Acute Kidney Injury

Question 1

What causes tubular injury, such as acute tubular necrosis or nephrosis?

Answer 1

Ischaemia

Exposure to toxins

Question 2

In what cases does anuria or oliguria present?

Answer 2

The most severe injury-
Ethylene glycol
Lily toxicity

Question 3

What are the 4 commonly encountered symptoms of AKI?

Answer 3

Anorexia
Lethargy
Vomiting
RECENT onset PUPD

Question 4

When might fever be a symptom of AKI?

Answer 4

Nephritis

Caused by Leptospirosis or Borrelia

Question 5

What finding can support ethylene glycol toxicity?

Answer 5

Calcium oxalate crystals in the urine

Question 6

What is the typical urine output for
A normal dog?
A dog receiving fluid volume expansion?

Answer 6

1-2ml/kg/hr

2-5ml/kg/hr

Question 7

What fluid can be used instead of saline to prevent hypernatremia?

Answer 7

Hypotonic fluid 0.45% + 2.5% dextrose

Question 8

What effects does Hyperkalaemia have and how is it managed in the acute setting?

Answer 8

If serum potassium is over 8mEq/L it causes Bradycardia

Treated with sodium bicarbonate infusion

Question 9

How can chronic hyperkalemia be managed?

Answer 9

Ion exchange resin - sodium polystyrene sulfate 2g/kg retention enema or divided into q8 orally

Question 10

When should alkali therapy be provided?

Answer 10

If total C02 is less than 15mEq/L

Add sodium bicarbonate to normal saline (or other fluids not containing calcium)

Question 11

What effect does high phosphate have? How is it managed?

Answer 11

Worsens renal lesions
Contributes to metabolic acidosis and hypercalcemia
Phosphate binders dosed according to serial measurements

Question 12

Why is it easier to manage a non-oliguric patient than an oliguric one?

Answer 12

They are less likely to develop hyperkalaemia and fluid overload

Question 13

How can you convert oliguria to non-oliguria?

Answer 13

Osmotic diuretic- Mannitol 0.25-0.5mg/kg IV repeated once

Loop diuretic- furosemide 1-2mg/kg followed by a 1mg/kg/hr infusion over 6 hours