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Acute Kidney Injury 23

infusions are preferred to intermittent dosing in patients with evidence of renal dysfunction • Stage of the underlying disorder (earlier
due to the ability to better balance analgesia or volume depletion. presentation usually associated with improved
VetBooks.ir • Antibiotics: early administration of antibiot- Possible Complications • Client and individual factors (e.g., financial Diseases and Disorders
with possible adverse effects.
chance of success)
ics in patients with sepsis or septic shock
• Potentially high mortality rate is associated
and emotional stress)
may improve outcome (p. 907)
optimization is associated with improved
• Exploratory laparotomy is indicated in the with many causes of acute abdominal pain • If shock is present, earlier hemodynamic
(e.g., septic peritonitis, hemoabdomen) if
presence of not treated appropriately and promptly. outcome
○ Intracellular bacteria seen in neutrophils in • Dehiscence of GI surgical sites is possible,
sample effusions (diagnostic for abdominal usually 3-5 days postoperatively. Risk factors PEARLS & CONSIDERATIONS
sepsis) include hypoalbuminemia, peritonitis, and/
○ Obstructive GI disease (e.g., foreign body) or compromised intestinal viability. Comments
○ GDV • Risk of systemic inflammatory response • Rapid identification of surgical disease is key
○ Bleeding intra-abdominal neoplasm syndrome, sepsis, hemostatic dysfunction to success.
○ Pyometra (e.g., disseminated intravascular coagulation • Pyometra should be considered in any intact
○ Uroabdomen (if a urinary catheter or other [DIC]), and multiple organ dysfunction/ female.
diversion device can be placed, surgery failure depending on underlying cause
does not need to be emergent) (p. 1012) (p. 665) Technician Tips
○ Other abdominal sepsis (e.g., prostatic • Severely volume-depleted patients may not
abscess) Recommended Monitoring always have free abdominal effusion evident
Perfusion parameters (heart rate, pulse quality, initially. Recheck after fluid resuscitation and
Nutrition/Diet mucous membrane color, capillary refill time), hourly during resuscitation.
Protracted inappetence likely contributes to mentation, respiratory rate, temperature, urine
overall morbidity. Early enteral feeding is output, PCV/TPP or TS, lactate, blood pressure SUGGESTED READING
ideal (e.g., voluntary intake, nasoesophageal or and electrolyte levels are monitored frequently Beal MW: Approach to acute abdomen. Vet Clin
nasogastric feeding tube, esophagostomy tube), pending clinical improvement. Small Anim 35:375-396, 2005.
but parenteral nutrition may be necessary in
some patients (pp. 1106 and 1107). PROGNOSIS & OUTCOME AUTHOR: Alex Lynch, MRCVS, DACVECC
EDITOR: Benjamin M. Brainard, VMD, DACVAA,
Drug Interactions Depends on several factors, including DACVECC
Potentially nephrotoxic medications (e.g., • Underlying disorder (i.e., reversible disease
aminoglycosides, NSAIDs) should be avoided process or not)

Acute Kidney Injury

BASIC INFORMATION ○ Ethylene glycol trauma, urinary tract obstruction, renal
○ Plants (e.g., Easter lily, raisins, grapes) lymphoma (cats > dogs)
Definition ○ Heavy metals
Abrupt decline of glomerular filtration rate ○ Hypervitaminosis D (e.g., cholecalciferol- CONTAGION AND ZOONOSIS
results in an accumulation of nitrogenous waste containing rodenticides, pharmaceuticals) Dogs: leptospirosis is contagious and zoonotic
products and inability to maintain normal fluid ○ Drugs (e.g., aminoglycosides, amphoteri- with exposure to urine. Lyme disease and Rocky
balance. Although acute kidney injury (AKI) cin B, cisplatin, sulfonamides, tetracy- Mountain spotted fever are not directly con-
is uncommon overall, it is a common result of clines, nonsteroidal antiinflammatory tagious but require a tick vector.
exposure to nephrotoxicants or infectious agents drugs, angiotensin-converting enzyme
or after kidney injury. [ACE] inhibitors) ASSOCIATED DISORDERS
○ Diet-associated nephrotoxicity (melamine/ Uremia, pulmonary edema, uremic encepha-
Synonyms cyanuric acid) lopathy, acute lung injury, hypertension,
Acute renal failure (ARF), acute kidney failure, ○ Pigmenturia (hemoglobinuria, myoglo- hyperkalemia with bradyarrhythmia
anuric/oliguric renal failure binuria)
○ Radiographic contrast agents Clinical Presentation
• Ischemia: hypotension, trauma, shock, sepsis, DISEASE FORMS/SUBTYPES
Epidemiology systemic inflammatory response syndrome, • Oliguric/anuric AKI
SPECIES, AGE, SEX hypoadrenocorticism, congestive heart ○ Anuria: urine production < 0.1 mL/kg/h
Both dogs and cats are susceptible. Often, failure, temperature extremes, prolonged ○ Oliguria: urine production < 0.5 mL/kg/h
animals with AKI are younger than those with anesthesia, anaphylaxis • Polyuric AKI
chronic kidney disease (CKD). • Infection ○ Polyuria: urine production > 2 mL/kg/h
○ Dogs: leptospirosis, pyelonephritis, bor-
GENETICS, BREED PREDISPOSITION reliosis, Rocky mountain spotted fever HISTORY, CHIEF COMPLAINT
Large-breed dogs (Rickettsia rickettsii) Some or all may be present:
○ Cats: pyelonephritis, feline infectious • Lethargy, depression
RISK FACTORS peritonitis • Vomiting, anorexia
• Free-roaming pets • Other: thromboembolic disease, hypercalcemia, • Collapse
• Nephrotoxins transfusion reaction, vasculitis, envenomation, • Abdominal/general discomfort

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