Acute Kidney Injury Overview
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Questions and Answers

What is the overall reported survival rate for animals suffering from Acute Kidney Injury (AKI)?

  • 34%
  • 19.2%
  • 50% (correct)
  • 66%

    • Euthanasia influenced the survival outcomes of dogs with AKI.

    False

    The survival rate for animals with Lily toxicity is typically __________.

    0-50%

    Which etiology has the lowest reported mortality rate in the context of AKI?

    <p>Non-infectious etiology</p> Signup and view all the answers

    Match the following toxins with their survival rates in AKI:

    <p>Ethylene Glycol = 5-20% Gentamicin = Slow recovery Lily = 0-50% Grapes and raisins = 50-75%</p> Signup and view all the answers

    Older patients are at a higher risk for developing renal failure.

    <p>True</p> Signup and view all the answers

    What percentage of non-survivors of AKI were euthanized?

    <p>20%</p> Signup and view all the answers

    What is a significant risk factor for increased mortality in dogs with AKI?

    <p>Hypocalcemia</p> Signup and view all the answers

    Euthanasia rates in cats with AKI tend to be low due to better treatment options.

    <p>False</p> Signup and view all the answers

    Identify one original condition that may lead to increased susceptibility to AKI.

    <p>Chronic Kidney Disease (CKD)</p> Signup and view all the answers

    The presence of ________ is associated with a 57% decrease in the chance of survival for cats with AKI.

    <p>Hyperkalemia</p> Signup and view all the answers

    Match the risk factor to its associated survival outcome in cats:

    <p>Hyperkalemia = Decreased chance of survival Oliguria = Increased chance of survival Hypoalbuminemia = Decreased chance of survival sCr normalization = Improved prognosis</p> Signup and view all the answers

    What factor contributes to the overall prognosis of animals with AKI?

    <p>Severity of Injury</p> Signup and view all the answers

    Medical management provides a wide window of opportunity for recovery when the disease is severe.

    <p>False</p> Signup and view all the answers

    What percentage of dogs with severe azotemia were euthanized as noted in the statistics?

    <p>26%</p> Signup and view all the answers

    The availability and type of _______ can influence survival rates in AKI cases.

    <p>therapy</p> Signup and view all the answers

    Match the mortality percentages to their corresponding conditions:

    <p>Died due to euthanasia = 37 cats Survived = 55 cats Euthanized patients = 40 cats Survival post-euthanasia = 30%</p> Signup and view all the answers

    What is the most consistent risk factor for mortality in animals with AKI?

    <p>Oliguria</p> Signup and view all the answers

    Etiology generally helps in predicting outcomes in all cases of AKI.

    <p>False</p> Signup and view all the answers

    List one parameter that should be used for outcome prediction besides etiology.

    <p>Disease severity, age, or comorbidities.</p> Signup and view all the answers

    The IRIS grading system is often used to assess ______ of a disease.

    <p>severity</p> Signup and view all the answers

    Match the following AKI grading systems with their years of introduction:

    <p>RIFLE = 2004 AKIN = 2007 IRIS = N/A APACHE = N/A</p> Signup and view all the answers

    What was the mortality rate for dogs in AKI stages 1-3?

    <p>54%</p> Signup and view all the answers

    Scoring systems for predicting AKI outcomes are validated for all animal management types.

    <p>False</p> Signup and view all the answers

    What is one reason scoring systems should not replace clinical judgment?

    <p>Scores must be validated and may not accurately predict individual patient outcomes.</p> Signup and view all the answers

    In overall outcome assessment, severity of AKI is often measured using _______ of kidney function.

    <p>markers</p> Signup and view all the answers

    Which of the following factors was identified as a risk factor linked to survival in dogs with AKI?

    <p>Respiratory rate</p> Signup and view all the answers

    Serum creatinine normalization is an uncommon outcome in dogs recovering from AKI.

    <p>False</p> Signup and view all the answers

    What is the estimated median survival time (MST) for dogs post-AKI?

    <p>1322 days</p> Signup and view all the answers

    Presence of multiple risk factors in AKI is likely associated with decreased _______.

    <p>survival</p> Signup and view all the answers

    Match the following AKI stages with their serum creatinine levels:

    <p>Stage 1 = 150–199% or ≥0.3 mg/dL Stage 2 = 200–299% Stage 3 = ≥300% Stage 4 = N/A</p> Signup and view all the answers

    What percentage of cats survived after AKI treatments?

