Acute kidney injury (Yr 4) Flashcards
what are the general causes of AKI?
decreased renal blood flow
toxins (antibiotics, NSAIDs, grapes…)
intrinsic renal disease
systemic disease
what are some toxins that can cause AKI?
antibacterials (aminoglycosides)
NSAIDs
ethylene glycol
lillies (cats)
grapes/raisins (dogs)
why are the kidneys so predisposed to toxins?
high blood flow
very metabolically active
epithelial cells (absorb things)
what is an example of an aminoglycoside?
gentamicin
what are the four stages of AKI?
initiation (damage starts)
extension (ischaemia, hypoxia, inflammation)
maintenance (GFR stabilised, azotaemia)
recovery (azotaemia improves, tubules repair)
what will be seen on a physical exam of AKI patients?
uraemia breath
hypothermia (unless infectious)
kidney pain/enlargement
tachycardia (pain/dehydration)
bradycardia (hyperkalaemia)
how does the kidney size often differ in AKI and CKD?
AKI - enlarged
CKD - small
what are the signs on haematology of AKI?
azotaemia
increased phosphate
hyperkalaemia
variable calcium
what can be seen on urinalysis of AKI?
usually isosthenuric
glucosuria and haematuria
sediments, casts, bacteria, crystals
how does body condition compare in AKI and CKD?
AKI - good
CKD - weight loss
how does onset of signs compare in AKI and CKD?
AKI - acute onset
CKD - history of PUPD, inappetence…
how does RBC status compare in CKD and AKI?
AKI - often no effects
CKD - non-regenerative anaemia
how does kidney appearance compare in AKI and CKD?
AKI - enlarged and painful
CKD - small, firm, irregular
how does effect of azotaemia compare in AKI and CKD?
AKI - disproportionally sick for degree of azotaemia
CKD - surprisingly well for degree of azotaemia
how does potassium levels compare in AKI and CKD?
AKI - possible hyperkalaemia
CKD - normal/low potassium
how does coat quality of AKI and CKD patients compare?
AKI - good coat
CKD - poor coat
how does presentation of AKI and CKD differ?
AKi has good BCS but CKD has weight loss
AKI is acute CKD have previous PUPD/poor appetite
CKD has possible non-regenerative anaemia
AKI have large painful kidneys, CKD has small irregular kidneys
AKI are very sick for azotaemia, CKD surprisingly well for degree of azotaemia
AKI often hyperkalaemia, CKD have normal/low potassium
AKI have good coat, CKD has poor coat
how is AKI treated?
eliminate cause (emesis, antibiotics…)
supportive treatment (fluids)
what is the aim of fluids in AKI?
improve renal blood flow
improve GFR
improve renal oxygen supply
should AKI patients receive aggressive fluid therapy?
no - over-hydration will cause more damage and oedema
if you rehydrate an animals with AKI, how do you expect the urine production to be?
increased (>2ml/kg/hr)
if you have rehydrated an AKI case and they still have oliguria, what should be done?
give extra 5% bodyweight IVFT if not overhydrated
what is oliguria?
low urine output (<2ml/kg/hr)
if you have rehydrated an AKI case and given them an extra 5% bodyweight IVFT and they are still oliguric, what should be done?
reduce IVFT and place urinary catheter
start treatment to increase urine output (furosemide)
what is used to increase urine output in cases of AKI with oliguria?
furosemide
what are some things to watch out for when treating AKI patients?
polyuria (after oliguria)
acid-base abnormalities
hyperkalaemia
what should be used as an anti-emetic for AKI cases?
maropitant
what should be used for hypertension in AKI, especially if you have overhydrated them?
reduce IVFT
furosemide
should you feed animals with AKI?
yes - disease is highly catabolic
what is the prognosis for AKI?
50% die
50% have CKD
(better for leptospirosis, worse for ethylene glycol)
what is maintenance fluid rate?
2ml/kg/hr
what animals ate UTIs most common in?
females>males
dogs>cats
what is a UTI?
adherence, multiplication and persistence of infectious agent within the urinary system
what is bacteriauria?
bacteria in urine
what is pyuria?
white blood cells in urine
what is the typical UTI seen in a female dog?
sporadic bacterial cystitis
if a female dog keeps getting a UTI, what is it called?
recurrent bacterial cystitis
what is it called if there is bacteria in the urine but no clinical signs of infection?
subclinical bacteriuria
what are the clinical signs of a cystitis (UTI)?
dysuria, pollakuria, haematuria, urinary incontinence
what are the clinical signs of pyelonephritis?
abdominal pain, AKI, septicaemia
PUPD
how do blood results differ with upper and lower UTIs?
upper - septicaemia or AKI
lower - no abnormalities
how is sporadic bacterial cystitis treated?
5 day antibiotics (amoxicillin, cephalexin…)
how is recurrent bacterial cystitis treated?
5 day antibiotic (consider longer)
look for predisposing cause
how is pyelonephritis treated?
10-14 days antibiotics
how is bacterial prostatitis treated?
4 week antibiotics
need one that penetrates blood-prostate barrier such as sulphonamides
how is subclinical bacteriuria treated?
no treatment recommended (get colonisation of resistant bacteria)
will cystitis cause PUPD?
no (causes pollakiuria)
if a make entire dog presents with signs of cystitis, would should be the presumptive diagnosis?
bacterial prostatitis
