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2011 july cb_diagnostistreenephrology
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2011 july cb_diagnostistreenephrology

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  • 1. D i a g n o s t i c T r e e / NEPHROLOGY Peer Reviewed Vanessa E. Von Hendy-Willson, DVM, & Larry G. Adams, DVM, PhD, Diplomate ACVIM (Small Animal) Purdue UniversityAcute Renal Failure History & clinical signs • Signalment • Anorexia Physical examination Initial diagnostics • Duration of • PU/PD • Hydration status • CBC signs • Lethargy, • BCS • Serum biochemical panel • Medications weakness • Oral exam (halitosis, • Urinalysis • Toxin exposure • Nausea ulcers) • Blood pressure • Travel • Vomiting • Abdominal palpation • Abdominal radiography/ultrasound • Tick exposure • CNS signs (pain, renal enlargement) Azotemia, hyperphosphatemia, metabolic • Concurrent • Diarrhea • Auscultation (bradycardia) acidosis, hypocalcemia, hypo- or illness • Oliguria/anuria • Other systemic signs hyperkalemia, isosthenuria, proteinuria, • Recent anesthesia glucosuria* Intrinsic renal azotemia Prerenal azotemia • Isosthenuria • Concentrated USG • Fractional excretion of Na > 1% • Fractional excretion of Na < 1% • Increased anion gap Evidence of Hypotension blood loss UP/C > 1† Nephrotoxi- Ischemic Exogenous cant drug event toxin or exposure infectious agent? Absolute Consider History of decrease in acute dehydration, effective glomerulo- Drug prior blood nephritis levels anesthesia? volume • Ethylene glycol test Investigate Consider Consider • Leptospiro- sis titers Relative underlying acute acute • Tick-borne decrease inflamma- interstitial tubular disease in effective tory or nephritis necrosis titers blood infectious volume diseases Additional diagnostics • Determine urine output (If oliguria/anuria, also consider postrenal azotemia) • Abdominal ultrasound • Urine culture • Consider renal biopsy if unresponsive to treatment * Not all findings must be present to continue.BCS = body condition score, CBC = complete blood count, CNS = central nervous system, † No history of nephrotoxicant drug exposure, ischemicCT = computed tomography, EU = excretory urogram, Na = sodium, PU/PD = polyuria/ event, toxin, or infectious agentpolydipsia, UP/C = urine protein:creatinine ratio, USG = urine specific gravity18 ..............................................................................................................................................................................NAVC Clinician’s Brief / July 2011 / Diagnostic Tree
  • 2. Investigation Treatment Diagnosis Result This algorithm can be downloaded and printed for use in your clinic at cliniciansbrief.com. Postrenal azotemia • Hyperkalemia • Abdominal effusion • Radiographic evidence of obstruction or oliguria/anuriaHyperkalemia &hyponatremiawithout oliguria • Abdominal ultrasoundConsider hypo- (If upper tract obstruction or rupture suspected)adrenocorticism • Contrast urethrogram(Addison’s disease) (If lower tract obstruction or rupture suspected) Confirmed Obstruction not Bladder or Ascites noted urethral or confirmed; suspect urethral tear Abdominocentesis for fluid ureteral ureteral obstruction creatinine concentration obstruction Excretory urogram (EU) OR Uroabdomen antegrade pyelogram (If serum creatinine < 5 mg/dL; no EU if > 5 mg/dL) _ Diagnostic Not diagnostic Ureteral obstruction Consider CT with contrast OR antegrade pyelogram if CT not availableDiagnostic Tree / NAVC Clinician’s Brief / July 2011 ..............................................................................................................................................................................19