Renal Dx - Companion Animals Flashcards
Aetiology AKI
Pre-renal:
< renal blood flow/ perfusion -> GRF decline.
Kidneys receive 20% of CO
- Hypovolemia, hypotension, reduce CO, hypotensive treatment
Renal:
Renal damage & renal tissue changes
Prolonged ischemia, immune-mediated disease, infectious disease (Leptospirosis, Lyme’s, FIP, Leishmania, Babesiosis,
Systemic disease (pancreatitis, DIC),
Toxins (Ethylene glycol, grapes/raisins, lily plant, heavy metals)
Post-Renal:
Urinary tract obstruction -> increased glomerular back pressure and reduction in GFR
urethral or ureteral calculi, neoplasia, urinary tract rupture and reabsorption of uraemic toxins
AKI - Clinical Signs
- Acute onset
- Anorexia
- V+/D+
- Lethargy
- Oliguria/anuria
- Drinking less
- Ataxia/ seizure
AKI - Physical Exam
- Good body condition
- Signs of fluid overload (> RR, peripheral oedema, hypertension)
- Bradycardia
- Abdominal palpation = renal enlargement and discomfort
- Halitosis or oral ulcers
- Melena
Diagnostic Investigations
Emergency Database
- PCV
- TP
- Electrolytes - hyperkalaemia
- Urea/creatinine - azotaemia
Urinalysis
- Before IVFT
- SG 1.007-1.015
- Culture and sensitivity
- Sediment exam
BP
Abdo imaging
AKI - Tx
Supportive:
* Fluid therapy
* Correct electrolytes imbalances
* Correct acidosis (Ph < 7.2)
* Diuretic (frusemide or mannitol)
* Dialysis
* Antiemetic
* Control hypertension
* Nutritional support
* MONITOR URINE OUTPUT (indwelling catheter)
AKI - Prognosis:
Initial phase - fair to good
-ve prognostic factors
- anuria
- low body temperature
- anaemia,
- low albumin,
- low lactate
- hyperkalaemia
- toxic cause
- current dx
+ve prognostic factors
- response to tx
- infectious cause
CKD - Clinical Signs
- Gradual onset
- PU/PD
- Weight loss
- Decreased appetite
- Lethargy
- Dehydration
- V+/D+
- Halitosis
CKD - Physical Exam
- Good/poor body condition
- Dehydration (skin tenting)
- Abdominal palpation = small & irregular kidneys/ one large kidney & one small one
- Halitosis or oral ulcers
- Melena
Blood Analysis
- Azotemia A/C
- SDMA A/C
- Hyperphosphatemia A/C
- Metabolic acidosis A
- Anaemia A/C
- Hyperkalaemia A
- Hypokalaemia C
Urinalysis
- Minimal concentration USG A/C
- Isostenuria A/C
- Proteinuria A/C
- Glucosuria (with
normoglycaemia)A - Casts A
- RBC A/C
- WBC A/C
- Calcium oxalate crystals A
- Positive C&S A/C
- RENAL BIOMARKERS: cystatinB AKI
Blood Pressure
- Hypertension A/C
- Hypotension A
Imaging
- Normal size kidneys A/C
- Increased size A/C
- Reduced size C
CKD - Tx
AIMS:
* Slow/halt progression
* Reduce frequency of uraemic crisis
* Manage 2° complications
* Ensure QoL
CKD - Diet
Reduce phosphate and protein intake
Phosphate Binders
Blood phosphate high (>1.5mmol/l).
Phosphate retained in bowel and absorption limited.
Antihypertensives
Amlodipine
* Ca channel blocker.
* 0.625mg – 1.25mg every 24hrs.
* Can double dose if no response.
Telmisartan
* Angiotensin receptor blocker.
* 1.5mg/kg BID then 2mg/kg SID.
Proteinuria
Cats >0.4
Dogs >0.5
Telmisartan (Semintra)
* Angiotensin II receptor blocker (ARB)
Benazepril (Fortekor)
* Angiotensin converting enzyme inhibitor (ACEI)
Other Treatment Options
K+ supplementation
GI Signs
➢Antiemetics: Maropitant, metoclopramide.
➢Appetite stimulants: Mirtazapine.
➢H2 blockers: Famotidine.
➢Proton pump inhibitor: Omeprazole.
Anaemia
➢Blood transfusions.
➢EPO injection.
Thromboembolism Risk
➢Dogs w serum albumin <20g/l.
➢Treat with Clopidogrel.
Fluids
- Stage III/IV
- Hospitalise and IVFT
- Consider s/c fluids by owners
- 2-3 times per week commonly
- 10-20ml/kg at single site
CKD - Prognosis
Cats - survive long periods of time
Increased urine protein levels = -ve prognostic factor
