Page 93 - Cote clinical veterinary advisor dogs and cats 4th

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)

www.ExpertConsult.com