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Small Animal Medicine > Renal - Acute Kidney Disease > Flashcards

Renal - Acute Kidney Disease Flashcards

1
Q

What acute kidney injury?

A

A sudden decline in renal function leading to the retention of nitrogenous wastes

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2
Q

What is AKI in regards to creatinine?

A

It is a small increase in creatinine

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3
Q

Generally, what are the pre-renal causes of AKI?

A

inadequate delivery of blood flow to the kidneys which decreases GFR

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4
Q

Generally what are the renal causes of AKI?

A

direct damage to some part of the kidney (majority of cases are tubular damage)

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5
Q

Generally what are the post-renal causes of AKI?

A

Decreased GFR due to increased hydrostatic pressure secondary to obstruction

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6
Q

What are the most commonly seen intrinsic factors of AKI?

A

leptospirosis, pyelonephritis, ischemia, and toxic

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7
Q

What are the risk factors for (hospital-acquired) AKI?

A

volume depletion/hypoperfusion, anesthesia and surgery, sepsis, and nephrotoxic drugs, and pre-existing renal disease

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8
Q

What are the four phases of the pathophysiology of AKI?

A

initiation, extension, maintenance, and recovery

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9
Q

What occurs during the initiation phase of AKI?

A

Renal insult occurs; phase ends when there is a definable decrease in function

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10
Q

What occurs during the extension phase of AKI?

A

Injury is perpetuated by hypoxia, inflammation, etc.

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11
Q

What occurs during the maintenance phase of AKI?

A

Critical damage has occured; duration is variable (weeks)

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12
Q

What occurs during the recovery phase of AKI?

A

Renal damage is repaired; duration variable (weeks to months)

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13
Q

When is the best time to intervene with treatment for AKI?

A

During the initiation phase

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14
Q

What history is associated with AKI?

A

Acute-onset (hours-days) of clinical signs, vomiting, diarrhea, loss of appetite, lethargy, and variable urination changes
May or may not have toxin exposure

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15
Q

On PE what will you see in patients with AKI?

A

Usually good body condition
Variable hydration
+/- uremic breath/halitosis, oral ulceration
+/- renal enlargement or pain
+/- other physical exam findings depending on underlying disease

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16
Q

What CBC changes may be found in AKI patients?

A

+/- anemia

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17
Q

What may you find on chemistry in an AKI patient?

A

Azotemia, hyperphosphatemia, metabolic acidosis, variable K values (hyperkalemia with oliguria/anuria)

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18
Q

What may you find on UA in a patient with AKI?

A

Isosthenuria or minimally concentrated urine
Proteinuria or glucosuria may be present
Casts will indicate ongoing damage

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19
Q

What additional diagnostics should you consider with AKI patients?

A

Leptospirosis testing if indicated, urine culture, ethylene glycol testing, abdominal testing, blood pressure

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20
Q

What are the treatment goals for patients with AKI?

A

Stop the ongoing injury, aid in the recovery of kidney cells, and support the patient by managing complications

21
Q

What should you do first in patients with AKI?

A

Diagnose and treat for specific underlying etiology whenever possible

22
Q

What non-specific supportive care can be provided until renal recovery?

A

Fluid balance, electrolytes, acid base status, blood pressure, GI complications, and nutrition

23
Q

How is urine output in AKI?

A

It can be increased, normal, or decreased to absent

24
Q

What urine output is associated with polyuria?

A

> 2 ml/kg/hr

25
Q

What urine output is associated with oliguria?

A

<0.5-1 ml/kg/hr

26
Q

What are the different components of fluid replacement requirements?

A

Maintenance, replacement, and ongoing losses

27
Q

Fluid maintenance for AKI is primarily made up of what?

A

urine output

28
Q

What are you replacing in AKI patients (fluids)?

A

volume to be replaced in a dehydrated patient

29
Q

What ongoing losses are you replacing in AKI patients?

A

vomitting, diarrhea, polyuria, and drain output

30
Q

How does hyperkalemia affect the electrical potential in cells?

A

It makes the resting membrane potential less negative

31
Q

What ECG changes are associated with hyperkalemia?

A

Bradycardia, tall spiked T waves, widened QRS, short QT interval, and small/absent P waves

32
Q

What can be administered to manage hyperkalemia?

A

Calcium gluconate, insulin/dextrose, bicarbonate, and albuterol

33
Q

How does calcium gluconate affect hyperkalemia?

A

It counteracts the effect of potassium on the cardiac cells

34
Q

How does insulin/dextrose affect hyperkalemia?

A

It promotes a K shift from the extracellular to intracellular space

35
Q

How does bicarbonate affect hyperkalemia?

A

It promotes alkalosis which promotes an intracellular shift

36
Q

How does albuterol affect hyperkalemia?

A

It promotes an intracellular K shift

37
Q

True or False: Hypertension is not a common finding in AKI patients.

A

False - it can affect up to 80% of dogs with AKI

38
Q

What is hypertension exacerbated by in AKI patients?

A

fluid overload

39
Q

If systolic blood pressure is >180mmHg in AKI patients, what should you do?

A

Correct over-hydration if possible and treat with amlodipine

40
Q

Why does metabolic acidosis occur in AKI patients?

A

Failing kidneys are unable to excrete H or reabsorb HCO3

41
Q

What can be administered in severe cases of severe acidosis?

A

sodium bicarbonate

42
Q

Why is nausea and vomiting commonly associated with AKI?

How is it treated?

A

Uremic toxins stimulate the chemoreceptor trigger zone

anti-emetic medications

43
Q

How do you treat GI bleeding that may or may not be associated with AKI?

A

with proton-pump inhibitors +/- sucralfate

44
Q

What nutritional support should be given to AKI patients?

A

Since they are highly catabolic they should get assisted enteral nutrition (feeding tube) if they are hospitalized

45
Q

What may cause anemia in AKI patients?

A

GI bleeding, thrombopathy due to uremia, repeated blood sampling, and loss secondary to dialysis

46
Q

What treatment may be indicated for anemia in AKI patients?

A

Blood transfusion or erythropoetin supplementation

47
Q

What is the prognosis for AKI?

A

~50% mortality rate - 25-50% of survivors will have persistent azotemia

48
Q

What are the poor prognostic indicators for AKI?

A

Oliguria/anuria and hyperkalemia

49
Q

What is renal replacement therapy?

A

The removal of uremic toxins and electrolytes with hemodialysis
Excessive fluid is removed using differences in osmotic pressure

Small Animal Medicine (100 decks)

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