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Acute Kidney Injury   25


             ○   Administer  1  of the deficit in intravenous   ○   If vomiting is intractable, consider par-  •  If animal survives short term (6-8 weeks),
                        2
               fluids over 6 hours.               enteral nutrition.              •  Renal failure may become chronic or may
                                                                                    long-term prognosis can be good.
  VetBooks.ir  •  Maintain mean arterial pressure > 60 mm   Drug Interactions       resolve. Animals with resolved AKI may   Diseases and   Disorders
           Monitor blood pressure (p. 1065).
                                               •  Drugs  that  are  renally  excreted  (e.g.,
             Hg, systolic > 80 mm Hg.
                                                                                    develop chronic kidney failure later in life.
           •  Systemic  hypertension  (systolic  pressure
             > 170 mm Hg) can accompany AKI. Per-  H2-receptor antagonists) may require dose    PEARLS & CONSIDERATIONS
                                                reduction or increased dosing interval.
             sistent hypertension should be addressed   •  If furosemide or metoclopramide is added
             medically (amlodipine 0.1-0.5 mg/kg q 24h)   to crystalloid fluids for constant-rate admin-  Comments
             (p. 501).                          istration, the bag should be protected from   •  Differentiating  acute  from  chronic  renal
           Medical therapy to decrease gastric acidity (see   light.                failure is essential for treatment and
           Drug Interactions):                 •  Metoclopramide  is  incompatible  with   prognostication.
           •  Omeprazole 0.5-1.5 mg/kg PO q 12-24h;   calcium-containing  crystalloid  fluids  (e.g.,   •  Because  of  the  zoonotic  importance  of
             efficacy delayed (days), or        Plasma-Lyte 148, Normosol-R).       leptospirosis, use barrier protection (e.g.,
           •  Famotidine  0.5-1 mg/kg  PO,  IM,  IV  q                              gloves) when handling urine from all dogs
             12-24h                            Possible Complications               with AKI.
           Antiemetic therapy as necessary:    •  Failure to produce urine        •  Renal  biopsy  no  longer  routinely  recom-
           •  Maropitant 1-2 mg/kg SQ, IM, IV, or PO   •  Overhydration, systemic or pulmonary edema  mended before dialysis.
             q 24h, or                         •  Hypertension
           •  Metoclopramide 0.1-0.5 mg/kg PO, IM, SQ   •  Severe metabolic acidosis  Prevention
             q 6-8h or 0.01-0.02 mg/kg/h IV constant   •  Electrolyte disorders, including hyperkalemia   •  If  considering  drugs  with  nephrotoxic
             rate infusion, or                  and cardiac dysrhythmia             potential, ensure hydration first, and monitor
           •  Dolasetron 0.5 mg/kg PO, IV, SQ q 24h,   •  CKD                       renal function.
             or                                •  Acute lung injury (uremic pneumonitis)  •  Educate owners regarding nephrotoxins.
           •  Ondansetron 0.5-1 mg/kg IV q 8h  •  Uremic encephalitis             •  Formulate vaccination programs considering
           Specific therapy for underlying disorders:                               regional prevalence of infectious causes of
           •  Leptospirosis (p. 583)           Recommended Monitoring               AKI.
             ○   If another explanation for AKI is not   •  Until azotemia is resolving, urine output is
               evident, treat for leptospirosis pending   > 1 mg/kg/h, and animal  is  drinking   Technician Tips
               diagnostic results.              voluntarily                       •  During initial telephone triage for vomiting
           •  Ethylene glycol (p. 1416)         ○   Body weight q 6-12h             or suddenly ill animals, remember that AKI
           Discontinue nephrotoxic drugs and foodstuffs.  ○   Blood pressure q 24h  can occur in animals of any age at any time.
                                                ○   Serum blood urea nitrogen/creatinine q   Inquire about potential exposure to toxins
           Chronic Treatment                      24-48h                            (antifreeze, raisins, grapes, Easter lilies) or
                                                                     −
                                                                 +
                                                              +
           •  Manage underlying cause of renal failure.  ○   Electrolytes (Na , K , Cl ), acid-base   drugs that can cause kidney damage. If
           •  Maintain fluid balance throughout recovery   status, and blood pressure q 6-24h  exposure might have occurred, these animals
             period (6-8 weeks).                ○   Packed cell volume and total protein q   should be seen immediately.
             ○   Intravenous (IV) fluids continued until   24h                    •  For hospitalized animals with AKI, monitor-
               the animal is producing urine, drinking,   ○   Measure urine output  ing urine production for decreased and
               maintaining hydration              ■   Indwelling urinary catheters predispose   increased volumes is crucial.
             ○   Wean  IV  fluids  gradually  (at  least  2-3   to urinary infection and should not be   •  Use of barrier nursing protocols (e.g., gloves,
               days). Subcutaneous fluid administration   left in place longer than necessary.  face shield), minimizing contact with urine,
               may be continued for a period after IV   ■   Maintain good aseptic technique with   and regular cleaning and disinfection can
               fluids are halted.                   catheters.                      minimize risk of staff exposure to zoonotic
             ○   Duration of hospitalization expected to   ■   Closed, sterile urine collection systems   infection (e.g., leptospirosis).
               take days to weeks                   and catheters should be cleaned daily   •  Monitoring animals with AKI for respiratory
           •  For owners considering peritoneal dialysis   and changed frequently (p. 1182).  rate and effort is critical.
             or  hemodialysis for persistently oliguric   ■   Remove catheter after urine output has
             animals, facilitate early referral, and avoid   been appropriate for > 24 hours.  Client Education
             jugular venipuncture to preserve vascular   •  Convalescent serologic evaluation as appro-  •  Educate clients regarding nephrotoxins.
             access for a dialysis catheter.    priate (e.g., leptospirosis)      •  Treatment of AKI may be costly, and recovery
           •  Treat CKD if necessary (pp. 167 and 169).  •  As uremic signs abate, reduce monitoring   may require at least 6-8 weeks.
                                                frequency.                        •  Lifelong therapy of CKD may be required
           Nutrition/Diet                      •  Body weight, serum chemistry, and packed   for surviving animals.
           •  Protein and phosphorus restriction are ideal,   cell volume are monitored often (at least
             but not at the expense of appetite/palatability.  every third day) until azotemia resolves or   SUGGESTED READING
           •  Cats and dogs that are anorexic from AKI   plateaus.                Langston C: Acute kidney injury. In Ettinger SJ,
             can develop food aversions if a diet change   •  With residual azotemia, long-term monitor-  Feldman EC, Cote E, editors: Textbook of veteri-
             is attempted before appetite returning;   ing should proceed as for CKD.  nary internal medicine, ed 8, St. Louis, 2016,
             therefore, it may be more prudent to institute                        Elsevier, pp 1919-1934.
             long-term,  renal-type  diet  after  resolution    PROGNOSIS & OUTCOME  AUTHOR: Marie E. Kerl, DVM, MPH, DACVECC,
             of uremic complications.                                             DACVIM
           •  Anorexia is common in AKI (p. 67).  •  Short term: poor (60% mortality rate for   EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
             ○   If vomiting is rare/absent and anorexia is   all causes of AKI; >90% mortality for eth-
               prolonged, consider enteral tube feeding.  ylene glycol intoxication)





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