Small animal acute kidney injury

A rapid decline in renal function which may lead to retention of uremic waste and other problems is known as what?

Acute kidney injury

Acute kidney injury is considered occurring if there is an increase in _______________ of about _____ or _________

• creatine

• 0.3

• 25%

How is AKI categorized

• pre renal

• renal

• postrenal

Renal AKI can be what types?

• acute

• chronic

What values characterize a prerenal AKI

• increased BUN

• increased creatinine

• increased USG

What can cause pre renal azotemia/AKI?

• not enough blood flow/decreased GFR

• too much waste to process

Intrinsic AKI is caused by damage to __________ of the kidney

any section

Post renal azotemia occurs when _________ can’t get out of the body

urine

What are the 5 phases of AKI

1. insult

2. initiation

3. extension

4. maintenance

5. repair

The insult and initiation phase of AKI begins with either an _______ or ________ and continues until there is definable change in _________

• ischemia

• nephrotoxin

• renal function

As a result of tubular pathology In AKI tubules are often under ___________ that causes a decrease in ATP levels which impairs the function of the _____________ pump on tubules leading to cellular _________

• hypoxia

• Na-k

• swelling

Ischemic AKI manifests as a dcrease in _________ and _______________

• GFR

• urine concentrating ability

An animal with renal azotemia will not be able to ________ their urine

concentrate

Post renal azotemia/AKI caused by ureteral obstruction occurs mostly in ______ cats

older

When should you be suspicious of a ureteral obstruction

• increase in creatinine

• hyperkalemia

• previous stone disease

• large painful kidneys

A cat with acute renal kidney injury will have what values on lab tests

• hyperkalemia

• active urine sediment

What are the two mechanisms of AKI

• tubular pathology

• vascular pathology

You cannot stage an animal in CKD if you have not decided whether it is ________ or _________

• acute

• chronic

What are general causes of AKI

• renal ischemia

• Nephrotoxicity

• Primary renal diseases

• systemic diseases with renal manifestations

What type of primary renal diseases can cause AKI

• infections

• immune mediated

• neoplasia

Of infections that can cause AKI which is more common in cats and which in dogs

• pyelonephritis in cats

• leptospirosis in dogs

What is the most common cause of AKI in dogs

• nephrotoxins

• leptospirosis

What is the most common cause of AKI in cats

• pyelonephritis

• nephrotoxins

Kidney injury can be acute on chronic meaning that an already existing conditions is made worth by things like __________ which cause a __________

• pyelonephritis/UTI

• uremic crisis

Tubular pathology can lead to AKI through what methods?

• Cellular metabolism alterations

• Disruption of cytoskeleton

• Inflammation

Similar to the changes in cellular metabolism in AKI the loss of _________ causes the renal tubules to lose __________, ________________, and _________ which leads to loss of tubular structure

• oxygen

• actin

• tight junctions

• integrins

The loss of actin during AKI causes the ____________ to blunt

microvilli

Loss of the tubular structure and cytoskeleton allows for ________ to leak back into the plasma

ultrafiltrate

Inflammation of the tubules brings what molecules to the region

• neutrophils

• macrophages

• T cells

Vascular pathology in AKI relates to the predominant release of ___________ substances leading to _______ and decreased ____________

• vasoconstrictive

• ischemia

• oxygen delivery

AKI can also increase ___________ leading to leaky vessels

vascular permeability

An animal with acute kidney injury will have what of these clinical features:

• renal size

• previous history of PU/PD

• nonregenerative anemia

• weight loss

• poor body condiiton

• poor hair coat

• appearance of parathyroid gland

• normal to enlarged

• absent

• absent

• absent

• absent

• absent

• normal

A pyelonephritis can be caused by what things?

• ascending infection

• hematogenous infection

What diagnostic results make you more sure that renal signs are because of pyelonephritis

• Azotemia

• UTI

Cats have a specific ____________ not _______________

• Lilly nephrotoxicity

• day lilies

Cats and dogs can experience AKI due to anti freeze which typically contains _____________

ethylene glycol

What is the toxic does of ethelyne glycol for cats and for dogs

• cats: 1.4

• dogs: 4.4 -6.6

Ethelyne glycol can cause acute _________ due to its ___________

• acute tubular necrosis

• metabolites

What Ethylene glycol metabolites cause AKI

• glycolaldehyde

• glycolic acid

• glyoxylic acid

An animal ethylene glycol AKI will present with what values

• azotemia

• hyperkalemia

• hypocalcemia

• hyperglycemia

• metabolic acidosis

A dog presents with AKI and formation of crystals in its urine. You then find out it ingested some antifreeze what crystals are going to be identified in its urine

calcium oxalate

What diagnostics should be run on an animal that ingested antifreeze

• test kit

• woods lamp

• ultrasound

What medications can cause AKI

• NSAIDs

• ACE inhibitors

• ARB

• aminoglycosides

• amphotericin B

NSAID’s prevent _________ of afferent arteriole through inhibition of _______ synthesis which leads to decreased renal blood flow and to AKI

• dilation

• prostaglandin

ACEI and ARBS prevent formation of ___________ which is a potent _________ of the efferent arteriole and if blocked will ________ the efferent arteriole leading to ___________

• angiotensin 2

• vasoconstrictor

• dilate

• decreased GFR

Antibiotics and antifungals can be _______ and cause _____________

• nephrotoxic

• tubular necrosis