AKI - Dowers Flashcards
If a patient has only one functioning kidney, should they also have azotemia? Can they concentrate their urine?
The could have no azotemia (as long as remaining kidney is fxn-ing)
They should have appropriately concentrated urine (as long as remaining kidney is fxn-ing)
If a well-hydrated (i.e. no prerenal azotemia) patient with a RIGHT ureteral obstruction has azotemia. What conclusion can you draw?
The LEFT kidney must be diseased as well
Hallmark Hx of AKI
- healthy prior
- recent onset
- may have risk factor (e.g. NSAIDs, toxins, anesthesia, etc)
Hallmark PE of AKI
- Good BCS
- Painful kidneys
- Size normal or increased
Hallmark Dx of AKI
- Glucosuria with normal serum glucose
- Casts (+/-)
- Proteinuria (+/-)
- “Bright” kidneys on US
Plants/food nephrotoxins of cats? dogs?
Cats: lilies
Dogs: raisins
Household (drugs) nephrotoxins
- NSAIDs
- aminoglycosides
- ethylene glycol
- amphotericin B
Infectious (Bacterial: Pyelonephritis) Causes
Cats?
Dogs?
Cats: FIP
Dogs: Lepto, Lyme
Some conditions that cause AKI (not the kidney!)
- dehydration
- fever
- heat stroke
- shock
- sepsis
- acidosis
- hypercoagulation
Some organ systems abnormalities that can lead to AKI (not kidneys!)
- Cardiac dz
- Pancreatitis
- Hypotension
When is AKI injury potentially reversible?
During initiation stage
- intervention may prevent progression
When are patients most fluid-dependent?
During recovery stage –> patient’s have an increased urine output (often due to solute diuresis, not inc GFR)
Whats the prognosis of AKI? How does the magnitude factor in? How do we know if they’ve responded to therapy?
NEVER condemn a patient based on magnitude!
You look at their response to therapy…. BUN, creatinine, etc –> you see plateaus
What are the three overarching goals of AKI therapy?
- Tx the treatable
- discontinue, decontaminate, culture, relieve obstruction, tx inciting dz - Save nephrons!
- FLUIDS!, maintain perfusion - Tx Uremia
- anti-nausea, appetite stimulants, remove waste
What dx test is MANDATORY in all AKI cases?
URINE CULTURE `
Patient has pyelonephritis… we do a urine culture. While we are waiting for results, what can we do?
IV Abx (start with ampicillin and then switch based on C&S results)
Tx for 4-6 wks
Culture again in 1-2 wks while pt is on Abx
Culture 1 wk and 1 mo after finishing Abx
What if the patient (dog) has Lepto? Is this dz zoonotic? How do you test for it? How do you tx it?
ZOONOTIC! so barrier nursing is mandatory
Testing:
- Serology (MAT): acute and convalescent titers
- PCR: good for acute infections
Tx:
- terminate leptospiremia with ampicillin or doxy
- then eliminate carrier state with doxy
MOA of ethylene glycol
Acute tubular necrosis from metabolites
What are the hallmark signs of Ethylene Glycol toxicity?
Acidosis, High AG, often hypocalcemia
How do you tx ethylene glycol toxicity in dogs? cats?
Dogs: Fomepazole
Cats: Ethanol
Fluid resuscitation! What three things should we take into consideration??
- Maintenance!
- Replace deficit!
- Replace on-going losses!
How do we calculate maintenance fluid rate??
30 x wt (kg) + 70 = total fluid (mLs) for 24 hours
Total/24 = mLs/hr
How can you calculate deficit? (dehydration)
Dehydration (%) x wt (kg) = Deficit (L)
Deficit (L) x 1000mLs/L = Deficit (mLs)
Deficit (mLs) / 24 hrs = mLs/hr
*Add this to the maintenance rate
How do we determine on-going losses?
On-going losses are determined by urine output
**Can only be determined by placing a urinary catheter