    <p>53%</p> Signup and view all the answers

    Study Notes

    Introduction

    • Severe acute kidney injury (AKI) is associated with high morbidity and mortality.
    • Prolonged hospitalization and high treatment costs are common.
    • Prognosis significantly influences owners' decisions to pursue treatment.

    Introduction - Pathophysiology of AKI

    • AKI can result from various underlying conditions, including normal function, increased susceptibility, and chronic kidney disease (CKD).
    • Different outcomes are possible, ranging from full recovery to progression to chronic kidney disease.
    • Factors like etiology, severity of injury, organs involved, comorbidities, and availability of therapies influence prognosis.

    Introduction - Multiple Factors Determining Prognosis

    • Etiology (cause) and reversibility are key prognostic factors.
    • Severity of injury, affected organs, and comorbidities also impact outcomes.
    • Availability and type of therapy (medical, dialysis, surgical) greatly influence the animal's result.

    Types of Management

    • Medical management provides a limited window of opportunity for recovery when the disease is severe.
    • Surgical intervention may eliminate the underlying cause and favor a favorable prognosis.
    • Dialytic intervention expands the window of opportunity and is associated with a slightly better outcome.

    Prognosis - Euthanasia

    • Survival rates are influenced by euthanasia decisions.
    • Studies report euthanized patients as non-survivors.
    • Euthanasia may occur due to poor outcome or financial constraints.
    • Survival rates are potentially underestimated in studies.

    Prognosis - Bias

    • Prolonged hospitalization and euthanasia in a perceived grave prognosis creates a major bias.
    • Retrospective studies might "falsely confirm" the impression of poor prognosis.

    Outcome Assessment

    • Various factors, including risk factors, are used to assess the different outcomes.

    Retrospective Case-Control Study (Dogs)

    • Risk factors for acute renal failure (ARF) include ethylene glycol intoxication, older age, severe azotemia, proteinuria, hypocalcemia, and disseminated intravascular coagulation (DIC).
    • Serum creatinine (sCr) normalized in 19% of the dogs.
    • Euthanasia rates varied according to factors including risk factors.

    Acute Intrinsic Renal Failure in Cats

    • 24 cats were managed medically.
    • 18 cats were oliguric (with low urine output).
    • Risk factors included hyperkalemia (high potassium), hypoalbuminemia (low serum albumin), and low bicarbonate.
    • Azotemia was not associated with survival.
    • sCr (serum creatinine) normalized in 25%.

    Acute Kidney Injury in Cats and Dogs – Meta-Analysis

    • Eighteen case series involving 1,201 animals.
    • Overall mortality was 53% in cats and 45% in dogs.

    Acute Kidney Injury in Dogs – Etiology

    • 249 dogs with AKI.
    • Different potential etiologies include inflammation, glomerular disease, unknown cause, leptospirosis, pyelonephritis, ischemia, and toxin-induced injury.

    Outcome Improving

    • A significant number of non-survivors were euthanized (20%).
    • Outcomes vary by geographical area and time.

    Survival Rates (Human Patients)

    • Reported survival rate is approximately 50%.
    • Dialysis is readily available, not influencing survivorship.
    • Older patients and higher prevalence of comorbidities are still a factor to consider.

    Predicting Outcome

    • Accurate prediction of the outcome is important for resource allocation and clinical decision-making.
    • Etiology plays a significant role.

    Outcome Based on Etiology

    • Infectious etiology (Leptospirosis, pyelonephritis, pyometra, sepsis) showed a mortality rate of 19.2%.
    • Non-infectious etiology had a mortality rate of 59.9%.

    Infectious Diseases – Leptospirosis

    • Survival rate of 56%–85% (with medical and hemodialysis intervention).
    • Injury may be reversible.
    • Death could happen from comorbidities.
    • The specific serovar may impact the outcome.
    • Pulmonary hemorrhagic syndrome is associated with high mortality.

    Infectious Diseases – Pyelonephritis

    • Survival rates vary depending on potential cause (100% vs 40-52%).

    Nephrotoxicity

    • Prognosis depends on the toxin.
    • Ischemic injuries are typically reversible.
    • Ethylene glycol toxicity is often irreversible (5–20% survival).
    • Gentamicin-induced injury is potentially reversible with slow recovery (survival rate undetermined).
    • Lily toxicity can cause severe injury, often with poor prognoses (0–50% survival).
    • Grape and raisin toxicity might have a slightly better prognosis.

