Approach to and Management of Acute Azotaemia in Small Animals Flashcards
What is the most common hospital test for renal disease
Urinalysis
What does Glomerular Filtration Rate measure
Excretory function of kidneys
Where is Urea synthesised
Liver
Where is urea excreted
freely filtered by glomerulus, undergoes tubular resorption depending on renal flow rates
In biochemistry what is the name of the marker used to measure Urea
BUN – blood urea nitrogen
Where is creatinine synthesised
muscle, breakdown of phosphocreatine
Where is creatinine excreted
freely filtered by glomerulus, no tubular resorption
Serum levels impacted by
Altered muscle mass
Altered renal blood flow
Altered renal function
Altered renal outflow
Limitation of creatinine test
Increases do not develop until GFR has decreased to 25%
Doesn’t tell you why the creatinine is increased
Need to consider a patients baseline
Will not distinguish between acute or chronic kidney disease
Synthesis of SDMA
Metabolism of animo acids during protein breakdown (arginine residues)
Excretion of SDMA
Freely filtered, not resorbed
Benefit of SDMA test
Not influenced by muscle mass
Increases with earlier changes in GFR (more sensitive test)
Limitation of SDMA test
Will not tell the difference between acute or chronic kidney disease
Only available through IDEXX laboratories
Definition of Azotaemia
Increase in the concentration of non-protein nitrogenous wastes in blood (urea and creatinine)
Definition of uremia
Clinical syndrome of renal disease,high levels of urea in blood
Clinical signs - uraemia
Inappetance
Depression
Vomiting/ Nausea
Halitosis
Oral ulceration/stomatitis
Diarrhoea
Common causes of azotaemia (pre renal)
Hypovolaemia
Hypotension
Aortic/renal thromboembolism
Common causes of azotaemia (renal)
Nephron damage
Nephron loss
Common causes of azotaemia (post renal)
Ureterolith
Urethrolith
Bladder rupture
What is Acute Kidney Injury (AKI)?
Sudden, often reversible reduction of the elimination and metabolic functions of the kidneys. AKI is a medical emergency
Causes of acute kidney injury
Reduced perfusion- Dehydration,Hypotension, shock
Nephrotoxic drugs- NSAIDS/Doxorubicin(Chemo)/Aminoglycosides(AntiB)
Toxicities- Lilies(cats)/Grapes(Dogs)/Anti freeze
Infections- Leptospirosis/ Borreliosis (lyme disease)
Ureteral obstructions-Ureteroliths
How to differentiate between acute and chronic kidney disease
History/Body condition/Presence of anemia
Normal urine output formula
1-2ml/kg/hr
Oliguria formula
<0.25ml/kg/hr
Polyuria formula
> 2ml/kg/hr
AKI treatment
Remove inciting cause
Restore renal perfusion
Monitor urine output and consider drugs to increase urine output (if needed)
Monitor weight, electrolytes, acid base balance regularly (Prevent fluid overload)
Treat uraemic complication and provide nutrition
