Felis ISSN 2398-2950

Nephrotoxicosis

Contributor(s): Penney Barber

Introduction

  • The renal cortex is particularly susceptible to toxins because it receives 90% of the renal blood flow and the tubular renal cells are exposed to high concentration of toxins due to renal excretion of toxins and reabsorption of water and other solutes.
  • Early recognition is important to limit renal damage.
  • Cause: different toxins cause renal damage at different sites, but ultimately causeacute renal failure Kidney: acute renal failure.
  • Treatment: emesis, gastric lavage, intravenous fluids, specific treatment of underlying cause if appropriate.
  • Prognosis: guarded.

Pathogenesis

Etiology

Ingestion of nephrotoxins

  • Antifreeze(ethylene glycol Ethylene glycol poisoning).
  • Heavy metals, eg lead, mercury, cadmium, chromium, arsenic, thallium, cisplatin.

Iatrogenic

Predisposing factors

General

  • Dehydration.
  • Decreased renal perfusion.
  • Pre-existing renal disease.

Pathophysiology

  • Different nephrotoxins act at different levels within the kidney:
    • Aminoglycosides  →   decreased available surface in the glomeruli for ultrafiltration and increased glomerular permeability for negative proteins.
    • Azathioprine  →   renal mesangial cell proliferation.
    • NSAIDs  →   decreased renal prostaglandin synthesis   →   decreased renal blood flow.
    • The renal cortex is particularly susceptible to toxins, because it receives 90% of the renal blood flow and the tubular renal cells are exposed to high concentration of toxins (glomerular filtration, proximal tubular excretion, reabsorption of water and other solutes).

Timecourse

  • Ethylene glycol poisoning   →   signs of acute renal failure 12-72 hours post ingestion.
  • Gentamicin accumulates and acute renal failure can develop after five days (sooner if overdosed).

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Mealey K L & Boothe D M (1994) Nephrotoxicosis associated with topical administration of gentamicin in a cat. JAVMA 204 (12), 1919-1921 PubMed.

Other sources of information

  • Rumbeiha W K (2000) Nephrotoxins. In: Current Veterinary Therapy XIII. Ed: Kirk Bonagura. Philadelphia: W B Saunders, pp 212-216. ISBN: 0 7216 5523 8.


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