Kidney: acute renal failure

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Sections available in full article Introduction, Presenting signs, Acute presentation, Geographic incidence, Cost considerations, Special risks (e.g. anesthetic), Pathogenesis, Etiology, Predisposing factors, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Histopathology findings, Differential diagnosis, Treatment, Standard treatment, Monitoring, Subsequent management, Prevention, Prophylaxis, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Phil Nicholls BVSc BSc PhD MRCVS MRCPath
Dr Melissa Wallace DVM DipACVIM
Synonyms Acute tubular nephrosis

Introduction

  • Cause : toxins/drugs, infection, renal ischemia.
  • Signs : vomiting, diarrhea, anorexia, dehydration, lethargy.
  • Sudden deterioration in renal function, causing uremia, loss of normal solute and water balance, oliguria (in most cases), anuria or polyuria (less commonly).
  • Treatment : prompt treatment to limit renal damage.
  • Prognosis : extensive renal damage will result in death (unless renal replacement therapy is provided) or chronic renal failure.

Diagnosis

Clinical signs

  • Enlarged kidneys.
  • Oral ulceration, halitosis.
  • Pyrexia in pyelonephritis.
  • Signs of shock:
    • Collapse.
    • Thready pulse.
  • Bradycardia, hypothermia, dehydration.
  • Melena.
  • Abdominal pain (sublumbar).

Diagnosis

Differential diagnosis

  • Chronic renal failure (CRF) Chronic renal failure :
    • No history of PU/PD in acute renal failure (ARF).
    • Usually large or normal sized kidneys in ARF, small kidneys in CRF.
    • No anemia in ARF.
    • Increased potassium more common in ARF, unless there is concurrent vasculitis or bleeding diathesis.
    • No osteoporosis in ARF.
  • Prerenal azotemia :
    • Dehydration, hemorrhage, shock, hypoperfusion of kidneys.
    • Hypersthenuric urine.
  • Hypoadrenocorticism Hypoadrenocorticism : can present with acute collapse, isosthenuric urine, hyperkalemia. ACTH stimulation test necessary to differentiate. Hypoadrenocorticism can cause ARF.
  • Post-renal azotemia Uremia : hyperkalemia, anuria, azotemia.

  • Look for evidence of urinary tract obstruction or urinary tract rupture.

Sequelae

Prognosis


Poor
  • If oliguria/anuria persists despite treatment.
  • If severe hyperkalemia occurs.
  • If severe metabolic acidosis occurs.
  • If azotemia continues to progress despite therapy.
  • Ethylene glycol poisoning Ethylene glycol poisoning.
Guarded
  • If underlying cause is addressed early, renal failure may be reversible only if renal damage is not too extensive.

Expected response to treatment

  • Urine production increases within first 48 hours.
  • Azotemia decreases.
  • Hyperkalemia resolves.
  • Metabolic acidosis resolves.
  • Improvement of clinical signs (less lethargic, appetite improvement, less vomiting).
  • Urine culture negative.

Reasons for treatment failure

  • Failure to increase urine production in oliguric patient.
  • Renal damage too severe.
  • Failure to recognize underlying cause early (ethylene glycol poisoning Ethylene glycol poisoning , infections).
  • Intractable hyperkalemia, acidosis or pulmonary edema without the option of dialysis.

Sources

Publications

Refereed papers

  • Yatsu T et al(1998) Effect of YM435, a dopamine DA1 receptor agonist, in a canine model of ischaemic acute renal failure. Gen Pharmacol 31 (5), 803-807.
  • Tsuji Y et al(1993) An experimental model for unilateral ischemic acute renal failure in dog. Int Urol Nephrol 25 (1), 83-88.
  • Nieto C G et al(1992) Pathological changes in kidneys of dogs with natural Leishmania infection. Vet Parasitol 45 (1-2), 33-47.

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