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Internal medicine (small) > Acute kidney injury (Yr 4) > Flashcards

Acute kidney injury (Yr 4) Flashcards

1
Q

what are the general causes of AKI?

A

decreased renal blood flow
toxins (antibiotics, NSAIDs, grapes…)
intrinsic renal disease
systemic disease

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2
Q

what are some toxins that can cause AKI?

A

antibacterials (aminoglycosides)
NSAIDs
ethylene glycol
lillies (cats)
grapes/raisins (dogs)

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3
Q

why are the kidneys so predisposed to toxins?

A

high blood flow
very metabolically active
epithelial cells (absorb things)

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4
Q

what is an example of an aminoglycoside?

A

gentamicin

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5
Q

what are the four stages of AKI?

A

initiation (damage starts)
extension (ischaemia, hypoxia, inflammation)
maintenance (GFR stabilised, azotaemia)
recovery (azotaemia improves, tubules repair)

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6
Q

what will be seen on a physical exam of AKI patients?

A

uraemia breath
hypothermia (unless infectious)
kidney pain/enlargement
tachycardia (pain/dehydration)
bradycardia (hyperkalaemia)

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7
Q

how does the kidney size often differ in AKI and CKD?

A

AKI - enlarged
CKD - small

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8
Q

what are the signs on haematology of AKI?

A

azotaemia
increased phosphate
hyperkalaemia
variable calcium

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9
Q

what can be seen on urinalysis of AKI?

A

usually isosthenuric
glucosuria and haematuria
sediments, casts, bacteria, crystals

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10
Q

how does body condition compare in AKI and CKD?

A

AKI - good
CKD - weight loss

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11
Q

how does onset of signs compare in AKI and CKD?

A

AKI - acute onset
CKD - history of PUPD, inappetence…

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12
Q

how does RBC status compare in CKD and AKI?

A

AKI - often no effects
CKD - non-regenerative anaemia

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13
Q

how does kidney appearance compare in AKI and CKD?

A

AKI - enlarged and painful
CKD - small, firm, irregular

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14
Q

how does effect of azotaemia compare in AKI and CKD?

A

AKI - disproportionally sick for degree of azotaemia
CKD - surprisingly well for degree of azotaemia

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15
Q

how does potassium levels compare in AKI and CKD?

A

AKI - possible hyperkalaemia
CKD - normal/low potassium

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16
Q

how does coat quality of AKI and CKD patients compare?

A

AKI - good coat
CKD - poor coat

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17
Q

how does presentation of AKI and CKD differ?

A

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

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18
Q

how is AKI treated?

A

eliminate cause (emesis, antibiotics…)
supportive treatment (fluids)

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19
Q

what is the aim of fluids in AKI?

A

improve renal blood flow
improve GFR
improve renal oxygen supply

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20
Q

should AKI patients receive aggressive fluid therapy?

A

no - over-hydration will cause more damage and oedema

21
Q

if you rehydrate an animals with AKI, how do you expect the urine production to be?

A

increased (>2ml/kg/hr)

22
Q

if you have rehydrated an AKI case and they still have oliguria, what should be done?

A

give extra 5% bodyweight IVFT if not overhydrated

23
Q

what is oliguria?

A

low urine output (<2ml/kg/hr)

24
Q

if you have rehydrated an AKI case and given them an extra 5% bodyweight IVFT and they are still oliguric, what should be done?

A

reduce IVFT and place urinary catheter
start treatment to increase urine output (furosemide)

25
Q

what is used to increase urine output in cases of AKI with oliguria?

A

furosemide

26
Q

what are some things to watch out for when treating AKI patients?

A

polyuria (after oliguria)
acid-base abnormalities
hyperkalaemia

27
Q

what should be used as an anti-emetic for AKI cases?

A

maropitant

28
Q

what should be used for hypertension in AKI, especially if you have overhydrated them?

A

reduce IVFT
furosemide

29
Q

should you feed animals with AKI?

A

yes - disease is highly catabolic

30
Q

what is the prognosis for AKI?

A

50% die
50% have CKD
(better for leptospirosis, worse for ethylene glycol)

31
Q

what is maintenance fluid rate?

A

2ml/kg/hr

32
Q

what animals ate UTIs most common in?

A

females>males
dogs>cats

33
Q

what is a UTI?

A

adherence, multiplication and persistence of infectious agent within the urinary system

34
Q

what is bacteriauria?

A

bacteria in urine

35
Q

what is pyuria?

A

white blood cells in urine

36
Q

what is the typical UTI seen in a female dog?

A

sporadic bacterial cystitis

37
Q

if a female dog keeps getting a UTI, what is it called?

A

recurrent bacterial cystitis

38
Q

what is it called if there is bacteria in the urine but no clinical signs of infection?

A

subclinical bacteriuria

39
Q

what are the clinical signs of a cystitis (UTI)?

A

dysuria, pollakuria, haematuria, urinary incontinence

40
Q

what are the clinical signs of pyelonephritis?

A

abdominal pain, AKI, septicaemia
PUPD

41
Q

how do blood results differ with upper and lower UTIs?

A

upper - septicaemia or AKI
lower - no abnormalities

42
Q

how is sporadic bacterial cystitis treated?

A

5 day antibiotics (amoxicillin, cephalexin…)

43
Q

how is recurrent bacterial cystitis treated?

A

5 day antibiotic (consider longer)
look for predisposing cause

44
Q

how is pyelonephritis treated?

A

10-14 days antibiotics

45
Q

how is bacterial prostatitis treated?

A

4 week antibiotics
need one that penetrates blood-prostate barrier such as sulphonamides

46
Q

how is subclinical bacteriuria treated?

A

no treatment recommended (get colonisation of resistant bacteria)

47
Q

will cystitis cause PUPD?

A

no (causes pollakiuria)

48
Q

if a make entire dog presents with signs of cystitis, would should be the presumptive diagnosis?

A

bacterial prostatitis

Internal medicine (small) (33 decks)

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