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year 4 small animal studies > Internal Medicine: Acute Kidney Injury and Urinary Tract Infection > Flashcards

Internal Medicine: Acute Kidney Injury and Urinary Tract Infection Flashcards

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1
Q

What is AKI?

A

Acute kidney injury

Spectrum of disease associated with a sudden onset of renal parenchymal injury

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2
Q

What happens with an abrupt drop in kidney function?

A
  • Abnormal GFR, tubular function and urine production
  • Sudden inability to maintain fluid, acid-base and electrolyte balance
  • May result in azotaemia
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3
Q

What are the causes of AKI?

A
  • Decreased renal blood flow
  • Toxins- ABs, NSAIDs, ethylene glycol, lillies (cats), grapes (dogs)
  • Intrinsic renal diseases- leptospirosis, pyelonephritis
  • Systemic diseases
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4
Q

Describe the pathophysiology of AKI

A

4 stages
* Initiation phase- damage starts
* Extension phase- ishaemia, hypoxia, inflammatory response, ongoing cellular injury, cell death
* Maintenance phase- stabilisation of GFR, azotamiea, uraemia
* Recovery phase- azotamia improves and the tubules undergo repair can be marked polyuria during this stage

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5
Q

When does AKI, AKD and CKD occur?

A

AKI- 0-7 days
AKD- 7-90 days
CKD- >90 days

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6
Q

What history may highlight AKI?

A
  • Recent onset of anorexia, polydipsia, vomiting
  • May get CNS signs in ethlylene glycol
  • Toxin exposure/nephrotoxis drugs
  • Vaccination- lepto
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7
Q

What may be found on a physical exam of an animal with AKI?

A
  • Uraemic breath
  • Hypothermia- unless infection
  • ± kidney pain or enlargment
  • Tachycardia- dehydration, pain
  • Bradycardai- hyperkalaemia
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8
Q

What may be found on blood samples and urine for an animal with AKI?

§

A

Blood
* Azotaemia
* Increased phosphate
* Hyperkalaemia
* Calcium variable

Urine
* Probably isothenuric
* Can see glucosuria, haematuria
* Sediment- casts, WBCs, bacteria, crystals

Potassium often down with chronic

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9
Q

What are the differences in symptoms with AKI and CKD?

A
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10
Q

How is AKI treated?

A
  1. Treatment to eliminate the cause- induce vomiting if toxin ingestion
  2. Supportive treatment- initial IVFT based on degree of hydration (improve renal blood flow, oxygen supply and GFR
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11
Q

What lillies are certified safe?

A

Calla lily
Peace lily

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12
Q

What can aggressive fluid therapy cause?

A
  • Increased renal venous pressure and renal interstitial oedema
  • Cerebral oedema
  • Pulmonary oedema
  • Myocardial oedema
  • Hepatic congestion
  • Tissue oedema

Not reccomended

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13
Q

How should anuria or oliguria be managed?

A
  • Specific and supportive Tx
  • Animal rehydrates
  • If urine flod > 2ml/kg/h- carry on
  • If under (oliguria) reassess hydration/BP:
    Reduce IVFT
    Place catheter
    Start treatment to increase urine output
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14
Q

What canbe used to increase urine output?

A

Furosemide
* Increases urine output but does not improve GFR
* Allows you to carry on with IVFT

Not recomended in human medicine as may slow referral for dialysis

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15
Q

What needs to be avoided post rehydration of an animal?

A

Polyuria

Acid base/electrolgy abnormalities
* Metabolic acidosis frequently occurs
* Bicarb treatment can be risky

Hyperkalaemia

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16
Q

Other then rehydration and managment of it what other treatments may be required for AKI?

A

Vomiting
* Maropitant

Hypertension
* exacerbated by overhydration
* Reduce IVFT, give diuretics

Nutrtition
* AKI is highly catabolic

17
Q

When should dialysis be considered?

A

When diuresis- increased urine production
Cannot be achieved

Very expensive- not common
Liverpool don’t do it

18
Q

When should euthanasia be considered for AKI?

A

Despite treatment renal function worsens, fails to improve or does not improve sufficiently to be managed at home

  • Dialysis
    or
  • Euthanasia
19
Q

If a dog has undergone a large surgery (GA) and has become hypotensive for several minutes is it safe to give an NSAID?

A

No
Should avoid renal insults after a potential primary one

20
Q

2 year old FN cross breed
* Sudden onset vomiting
* Lethargic
* BCS 5/9
* Spayed 3 days ago
* Temp 37.5
* Cratinine high

Is AKI or CKD more likely

A

AKI

21
Q

2 year olf FN Lhasa
* Gradual onset vomiting
* PUPD 2 months
* Bright
* BCS 3/9
* Temp 37.5
* Creatinine high

AKI or CKD?

A

CKD

22
Q

What are the following definitions?
1. UTI
2. Bacteriuria
3. Pyuria?

A
  1. Adherence, multiplication and persistence of an infectious agent within the urinary system
  2. Bacteria in the urine- not a UTI
  3. White blood cells in the urine- not a UTI
23
Q

What are the different classifications of UTIs in small animals?

A
  • Sporadic bacterial cystitis
  • Recurrent bacterial cystitis
  • Pyelonephritis
  • Bacterial prostatitis- male
  • Subclinical bacteriuria
24
Q

What clinical findings may be obvious with UTI?

What blood results may be present?

A

Clinical findings
* Cystitis may cause dysuria, pollakiuria, haematuria or urinary incontinence
* Pyelonephritis may cause abdominal pain, AKI, or septicaemia- may also be PU/PD

Blood results
* Lower UTIs- likely none
* Upper UTIs- bloods may show septicaemia

25
Q

What is the main way to diagnosed UTI?

A

Urine culture
Cystocentesis best way to sample

26
Q

How is sporadic bacterial cystitis treated?

A
  • ABs for 3-5 days
  • NSAIDs can be used as well
  • Amoxicillin, cephalexin or trimethoprim

No need to culture if simple-sporadic baterial cystitis

Not fluoroquinolones or extened release cephalosporins

27
Q

How should recurrent bacterial cystitis be treated?

What can predispose?

A
  • Treat for 3-5 days- consider 7-14 days
  • Find predisposing factor and treat

Predisposing- e.g
* Endocrinopathy
* Kidney disease
* Abnormal vulva
* Congenital
* Prostatis disease
* Bladder tumour
* Polypoid cystitis
* Urolithiasis
* Immunosuppressive therapy
* Urinary incontinence

28
Q
  1. How long should pyelonephritis be treated for?
  2. How long should prostatitis be treated for?
  3. How long should sub-clinical bacteriuria be treated for?
A
  1. 10-14 days
  2. ABs that penetrate blood-prostate barrier- sulphonamides, fluoroquinolones- 4 weeks
  3. Treatment not recommneded
29
Q

Does cystitis cause PUPD?

A

False

30
Q

What type of UTI does the following dog have?

4yo FN Lab
Stranguria, haematuria
Bright
BCS 5/9
Bacteria on culture
3rd episode this year

A

Recurrent bacterial cystitis

31
Q

If entire male has UTI what is presumed?

A

Presume bacterial prostatitis and treat for

year 4 small animal studies (97 decks)

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