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749 - Ex 1 > AKI - Dowers > Flashcards

AKI - Dowers Flashcards

1
Q

If a patient has only one functioning kidney, should they also have azotemia? Can they concentrate their urine?

A

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)

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2
Q

If a well-hydrated (i.e. no prerenal azotemia) patient with a RIGHT ureteral obstruction has azotemia. What conclusion can you draw?

A

The LEFT kidney must be diseased as well

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3
Q

Hallmark Hx of AKI

A
  • healthy prior
  • recent onset
  • may have risk factor (e.g. NSAIDs, toxins, anesthesia, etc)
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4
Q

Hallmark PE of AKI

A
  • Good BCS
  • Painful kidneys
  • Size normal or increased
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5
Q

Hallmark Dx of AKI

A
  • Glucosuria with normal serum glucose
  • Casts (+/-)
  • Proteinuria (+/-)
  • “Bright” kidneys on US
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6
Q

Plants/food nephrotoxins of cats? dogs?

A

Cats: lilies

Dogs: raisins

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7
Q

Household (drugs) nephrotoxins

A
  • NSAIDs
  • aminoglycosides
  • ethylene glycol
  • amphotericin B
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8
Q

Infectious (Bacterial: Pyelonephritis) Causes

Cats?
Dogs?

A

Cats: FIP

Dogs: Lepto, Lyme

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9
Q

Some conditions that cause AKI (not the kidney!)

A
  • dehydration
  • fever
  • heat stroke
  • shock
  • sepsis
  • acidosis
  • hypercoagulation
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10
Q

Some organ systems abnormalities that can lead to AKI (not kidneys!)

A
  • Cardiac dz
  • Pancreatitis
  • Hypotension
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11
Q

When is AKI injury potentially reversible?

A

During initiation stage

  • intervention may prevent progression
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12
Q

When are patients most fluid-dependent?

A

During recovery stage –> patient’s have an increased urine output (often due to solute diuresis, not inc GFR)

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13
Q

Whats the prognosis of AKI? How does the magnitude factor in? How do we know if they’ve responded to therapy?

A

NEVER condemn a patient based on magnitude!

You look at their response to therapy…. BUN, creatinine, etc –> you see plateaus

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14
Q

What are the three overarching goals of AKI therapy?

A
  1. Tx the treatable
    - discontinue, decontaminate, culture, relieve obstruction, tx inciting dz
  2. Save nephrons!
    - FLUIDS!, maintain perfusion
  3. Tx Uremia
    - anti-nausea, appetite stimulants, remove waste
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15
Q

What dx test is MANDATORY in all AKI cases?

A

URINE CULTURE `

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16
Q

Patient has pyelonephritis… we do a urine culture. While we are waiting for results, what can we do?

A

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

17
Q

What if the patient (dog) has Lepto? Is this dz zoonotic? How do you test for it? How do you tx it?

A

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
18
Q

MOA of ethylene glycol

A

Acute tubular necrosis from metabolites

19
Q

What are the hallmark signs of Ethylene Glycol toxicity?

A

Acidosis, High AG, often hypocalcemia

20
Q

How do you tx ethylene glycol toxicity in dogs? cats?

A

Dogs: Fomepazole

Cats: Ethanol

21
Q

Fluid resuscitation! What three things should we take into consideration??

A
  1. Maintenance!
  2. Replace deficit!
  3. Replace on-going losses!
22
Q

How do we calculate maintenance fluid rate??

A

30 x wt (kg) + 70 = total fluid (mLs) for 24 hours

Total/24 = mLs/hr

23
Q

How can you calculate deficit? (dehydration)

A

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

24
Q

How do we determine on-going losses?

A

On-going losses are determined by urine output

**Can only be determined by placing a urinary catheter

25
Q

Is placing a urinary catheter needed with AKI?

A

Its MANDATORY!!!

26
Q

We need to ensure perfusion in these guys…so lets lower the blood pressure (carefully!). Can we use ACE-Inhibitors if the patient is proteinuric?

A

NO don’t use ACEI!! These are nephrotoxic and will dec GFR in a kidney that already has dec GFR

Dont forget: risk factors are additive

27
Q

We need to address uremia… whats the most important part of this?

A

NAUSEA and VOMITING

  • Ondanestron
  • Maropitant
  • Omeprazole
28
Q

What other part of uremia is important? besides nausea and vomiting

A

Removing the waste products (BUN, creatinine, etc)

  • peritoneal dialysis - rarely done here
  • intermittent hemodialysis
  • continuous hemodialysis

These are only offered at specialty hospitals and are pricey $$$$

29
Q

AKI has _____ causes and are _______

A

Multiple

additive

30
Q

Urine can be _____, minimally concentrated, or ____ with AKI

A

hypersthenuric

isosthenuric

**can’t R/O AKI based on USG!

31
Q

You MUST place a _____ ____ and measure/calculate losses to match losses and know when to use furosemide or mannitol (only using these to overload pts)

A

URINARY CATHETER

32
Q

_____ is mandatory

A

Urine culture

33
Q

Testing and tx’ing dogs for _____ is mandatory

A

Lepto

749 - Ex 1 (21 decks)

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