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A. Small Animal Medicine and Surgery > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

what are the criteria for injury to the kidney in the rifle criteria?

A

creatinine 2xbaseline
GFR decrease >50%

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2
Q

how can you diagnose acute kidney injury?

A

azotemia
isosthenuria or inappropriate concentrating ability
hyperkalemia
hyper/hypocalcemia
hyperphosphatemia
acidosis

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3
Q

what are the causes of pre renal or fluid responsive AKI?

A

hypovolemia
hypotension
prolonged hypotension
cardiac disease
renal artery or vein obstruction

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4
Q

what is a post renal AKI?

A

blockage of urine flow or abdominal leakage

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5
Q

what are the general AKI etiologies?

A

infectious agents
ischemia
nephrotoxin
systemic disease

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6
Q

what drugs cause toxic nephropathies?

A

aminoglycosides
non steroidal anti-inflammatories

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7
Q

how do aminoglycosides cause nephrotoxicity?

A

necrosis of renal tubular epithelial cells

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8
Q

what is the principle toxicity of non steroidal anti-inflammatory drugs?

A

nonoliguric ischemic nephrosis

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9
Q

how do non steroidal anti-inflammatories decrease renal perfusion?

A

inhibition of prostaglandin I2 and E2 synthesis

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10
Q

when does AKI occur after non steroidal anti-inflammatory exposure?

A

3-5 days after exposure

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11
Q

in whom is lily toxicity observed?

A

cats

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12
Q

what does lily toxicity cause?

A

renal tubular necrosis

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13
Q

when will death occur if lily toxicity is not treated?

A

3-7 days

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14
Q

if treatment is delayed for longer than ____________ from lily ingestion, acute kidney injury will develop

A

18 hours

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15
Q

what is the toxic component of grape and raisin toxicity?

A

tartaric acid

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16
Q

what does toxicity from ethylene glycol develop from?

A

actions of metabolites on tubular epithelium and deposition of calcium oxalate crystals in tubular lumens and interstitium

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17
Q

what signs are seen in 12-24 hours after ethylene glycol ingestion?

A

severe metabolic acidosis: tachypnea, tachycardia, maybe pulmonary edema and congestion

18
Q

how can you diagnose ethylene glycol toxicity?

A

severe metabolic acidosis, high anion gap
serum hyperosmolality
hypocalcemia
azotemia
calcium oxalate monohydrate crystalluria

19
Q

when is dialysis indicated for ethylene glycol toxicity?

A

if metabolites already formed

20
Q

what is pyelonephritis usually secondary to?

A

ascending lower urinary tract infections

21
Q

what is the most common organism of pyelonephritis?

A

E. coli

22
Q

what can you monitor for an AKI for volume overload?

A

chemosis, serous nasal discharge, peripheral edema
pulmonary edema

23
Q

what fluids should you give if a patient is anuric?

A

replace insensible losses only

24
Q

how is acute kidney injury diagnosed?

A

abrupt change in serum creatinine and/or urine output
creatinine increase >0.3 mg/dl or >50% from baseline

25
Q

what are the causes of pre-renal AKI?

A

hypovolemia
hypotension
prolonged hypotension
cardiac disease
renal artery or vein obstruction

26
Q

what are the causes of post-renal AKI?

A

blockage of urine outflow
abdominal leakage

27
Q

what are some causes of toxic nephropathies?

A

drugs
plants
ethylene glycol
food contaminants
vitamin D

28
Q

how long should you give aminoglycosides for to prevent aminoglycoside nephrotoxicity?

A

<5-7 days
give once daily

29
Q

are NSAID kidney lesions usually reversible?

A

yes: ischemic nature

30
Q

what dose of ibuprofen causes an AKI in dogs?

A

200-300 mg/kg

31
Q

what host factors contribute to lily toxicity?

A

gastrointestinal absorption
preexisting kidney disease

32
Q

how can you diagnose lily toxicity?

A

severe azotemia
normocalcemia
urinalysis changes

33
Q

what is the estimated toxic dose of grapes?

A

32 g/kg
11-30 g/kg raisins

34
Q

what are the most common clinical signs of grape and raisin toxicity?

A

vomiting
diarrhea
excessive thirst
excessive urination
lethargy
dehydration

35
Q

when do AKI signs show with ethylene glycol toxicity?

A

24-72 hours

36
Q

how can you treat ethylene glycol toxicity?

A

ethanol
4-MP (fomepizole)
dialysis

37
Q

what does vitamin D cause?

A

hypercalcemia
acute tubular damage

38
Q

what is a significant risk factor for AKI?

A

volume depletion

39
Q

between what blood pressures can kidneys autoregulate blood flow?

A

80-160 mmHg

40
Q

how quickly should you restore kidney perfusion in an AKI?

A

2-4 hours
12-24 hours if heart disease

41
Q

what can you give to convert oliguria to nonoliguria?

A

loop diuretics
bolus
CRI of furosemide
mannitol if hydrated
fenoldopam

42
Q

are initial BUN and creatinine values in an AKI prognostic?

A

no

A. Small Animal Medicine and Surgery (71 decks)

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