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Renal > Acute Kidney Failure and Acute Kidney Injury > Flashcards

Acute Kidney Failure and Acute Kidney Injury Flashcards

1
Q

Define acute kidney failure

A

Sudden onset of excretory failure leading to accumulation of metabolic/uraemic toxins

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2
Q

How are GFR and creatinine related?

A

As GFR increase, creatinine decreases

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3
Q

Define acute kidney injury. How does this differ from acute renal failure?

A

Abrupt reduction in kidney function - increase of creatinine or decreased urine output

Patients may not be azotaemic

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4
Q

What is the typical history for acute kidney failure?

A
  • Non-specific - lethargy, weakness, anorexia, V/D
  • Known toxin ingestion
  • Altered urine output
  • Signs of concurrent disease
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5
Q

What are the clinical signs of acute renal failure?

A 
Dehydration
Oral ulceration, halitosis
Hypothermia
Brady/tachycardia
Swollen, painful or normal kidneys
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6
Q

How should a newly documented azotaemic patient be refined?

A

Acute or chronic?

Pre-, renal or post-renal?

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7
Q

What differentiates acute from chronic renal disease?

A 
History
PE - renal size
Non-regenerative anaemia
Renal US
CKD-mineral bone disorder
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8
Q

Does hyperphosphataemia occur with acute or chronic renal disease?

A

Both, cannot use it to decide.

Use presence of CKD-mineral bone disorder instead

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9
Q

What is rubber jaw? How is it caused?

A

Softening of the lower jaw caused by secondary renal hyperparathyroidism

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10
Q

What can cause azotaemia?

A

High production of nitrogenous waste
Low GFR
Reabsorbed urine leaking from UT

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11
Q

Which diagnostic test should always be performed when evaluating renal function?

A

Urinanalysis

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12
Q

What USG values indicate prerenal and renal azotaemia?

A

Pre-renal
Dog: >1.030
Cat: >1.035

Renal
Dog: <1.030
Cat: <1.035

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13
Q

What results can you expect on UA with renal azotaemia?

A

Glucosuria
Casts
Calcium oxalate

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14
Q

Which type of azotaemia can be greatly improved with IVFT?

A

Pre-renal

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15
Q

What changes in WBCs occur in a stress leukogram?

A

Neutrophilia
Monocytosis
Lymphopenia
Eosinopenia

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16
Q

How can you confirm a suspected leaking urinary tract?

A

Sample abdominal fluid and test creatinine levels

17
Q

Why won’t an obstruction in one ureter result in post-renal azotaemia?

A

The other kidney is still function and can pass fluid through ureter into bladder

18
Q

What causes renal azotaemia and how common are they?

A

Tubular necrosis - v common
Intersitital nephritis - common
Acute glomerulenephritis - uncommon

19
Q

What is the most common cause of pyelonephritis? What are the clin signs?

A

Ascending infections

  • PU/PD
  • +/- azotaemia
  • Asymptomatic
20
Q

How is pyelonephritis treated?

A
  1. Culture urine, empiric ab therapy
  2. Specific ab therapy 4-6w, re-culture throughout
  3. Re-culture 1-2w post-treatment
21
Q

What are the clinical signs of leptospirosis in the small animals? How is it diagnosed?

A
  • Azotaemia
  • Hepatic necrosis
  • Thomrocytopenia
  • Vasculitis
    Rising titres to non-vaccinal serovar
22
Q

How is leptospirosis treated?

A

Pencillin G, ampicillin, amoxycillin

Doxycycline

23
Q

What are the most common toxins to cause tubular necrosis?

A
  • Ethylene glycol
  • Raisins/grapes
  • Lillies in cats
24
Q

Which therapeutic agents can cause tubular necrosis?

A 
ABs - aminoglycosiders and tetracyclines
Chemo - doxorubicin and cisplatin
NSAIDs
ACE-i
IV contrast agents
25
Q

How are ischaemia and toxins related when it comes to acute renal failure?

A

They are synergistic of each other

26
Q

Outline the pathogenesis of acute renal failure…

A
  • Reduced GFR
  • Intra-tubular obstruction
  • Disrupted epithelial - back flow of fluid
  • Vasoconstriction in kidneys
27
Q

How is acute renal failure managed?

A
  • Treat underlying causes
  • Expand volume mildly
  • Maintain K and acid-base
  • Supportive care - nutrition, anti-emetics
  • Allow renal repair
28
Q

What renal replacement therapies are available?

A

Haemodialysis

Peritoneal dialysis

29
Q

How can urine output be increased?

A

Diuretics

Vascoactive agents

30
Q

Give examples of causes of interstitial nephritis

A

Lepto

Pyelonephritis

31
Q

Explain what pharmacological therapies you might use in AKI/ARF

A

Mannitol (0.25 - 1.0g/kg as slow IV over 20 minutes) - increase renal blood flow, decrease cellular swelling.

Furosemide (Boluses of 2-4mg/kg) - to promote formation of urine, and facilitate hyperkalaemia

Renal (12 decks)

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