34. Acute kidney diseases in dogs and cats

Question 1

General Clinical signs of renal diseases

Answer 1

Anorexia
Weightloss
Vomitting
Immunosuppresion
Anaemia
Dehydration
Oedema
PU/PD
Anuria
Uraemic coma
Uraemic Pneumonia
Resp signs
CNS signs
Blindness

Question 2

What is the 3 legged chair for renal diagnosis

Answer 2

Blood test
Imaging
Urinalysis

Question 3

How to assess glomerular filtration

Answer 3

GFR
Urinary protein - dipstick

Question 4

How to assess tubular function

Answer 4

SG
Urine sediment - glycosuria, proteinuria

Question 5

Glomerular filtration rate involves

Answer 5

Urea, creatinine, SDMA measurement
Clearance testing

Question 6

UPC parameters

Answer 6

Normal - <0.2
Borderline 0.2 — .4
Proteinuria >0.4 (.5 in dogs)

Question 7

SG measurements

Answer 7

Isosthenuria = 1.008 - 1.012
Hypersthenuria = >1.030
Hyposthenuria = <1.007

Question 8

Clinical syndromes associated with renal disorders

Answer 8

Kidney disease
azotaemia
Uraemia
Renal failure

Question 9

Types of Azotaemia

Answer 9

Pre/ extra renal Azotaemia
Renal Azotaemia
Post renal Azotaemia

Question 10

Pre renal Azotaemia

Answer 10

Haemodynamic, transient & fluid responsive
Very common, curable
Decreased GFR due to dehydration

Question 11

Aetiology of pre renal Azotaemia

Answer 11

heart failure
diuuretic/ vasodilator use

Question 12

What can long term pre renal Azotaemia lead to

Answer 12

kidney injury in > 1 days

Question 13

Renal Azotaemia

Answer 13

infectious
Ischaemic
Toxic causes

can lead to AKI

Question 14

Post renal Azotaemia

Answer 14

Lower urinary tract
obstruction/ leakage into abdomen

Question 15

Diagnosis of post renal Azotaemia

Answer 15

imaging
Abdo fluid creatinine: blood creatinine = >2.1
Abdo fluid K&raquo_space;> Blood K

Question 16

Which Azotaemias are treatable

Answer 16

Prerenal Azotaemia
Postrenal Azotaemia
AKI due to these

Question 17

Non treatable Azotaemias

Answer 17

CKD & prerenal/ postrenal cause
CKD & end stage kidney failure

Question 18

Acute Nephrosis & Nephritis

Answer 18

Acute tubular cell injury & death —-> nephron dysfunction —-> decreased GFR & AKI

Question 19

Nephrotoxic causes of Acute Nephrosis & Nephritis

Answer 19

Abx (Gentamycin)
Ethylene Glycol
Lilies (Fe. only)
Myoglobin
IV Xray contrast fluid
Heavy metals
Hypercalcaemia
Anaesthetic
Haemoglobin
Grapes/Raisins
Chemotherapy

Question 20

Ischaemic causes of Acute Nephrosis & Nephritis

Answer 20

Hypotension
Sepsis
Hypercalcaemia
Trauma
Hypovolaemia
NSAIDS
Deep anaesthesia
Hypothermia
Hyperthermia
Burns

Question 21

How to avoid renal ischaemia

Answer 21

IVFT during GA to prevent hypotension and hypothermia
No NSAIDS use opioids instead

Question 22

Infectious causes of Acute Nephrosis & Nephritis

Answer 22

Pyelonephritis
Leptospirosis

Question 23

Obstructive causes of Acute Nephrosis & Nephritis

Answer 23

Ureteric obstruction

Question 24

Phases of Acute Kidney Injury

Answer 24

1. Initiation
2. Extension
3. Maintenance
4. Recovery

Question 25

Initiation phase of AKI

Answer 25

kidney injury

Question 26

Extension phase of AKI

Answer 26

inflammation, vasoconstriction, coagulopathy, microvascular obstruction, Increased ROS

Question 27

Maintenance phase of AKI

Answer 27

differentiation, migration, proliferation of new cells Death of animal

Question 28

Recovery phase of AKI

Answer 28

redifferentiation & repolarisation --> complete regeneration/ partial regeneration --> CKD

Question 29

Grade I AKI

Answer 29

no azotaemia

Question 30

Grade II AKI

Answer 30

Mild azotaemia

Question 31

Grade III, IV, V AKI

Answer 31

Moderate to severe AKI

Question 32

Clinical signs of AKI

Answer 32

Lethargy Anorexia Diarrhoea Dull consciousness Dehydration Hyperhydration Oliguria Anuria Painful kidneys Halitosis Vomiting Polyuria Seizures Uraemic ulcers Hypertension

Question 33

Diagnosis of AKI

Answer 33

Lab D - biochem, bloods, urine US - cortical hypertrophy

Question 34

Biochem of AKI

Answer 34

Hypovolaemia Hypervolaemia Metabolic acidosis Hyperkalaemia Toxic metabolic products

Question 35

Bloods of AKI

Answer 35

Azotaemia Increased Urea, creatinine Haemoconcentration

Question 36

Urine of AKI

Answer 36

Iso/ Hyposthenuria Sediment Glucosuria Proteinuria

Question 37

Early Diagnosis of AKI

Answer 37

urine production USG sediment plasma creatinine

Question 38

Aim of Treatment of AKI

Answer 38

Maintain adequate perfusion Increased GFR Avoid nephrotoxins Maintain urine output Acid Base balance Electrolyte balance Treat underlying disease Optimise nutrition

Question 39

what to give in case of hypotension

Answer 39

Norepinephrine

Question 40

What to give in case of hypertension

Answer 40

Amlodipine

Question 41

Indications for dialysis

Answer 41

Anuria Hyperkaelamia Fluid overload Severe metabolic acidosis

Question 42

Progenosis of AKI

Answer 42

Grade I --- II = after a few days of treatment, normal kidney function may return Grade III --- V = After a few weeks of treatment, normal kidney function may return Grade IV --- V = the animal may die

Question 43

How quickly is ethylene glycol absorbed

Answer 43

40-60mins

Question 44

Pathogenesis of ethylene glycol toxicosis

Answer 44

ethylene glycol ----> glycoaldehyde ---> glycocolic acid ----> glyoxylic acid ----> oxalic acid ----> calcium oxalate crystals

Question 45

What do calcium oxalate crystals cause

Answer 45

nephrotoxicity Neurotoxicity

Question 46

Clinical signs of ethylene glycol toxicosis

Answer 46

Phase I (30min - 12hrs) = depression, vomiting, salivation, pu/pd Phase II (12-24hrs) = acidosis Phase III (36-72hrs in dogs) = AKI, oliguria, anuria, painful kidneys (12-24hrs in cats_

Question 47

Diagnosis of ethylene glycol toxicosis

Answer 47

Anamnesis CLinical signs Lab D US -- halo signs in corticomedullary region

Question 48

Lab D of ethylene glycol toxicosis

Answer 48

hypokalaemia Hypocalcaemia met acidosis

Question 49

Urinalysis of ethylene glycol toxicosis

Answer 49

Isothenuria Calcium Oxalate monohydrate crystals can appear from 6hrs

Question 50

Treatment of ethylene glycol toxicosis

Answer 50

Early diagnosis is NB Within 1-2hrs ---> emesis, gastric lavage

Question 51

Antidotes of ethylene glycol toxicosis

Answer 51

Fomepizole Ethyl Alcohol

Question 52

cause of Haemoglobin Nephrosis

Answer 52

Haemolytic disorders IMHA Babesia