    Hospital Acquired AKI

    • Ischemia and nephrotoxicity are leading causes.
    • Mortality rate is 54–62%.
    • Risk factors for mortality were determined to be older patients, risk of developing renal failure, and presence of concurrent cardiac disease. Initial urine output is also a factor to assess risk.

    Etiologies - Summary

    • Identifying the etiology is imperative for prognostic projection.
    • Etiologic factors vary geographically.
    • Temporal changes or shifts in etiological factors occur.

    Outcome Assessment

    • Etiology, although significant, might remain unknown.
    • Other essential components should be used for prediction, including disease severity, age, and comorbidities.

    Outcome Prediction - Risk Factors

    • Anuria/oliguria is the most consistent risk factor for mortality, often a surrogate for severity.
    • Other risk factors might not be consistently linked to poor outcomes.
    • The presence of multiple risk factors is often related to decreased survival.

    Scoring/Grading Systems

    • Used to evaluate disease severity and prognosis of AKI.
    • Disease severity is assessed using markers of kidney function. (e.g., serum creatinine, urine production). The IRIS Grading system, RIFLE, and AKIN are important examples of human clinical classification systems.
    • Scoring systems assign values to clinical variables. APACHE is an example of a scoring system used with human ICU patients.

    IRIS Grading Criteria

    • IRIS grading criteria categorize AKI by severity levels.

    IRIS AKI Grade

    • IRIS AKI grade is correlated with increased mortality.

    Prediction Using Grading Systems (RIFLE and AKIN)

    • These systems (RIFLE and AKIN) were developed to predict and stratify AKI severity and prognosis. They assess serum creatinine and urine output to monitor renal function.

    Scoring Systems Limitations

    • No scoring systems exist specifically for medically managed AKI.
    • Systems are generally helpful for broad categorisation but not single indicators for individual patients.
    • Systems should not replace clinical judgment. (e.g., clinical diagnosis).

    Scoring Systems - Summary

    • Grading schemes and scoring systems can objectively assess disease severity, facilitate communication, objectively assess disease severity, and compare different cohorts. The efficacy of certain interventions and outcomes can also be better assessed.

    Outcome Assessment - Summary

    • The most important aspects for determining outcomes, for medically managed animals with AKI, are etiology, reversibility, severity of AKI, body systems involved, comorbidities, and treatment management.

    Long-Term Survival of Dogs and Cats with AKI

    • Seventy-six percent of dogs were alive at last contact.
    • 55% of dogs normalized creatinine at discharge.
    • 20% normalized creatinine during the follow-up period (up to 3 months).
    • Animals recovering with a good short- and long-term outlook.
    • Only 10 dogs died due to renal causes.
    • Dogs in which sCr did not normalize had median sCr concentrations of 1.9 mg/dL.
    • 23% of dogs were classified as CKD stage 2.
    • No statistically significant differences existed between dogs who normalized and those with CKD. Slow progression occurred in CKD cases.

    Outcome in Dogs and Cats with Acute on Chronic Kidney Disease

    • Acute decompensation is common in animals with pre-existing CKD.
    • Short and long-term prognosis, in studies, were not widely investigated.
    • No significant association detected between etiology and short-term outcome.
    • Relatively long hospitalizations are expected.

    Specific Risk Factors and Survival Rates (Dogs & Cats)

    • Details regarding risk factors, including respiratory rates, age, temperature, and bloodwork data (e.g. serum creatinine, urea, phosphate, venous pH) for cats and dogs with AKI and AKI on CKD are provided.
    • Survival rates for those discharges or outcomes are provided.

    Long-Term Survival (Dogs & Cats)

    • Follow-up and long-term survival data, including median survival times in cats and dogs, was determined in different conditions, including overall recovery, stage of AKI, and survival at various time intervals (up to 24 months after discharge).

    Further details

    Specific details include (where available) and include information for various models, their performance, and specific cutoff scores. Various categories are provided, including risk factors, survival, and mortality. Statistical details regarding significance of mortality associations between AKI stage and mortality also exist.

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    Related Documents

    Outcomes for Medically Managed AKI in Dogs and Cats PDF

    Description

    This quiz explores the pathophysiology of acute kidney injury (AKI), its underlying causes, and the factors influencing prognosis. It also examines different management strategies for AKI. Understanding these elements is crucial for effective treatment and decision-making in veterinary care.

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