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Small Animal Medicine > Azotemia & Acute Kidney Injury > Flashcards

Azotemia & Acute Kidney Injury Flashcards

1
Q

What are the major components of the upper and lower urinary tracts?

A

UPPER = kidneys, proximal ureters

LOWER = caudal ureters, bladder (+ detrusor), urethra (+ internal sphincter), external sphincter of distal urethra

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2
Q

What is the functional unit of the kidney?

A

nephron —> glomerulus, arterioles, JG apparatus, tubules, and collecting ducts responsible for balancing fluids, blood pressure, and filtration

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3
Q

What are 4 functions of the kidneys?

A
  1. regulation of blood volume and HCT
  2. regulation of extracellular fluid volume and composition
  3. regulation of systemic arterial blood pressure
  4. regulation of acid-base plasma concentration of electrolytes, minerals, and metabolic waste products
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4
Q

What 4 values are used to assess renal function?

A
  1. BUN
  2. creatinine
  3. urinalysis
  4. SDMA
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5
Q

What values are given to USG? How must they be evaluated?

A
  • HYPOSTHENURIA = < 1.008
  • ISOSTHENURIA = 1.008-1.012
  • HYPERTHENURIA = > 1.012

one isn’t better than the other - must be related to hydration status and signs in the patient

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6
Q

What is the most common value of properly concentrated urine in dogs and cats?

A

> 1.030

> 1.035

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7
Q

What are 4 common signs of abnormal kidney function?

A
  1. azotemia - increased BUN and creatinine
  2. increased SDMA
  3. inappropriate urine concentration
  4. proteinuria
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8
Q

What are the 3 classes of azotemia? What causes each?

A
  1. PRERENAL - dehydration and low volume status; concentrated urine (kidneys are still functioning!)
  2. RENAL - direct kidney disease; USG < 1.030-1.035, usually isosthenuric
  3. POSTRENAL - no outflow causes a buildup of toxins, usually caused by obstructions or ruptures (PE signs and imaging); USG varies
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9
Q

What is the difference between acute kidney injury and failure?

A

AKI - sudden onset of renal parenchymal injury due to a variety of acute diseases and is a continuum of functional and renal parenchymal damage (weeks to months to recover)

ARF - rapid injury to the kidneys and subsequent accumulation of metabolic toxins and fluid, electrolyte, and acid-base balance alterations

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10
Q

What is chronic kidney disease?

A

any structural, functional abnormality, or both or one or more kidneys three months or longer

  • irreversible and progressive
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11
Q

What is the general approach to acute azotemia?

A
  • assess USG to determine origin
  • determine if acute or chronic if renal
  • palpate bladder and make sure patient can or has been urinating
  • determine if there are any risk factors to kidney injury are present
  • discontinue any nephrotoxic drugs
  • assess hydration and provide fluid therapy
  • symptomatic therapy: GI signs, hypertensive, proteinuria
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12
Q

What history, hemogram findings, and renal structure is associated with AKI?

A

ischemia or toxicant (ethylene glycol, raisins, lilies)

normal or increased HCT

swollen kidneys

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13
Q

What history, hemogram findings, and renal structure is associated with CKD?

A

renal disease or PU/PD

nonregenerative anemia (decreased EPO)

small, irregular kidneys

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14
Q

What biochemical changes are associated with AKI?

A
  • hyperkalemia (oliguria)
  • severe metabolic acidosis
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15
Q

What biochemical changes are associated with CKD?

A
  • normal or hypokalemia
  • normal or mild metabolic acidosis
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16
Q

What urine sediment, BCS, clinical signs, and renal echogenicity is associated with AKI?

A

active sediment with normoglycemic glucosuria

good BCS

relatively severe clinical signs

usually normal

17
Q

What urine sediment, BCS, clinical signs, and renal echogenicity is associated with CKD?

A

inactive sediment

weight loss

relatively mild clinical signs

dense renal cortices with loss of cortex-medulla junction

18
Q

Causes of AKI:

A
19
Q

What are the 4 minimum tests used for working up azotemia and AKI? What additional testing is helpful?

A
  1. CBC/chem
  2. UA
  3. BP —> hypertensive
  4. fundic exam —> retinal detachment, hyphema
  • urine culture: pyelonephritis
  • 4Dx: Lyme nephritis
  • witness, PCR, MAT: Leptospirosis
  • toxic metabolites
20
Q

How are abdominal radiographs and ultrasounds used for diagnosing AKI?

A

RADIOGRAPHS - size of kidneys, stones in ureters

US - architecture of kidneys, perirenal fluid (hemorrhage), obstructions indicative of hydronephrosis, dilated pelvis indicative of pyelonephritis

21
Q

What therapies are recommended for AKI?

A
  • fluid therapy
  • supportive care
  • antiproteinurics (over-filtering can damage kidneys)
  • antihypertensives
22
Q

What should be monitored in patients with AKI?

A
  • blood pressure
  • body weight (should increase with hydration)
  • urine output (catheters, bladder palpation)
23
Q

What is the normal urine output? What are 3 changes?

A

1-2 mL/kg/day

  1. polyuria = >2 mL/kg/day
  2. oliguria = <0.5 mL/kg/day
  3. anuria = no urine production
24
Q

What is prognosis of AKI?

A
  • mortality = 50%
  • of those that survive, 50% develop CKD
25
Q

AKI:

A

Small Animal Medicine (52 decks)

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