ECC

Question 1

Can you have AKI with a CREA within the reference interval?

Answer 1

Yes! That is nonazotemic AKI. Increase in creatinine by more than 0.3 mg/dl within 48 hours, even within the reference interval, is AKI.

Question 2

T/F. Sustained decrease of less than 1 ml/kg/h for 6 h in euhydrated/euvolemic animal receiving fluids should raise suspicion for onset of AKI.

Answer 2

True!

Question 3

What are some patients at risk of hospital-acquired AKI?

Answer 3

Septic patients, cardiac disease, renal disease, anesthesia (risk of hypo perfusion).

Question 4

3 categories of etiology of AKI

Answer 4

Pre-renal, renal (or intrinsic), and post-renal.

Question 5

Causes of prerrenal AKI

Answer 5

Decreased renal blood flow
Renal vasoconstriction (NSAIDs, hypo or hypercalcemia???).

Question 6

Causes of renal AKI (4 main categories)

Answer 6

Ischemic (shock, anesthesia, thrombosis, surgery)
Primary renal disease (pyelonephritis, lepton, Lyme, immune-mediated, lymphoma)
Systemic disease (hypertension, pancreatitis, sepsis, SIRS)
Nephrotoxins (NSAIDs, ACEI, diuretics, lilies, grapes/raisins)

Question 7

Is urine culture indicated in cases of AKI?

Answer 7

Yes, Dr. Vea does recommend urine culture in most cases even if no bacteria seen in the UA.

Question 8

Infectious diseases we should rule out in cases of AKI

Answer 8

Lepto and Lyme

Question 9

T/F. The goal of fluid therapy treatment for patients with AKI is to achieve and maintain euvolemia/euhydration without creating fluid overload.

Answer 9

True! But it’s very difficult.

Question 10

Do we give IV fluids to animals with AKI that are anuric in the stabilization part of fluid therapy?

Answer 10

Apparently, we don’t! Only cover losses because of the risk of fluid overload.

Question 11

How much are insensible losses?

Answer 11

22 ml/kg/day

Question 12

Is 0.9%NaCl the fluid of choice for most AKI cases?

Answer 12

Nope! Because it’s no buffer, has excess Na+, and excess Cl- (the last can cause acidosis because it reduces the absorption of bicarb)

Question 13

LRS and Normosol-R are good for

Answer 13

Resuscitation and replacement in patients with AKI.

Question 14

What is the treatment for fluid overload?

Answer 14

DISCONTINUE all fluid therapy, and consider diuretics if severe or respiratory compromise

Question 15

Findins in animals with fluid overload?

Answer 15

Peripheral edema, increased respiratory rate/effort, increased weight>10% from non-dehydrated baseline, serous ocular and nasal discharge, chemosis, cavitary effusions

Question 16

Does fluid overload improve or worsens azotemia?

Answer 16

It does worsen it. It also decreases GFR, causes pulmonary edema, decreased hepatic blood flow +/- cholestasis, vomiting, etc.