Acute Kidney Injury

Question 1

What is Acute Kidney Injury?

Answer 1

an abrupt (within 48 hours) reduction in kidney function with an absolute increase in serum creatinine or a reduction in urine output

Question 2

What are the clinical signs of AKI?

[but remember they can be non specific]

Answer 2

lethargy, weakness, anorexia/ vomiting
altered urine output
dehydration
brady or tachycardia
swollen, painful kidneys

Question 3

How do we differentiate Chronic Kidney Disease from Acute?

Answer 3

Unlike Acute, Chronic will present as anaemia with possible mineral bone disorder (‘rubber jaw’) and PU/PD

Question 4

What causes Azotaemia (high nitrogenous waste)? (3)

Answer 4

1. High production nitrogenous waste
2. Low GFR due to reduced renal perfusion, renal disease or obstruction
3. Reabsorption of urine from tract

Question 5

How can we differentiate Pre Renal Azotaemia from Renal Azotaemia?

Answer 5

Urinalysis- pre renal will have concentrated urine and renal will have glucosuria or casts in the urine
Pre renal azotaemia will improve when given fluids- renal azotaemia will not

Question 6

What are the three categorical causes of (Intrinsic) Renal Azotaemia?
Which is most/ least common?

Answer 6

Tubular Necrosis (Ishcaemia or Toxins) (most common)
Interstitial Nephritis
Acute Glomerulonephritis (least common)

Question 7

Give two examples of Interstitial Nephritis?

Answer 7

Pyelonephritis
Leptospirosis

Question 8

How is Pyelonephritis treated?

Answer 8

culture urine > empiric antibiotic therapy pending results then treat with appropriate antibiotics

Question 9

An animal with interstitial nephritis caused by Leptospirosis will also have symtoms such as…

Answer 9

Hepatic Necrosis (think high bilirubin)
Thrombocytopaenia
Vasculitis

Question 10

How is Leptospirosis treated?

Answer 10

Penicillin G or Amoxycillin

Question 11

What toxins can cause Tubular Necrosis and therefore AKI?
Give 3.

Answer 11

Pesticides
Snake Venom
Rodenticides
Raisins/ Grapes (dogs)
Lilies (cats)

Question 12

How do we treat toxin induced tubular necrosis?

Answer 12

Chemotherapeutics
NSAIDs
ACE inhibitors
Angiotensin Receptor Blockers
IV Contrast agents

Question 13

What can cause Ischaemic AKI?

Answer 13

Drugs e.g. NSAIDs, ACE inhibitors
Vascular Disease
Sepsis
Decreased intravascular volume/ Hypotension

Question 14

What do we mean by Hospital Acquired AKI?

Answer 14

Ischaemic or toxin induced tubular necrosis are synergistic-and can be worsened by…
anaesthesia/ surgery
nephrotoxic drugs

Question 15

What parameters could be serially evaluated to monitor fluid balance in the treatment of Kidney Disease?

Answer 15

Input vs Output
Bodyweight
Physical Exam e.g. palpation of muscles
PCV/TP

Question 16

What should be monitored (apart from fluid balance) in the treatment process of acute kidney disease? (3)

Answer 16

Electrolytes
Renal Function aka Creatinine levels
Urine Culture once Catheter is removed