Page 245 - Small Animal Clinical Nutrition 5th Edition

248 Small Animal Clinical Nutrition

should be documented.
2. The most obvious differences between
VetBooks.ir acute and chronic renal failure are the

speed of onset and duration of signs. In
ARF, signs appear rapidly with illness
usually lasting less than one week. ARF
patients are oliguric or anuric, whereas
animals with chronic renal failure are
usually polyuric. However, normal or
increased urine production should not
be used to rule out ARF. In cases of
Figure 1. Melamine/cyanuric crystals produced in vitro (left). Crystal from the urine of an acute uremia, mucous membranes
affected cat (Magnification 1,000x) (right).
remain pink, as opposed to pale mucous
membranes and anemia often noted in
chronic renal failure. Mineral and electrolyte imbalances may
also be more apparent in cases of ARF, and may include
hypocalcemia and hyperphosphatemia. Patients with chron-
ic renal disease also show outward signs of chronic disease
including poor body condition and coat, whereas patients
with ARF generally present with good body condition and a
normal coat.
3. Management of ARF is multifactorial. Immediate actions
should include removing the inciting source, in this case, dis-
continuing use of the contaminated food. Fluid therapy
should be instituted to correct extracellular fluid imbalances
and deficits. After replacement fluids have been administered
and adequate hydration achieved, fluid therapy should con-
tinue with respect to maintenance and continued fluid loss.
Diuresis is the optimal method of preventing medullary
Figure 2. Creatinine changes during ARF. tubule blockage by crystals. To prevent further acid-base
derangements, gastric protectants should be administered,
and continued for two to three weeks, until uremic gastritis
has been effectively controlled. Caloric intake should be care-
fully monitored. Uremia and metabolic acidosis can induce
protein catabolism, which is compounded by anorexia and
vomiting. Patients should be routinely weighed to evaluate
weight loss, although this measure can be confounded by
changes in hydration status and lean body mass. A low-pro-
tein, low-phosphorus food is typically recommended for ure-
mic patients.The protein should be highly digestible, and the
food should have increased amounts of fat to increase caloric
density. Whenever possible, enteral feeding methods should
be employed to promote gastrointestinal health.
4. Risks associated with acute uremia include derangements of
fluid balance, electrolyte imbalances and cardiovascular and
pulmonary complications. If morphologic changes are not
treated and reversed during the recovery phase, acute uremia
Figure 3. BUN changes during ARF. can progress to chronic renal failure. Overaggressive fluid
therapy can potentially result in volume overload, leading to
hypertension and pulmonary edema. Care should be taken to
continually assess the hydration status of the patient.

Progress Notes
The patient was assessed and diagnostic studies were conducted to detect ARF before the onset of clinical signs. Due to aggressive
treatment, the patient recovered fully within three weeks. The patient was discharged from the blood donor program and given to
a private owner. At the time of discharge, the cat’s BUN and creatinine concentrations had decreased to normal limits, and no signs
of renal disease were present.The cat was bright, alert and responsive and fully recovered. Recommendations were made to contin-