Page 2699 - Cote clinical veterinary advisor dogs and cats 4th

1398 Acute Kidney Injury

Acute Kidney Injury
VetBooks.ir (history, renal azotemia, supportive ancillary diagnostics)

Diagnose acute kidney injury

Toxin? Infectious cause?
Yes No or uncertain No or uncertain Possible

Administer antidote Look for a Administer appropriate
for known nephrotoxin predisposing cause therapy (e.g., doxycycline
(e.g., ethanol or 4-MP (p. 1194) for leptospirosis)
for ethylene glycol)

Is the animal dehydrated?
Yes No

Rehydrate with isotonic crystalloid at maintenance Is animal oliguric/anuric
(60 mL/kg/d) dehydration [% of dehydration as a ( 0.25 mL urine/kg/h)?
decimal (e.g., 10% 0.1) BW (in kg) 1000 mL]
ongoing loss. Administer this volume (in mL) over 12 Yes No
hours while monitoring urine output, BW, and clinical
signs of dehydration
Discontinue maintenance fluids, and • Continue fluids, carefully monitor-
initiate “ins and outs” therapy and ing to maintain hydration
monitoring: • Adjust fluid therapy to promote
1. Insensible losses at 20 mL/kg/d diuresis
2. Measure urine output q 1-4h
3. Replace each mL of urine “out” with
1 mL isotonic crystalloid “in” for the
next 1- to 4-hour period
4. Monitor body weight to maintain
within 5% of hydrated weight
5. Maintain CVP at 6 to 8 cm of water
6. Maintain arterial systolic blood pres-
sure between 80 and 160 mm Hg

Severe metabolic Initiate drugs to promote urine output: Initiate ancillary
Serum potassium acidosis therapy for uremia:
7 mEq/L? – 1. Mannitol 250-500 mg/kg bolus
(pH 7.1, HCO 3 OR proton pump inhibitor
12 mEq/L)? 2. Furosemide 2-6 mg/kg bolus Antiemetics
Nutritional therapy
Yes No Yes No (p. 23)

Administer Continue to Administer Continue to Is urine output 1 mL/kg/d?
emergency monitor sodium monitor
treatment for q 6-24h bicarbonate q 6-24h No Yes
hyperkalemia and recheck
and recheck
(p. 516) Consider renal replacement • Continue drugs as needed
therapy (e.g., hemodialysis, to maintain urine output
peritoneal dialysis, renal and the ins and outs until
transplant) or euthanasia urine output stable
• Taper drugs and fluids
when stable and drinking
4-MP, 4-methylpyrazole; BW, body weight; CVP, central venous pressure.
UPDATED AND EDITED BY: Leah A. Cohn, DVM, PhD, DACVIM
ORIGINALLY WRITTEN BY: Marie E. Kerl, DVM, MPH, DACVECC, DACVIM
www.ExpertConsult.com