT?
Pre-renal
What changes in WBCs occur in a stress leukogram?
Neutrophilia
Monocytosis
Lymphopenia
Eosinopenia
How can you confirm a suspected leaking urinary tract?
Sample abdominal fluid and test creatinine levels
Why won’t an obstruction in one ureter result in post-renal azotaemia?
The other kidney is still function and can pass fluid through ureter into bladder
What causes renal azotaemia and how common are they?
Tubular necrosis - v common
Intersitital nephritis - common
Acute glomerulenephritis - uncommon
What is the most common cause of pyelonephritis? What are the clin signs?
Ascending infections
- PU/PD
- +/- azotaemia
- Asymptomatic
How is pyelonephritis treated?
- Culture urine, empiric ab therapy
- Specific ab therapy 4-6w, re-culture throughout
- Re-culture 1-2w post-treatment
What are the clinical signs of leptospirosis in the small animals? How is it diagnosed?
- Azotaemia
- Hepatic necrosis
- Thomrocytopenia
- Vasculitis
Rising titres to non-vaccinal serovar
How is leptospirosis treated?
Pencillin G, ampicillin, amoxycillin
Doxycycline
What are the most common toxins to cause tubular necrosis?
- Ethylene glycol
- Raisins/grapes
- Lillies in cats
Which therapeutic agents can cause tubular necrosis?
ABs - aminoglycosiders and tetracyclines Chemo - doxorubicin and cisplatin NSAIDs ACE-i IV contrast agents
