Azotemia & Acute Kidney Injury

Gregory F. Grauer, DVM, MS, DACVIM (SAIM), College of Veterinary Medicine, Kansas State University

Sarah Guess, DVM, MS, Columbia River Veterinary Specialists, Vancouver, Washington


History, Examination, & Laboratory Findings of CKD & AKI*

Findings CKD AKI
Weight loss, poor coat, poor body condition + -
Small, irregular kidneys (on radiography or palpation) + -
Nonregenerative anemia + -
Acidosis/hyperkalemia - +
Oliguria/anuria - +
Small, irregular kidneys with hyperechoic cortices with or without loss of corticomedullary junction (on ultrasonography) + -
Chronic history of polyuria/polydipsia or stage 1 CKD + -
Urine sediment changes compatible with tubular cell damage (eg, granular casts, renal tubular epithelial cells) - +
Relatively severe signs for magnitude of azotemia - +

*+ = presence more likely; - = presence less likely

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EXAMPLE OF Fluid Volume Requirements for A 20-KG DOG WITH 8% DEHYDRATION & AKI

Deficit needs(8% 20 kg) over 6 hours = 1600 mL (replace over 4-6 hours)
Maintenance (60 mL/kg/day) = 1200 mL/day
Continuing losses (dog vomits 4 times at 100 mL/episode) = 400 mL/day
Total = 3200 mL/day (deficit replaced over 4-6 hours if possible)


Hypothetical Comparison of TOTAL FLUID NEEDS in Normal, Oliguric, & Polyuric Dogs

  Normal Oliguric Polyuric
Insensible fluid needs 20 mL/kg/day 20 mL/kg/day 20 mL/kg/day
Sensible fluid needs (urine output) 40 mL/kg/day 6 mL/kg/day 165 mL/kg/day
Total 60 mL/kg/day 26 mL/kg/day 185 mL/kg/day

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AKI = acute kidney injury,BP = blood pressure,CKD = chronic kidney disease,PCR = polymerase chain reaction,UP:C = urine protein:creatinine,USG = urine specific gravity

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