Acute Renal Failure
Acute kidney disease is a general term referring to kidney disease of sudden onset. About three-fourths of the total kidney tissue must be damaged before signs of illness appear. Kidney disease is often life-threatening, as the body cannot eliminate waste products or maintain the balance of fluid and elements vital to life.
Causes of acute kidney disease include infections, chemical poisons, trauma, urinary tract obstructions and disease of the immune system. The resulting damage to the kidneys is not always reversible. If the damage to the kidneys cannot be reversed and is severe enough that the body cannot get by on the capacity that is left the alternatives are limited. In these cases either kidney transplant or chronic dialysis are the only solutions. These alternatives are done in veterinary medicine but would be considered extraordinary and somewhat impractical in this practice. If you wish to consider these alternatives we will try to help you in that direction. Our primary goal of treatment will be to:
Common signs of illness may include depression, lack of appetite, vomiting, diarrhea, increased water consumption, and increased or decreased urine output.
Important Points in Treatment
1. Kidney disease is very serious and hospitalization is usually required. Laboratory tests are necessary for diagnosis and evaluation of the response to treatment.
2. Intravenous fluids are given to improve urine production and restore normal electrolyte and fluid balance. During the course of initial treatment we have to balance the desire to "push" fluids quickly to eliminate wastes quickly with problems associated with over hydration and the shifts that occur in the componenents of body fluids as we do so. It is common for the recovery period to have good times and bad times.
3. When we start therapy we cannot know whether treatment will be successful. We know a lot about what to do to help and have ways of predicting prognosis. However, we are often wrong with our predictions. In the end, the only way we know is to do our best and try. We will try to tell you what we can about how that patient feels. However, they all feel pretty bad at times during the treatment of acute renal failure.
4. To do the best job that we can requires very frequent testing to evaluate what is happening with electrolytes, proteins, blood cellular components and wastes buildup. We would like to be able to and have equipment to frequently check these things. Doing so improves our ability make good decisions in treatment however, it also significantly increases cost. Thorough monitoring for a routine case may add $50-100 per day to the cost of treatment. You may want to advise us of your desire to keep these type of costs to a minimum or whether to try to maximize our ability to provide the best care we can. It is a fact that this is frequently a problem that we treat with great expense and are unsuccessful. Other times the cost is minimal and we are successful. However, between these two extremes are patients that are more likely to survive if we are able to thoroughly monitor progress.
5. There is a significant chance that animals that survive acute renal failure will need to have some form of treatment for chronic renal failure for the rest of their lives. Monitoring the course of this disease will be needed in almost all cases.
Acute Renal Failure, outcomes
synonyms: acute kidney disease, renal failure, oliguric renal failure, polyuric renal failure
Retrospective study of Acute renal Failure (ARF) in 99 Dogs
* 56% of the dogs died
*- 22 died and 34 were euthanized (n = 34) prior to discharge
- chronic renal failure
*- of the dogs discharged, 24 developed this syndrome
*- 19 dogs had their creatinine levels return to normal
- dogs that survived in the hospital over 5 days were more likely to recover and be discharged
- dogs with severe azotemia (below) were less likely to survive
*- serum creatinine concentration > 10 mg/dL
*- hypocalcemia <8.6 mg/dL
- ethylene glycol ingestion and disseminated intravascular coagulation were associated with failure to recover
*- only 1 of the 12 dogs reported to have ingested ethylene glycol
Vaden SL, Levine J, Breitschwerdt EB
A Retrospective Case-Control of Acute renal Failure in 99 Dogs
J Vet Intern Med., JVIM., 11:58-64. Mar/Apr 1997
Retrospective case series of 29 dogs with hospital-acquired acute renal failure
- - mortality was 62%
- - factors that contributed to mortality were age and initial urine output
- - dogs that were initially oliguric had a 20 times greater chance of dying or being euthanatized than did dogs that were not initially oliguric
- - dogs that died had a significantly higher initial anion gap and serum phosphorus concentration than did dogs that survived
- - 72% of the dogs had been exposed to a nephrotoxicant in the 2 weeks before diagnosis of HARF
- - aminoglycoside in combination with some other drug with nephrotoxic potential (6 dogs, 2 survived)
- - aminoglycoside alone (5 dogs, 2 survived)
- - combination of drugs used to treat heart disease other than a combination of angiotensin converting enzyme inhibitor and diuretic (4 dogs, 1 survived)
- - cisplatin (4 dogs, 3 survived) - a diuresis protocol had been used in these dogs
- nonsteroidal anti-inflammatory drug (1 dog, which survived)
- angiotensin converting enzyme inhibitor in combination with a diuretic
(1 dog, which did not survive)
Behrend EN, Grauer GF, Mani L, Groman RP, Salman MD, Greco,
Hospital-acquired acute renal failure in dogs: 29 cases (1983-1992)
J Am Vet Med Assoc., JAVMA., 208:537-541. Feb15 1996
Back to Client Info Index