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A - Medicine Urology > Azotaemia and renal failure > Flashcards

Azotaemia and renal failure Flashcards

1
Q

Do azotaemia and uraemia always appear together?

A

No
You can have azotaemia without uraemia
But you can’t get uraemia without azotaemia

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2
Q

What are the 3 (4) reasons for developing azotaemia?

A

Inadequate renal perfusion
Loss of nephrons
Back pressure

-Leading to decreased GFR

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3
Q

What are some causes of inadequate renal perfusion?

A

Shock
Heart failure
Severe dehydration

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4
Q

What are the 3 categories of azotaemia?

A

Prerenal
Renal
Postrenal

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5
Q

At what remaining renal function percentage do you see PU/PD in a dog that can no longer concentrate urine enough?

A

33% remaining

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6
Q

At what remaining renal function percentage will a patient become azotaemic?

A

25% remaining

-Also when creatinine levels will start to slowly change

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7
Q

What is SDMA and why is it useful?

A

New renal biomarker test
Can now detect damage earlier
Instead of having to loose 75%, now you can pick up on a patient that has lost 40%
(Just before renal insufficiency occurs)

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8
Q

Is creatinine or BUN more renal specific?

A

Creatinine

-Urea is made in the liver

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9
Q

What 4 things can BUN be affected by, other than renal function?

A

Diet -High in protein
GI bleeding
Catabolic rate
Dehydration

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10
Q

How do you manage a patient with suspected prerenal azotaemia?

A

Get baseline bloodwork and urine
-See that they can concentrate properly at the start
Rehydrate the patient over 4-8 hours
Continue with maintenance fluid therapy
Monitor urine output, hydration status, weight, central venous pressure
Avoid over-hydration
Repeat blood work after 24-48 hours and see what has changed

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11
Q

Why should you first try and correct any prerenal cause of azotaemia first?

A

Can re-check from baseline levels, if they become normal then only pre-renal problem
If there are renal or postrenal components you will at least get a better understanding of how badly they are affected, and make the patient feel better

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12
Q

If after fixing any fluid deficits of a suspected prerenal azotaemia, and the azotaemia still persists, what are the 2 possibilities?

A

-Further fluid therapy is needed
Degree of dehydration and renal perfusion impairment was underestimated or there are on-going losses
-Renal or postrenal azotaemia is present

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13
Q

What are 2 common causes of post-renal azotaemia?

A

Urolithial obstruction

Bladder rupture

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14
Q

In the correct order, how do you manage post-renal azotaemia?

A

Correct the life-threatening metabolic disturbances first
-IV catheter and any fluid
Relieve the urinary outflow obstruction
Anticipate post obstruction diuresis and monitor/treat accordingly

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15
Q

What is the first thing you need to work out when dealing with a patient with renal azotaemia?

A

If it is acute or chronic renal failure

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16
Q

Why can acute renal failure be better and also worse than chronic?

A

Acute renal failure usually present worse than a chronic case, with worse prognosis of survival
However for acute renal failure there may be improvement in renal function as nephrons repair after injury
-For chronic there is little chance of improved function

17
Q

What is the aim of therapy for treating CKD?

A

Deal with prerenal and any post renal complications

  • May slow down rate of progression
  • Unlikely to improve GFR
18
Q

Describe the pathogenesis of CKD?

A

Inciting cause occurs
-Often difficult to determine, histological changes are not process specific
Progressive, inexorably destruction of diseased nephrons
But done at a rate where there is time for compensatory hypertrophy of unaffected nephrons
Eventually the hypertrophied nephrons cannot maintain adequate renal function
Renal insufficiency - PU/PD
Chronic renal failure -Azotaemia

19
Q

Why do dogs with CKD produce more urine, not less?

A

Because the tubule cells are not able to re-uptake all the solutes
-Mainly sodium

20
Q

Describe some of the features of CRF?

A 
PU/PD
Vomiting
Anorexia
Dehydration
\+/- Pale mucous membranes
\+/- oral ulceration/halitosis
\+/- abnormal kidneys 
Isosthenuria despite dehydration
Azotaemia and hyperphosphataemia*
\+/- metabolic acidosis in end stage
Non-regenerative anaemia
Hypokalaemia - early
Hyperkalaemia - end stage
Hyper/hypocalcaemia uncommon
Thrombocytopathia
21
Q

Describe some features of advanced CRF/uraemia?

A 
Increased plasma hormone concentrations
-Gastrin
-Glucagon
-Insulin
-Growth hormone
-PTH
Immunodeficiency 
\+/- systemic arterial hypertension
\+/- rare osteodystrophy (Rubber jaw) 
\+/- uraemic encephalopathy
22
Q

What are some other clinical problems that you sometimes may see with uraemia/CRF?

A 
Urinary incontinence
-Underlying PU/PD
Haematuria
Proteinuria
Stranguria
Pollakiuria
Dysuria
Melaena
Urinary outflow obstruction
Urolithiasis
Fever
Urinary tract infection
Urinary tract mass lesions
23
Q

Describe a diagnostic approach to CRF?

A 
Signalment and history
Physical exam
Routine blood work
Urinalysis
Response to rehydration
Imaging of kidney size/shape
Staging of disease
24
Q

Describe how you would manage a patient with CRF?

A

*Identify and treat any contributing underlying causes
-Usually won’t find
-Systemic arterial hypertension, UTI, toxins, drugs
*Maintain optimal hydration
-Provide water ad lib.
-Short term i/v fluid therapy
-Maybe teach owners to administer fluids s/c
Restrict phosphorus intake
-Low phosphorus diet, enteric phosphate binders
Restrict protein intake as needed
*Supplement water-soluble vitamins
*Once hyperphosphataemia controlled give calcitriol
-Reduces hyperparathyroidism
*H2 receptor blocker like ranitidine
-Hypergastronemia
*Anti-emetic
*Anabolic steroids
-May help to feel better
*r-HuEPO
-Erythropoietin
-Good way to treat anaemia
-Expensive, may get hypertension and anti-EPO antibody

25
Q

Describe how you can manage systemic hypertension complicating CRF?

A 
\+/- salt restriction
ACEI in dogs
ACEI in mild-moderately affected cats 
ACEI & Amlodipine in severely affected cats 
Use combinations in refractory cases
26
Q

Describe how you can manage proteinuria complicating CRF?

A

ACEI

Angiotension receptor blocker

27
Q

What do you use to monitor a patient with CKD?

A 
At home
Attitude, activity, appetite, vomiting
Thirst, drinking
Body weight
Urination habits

At the clinic
Measure BUN, creatinine, phosphorus (SDMA)
Arterial blood pressure
Urinary protein/ albumin

A - Medicine Urology (5 decks)

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