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[A220]Acute Renal Kidney Failure
by Hannah, Han
Acute renal failure or ARF is characterized by a rapid onset of renal insufficiency/failure, reduction in glomerular filtration rate and renal plasma flow, and the clinical and biochemical aftermath of the excretory failure. This is a serious form of kidney disease where the dog's kidney quit working all of a sudden and that can leads to death. The kidneys have an abrupt decrease in the GFR due to a toxin or loss of adequate blood supply (called ischemia). The excretory failure is identified by rapid (hours to days) increases in BUN, serum creatinine and phosphate, and variable hyperkalemia and metabolic acidosis. Acute renal failure is a tenuously reversible state, which must be diagnosed quickly and aggressively treated. Failure to initiate therapy may result in irreversible parenchymal damage or death. Acute renal failure is frequently a complication of other surgical or medical diseases and must be recognized within the clinical features of these associated disorders.

Common clinical signs of kidney failures in dogs are loss of appetite, depression, vomiting, diarrhea, very bad breath, pale gums and ulcers in the mouth. While the consistent signs of severe ARF include the sudden onset and rapid development of listlessness, depression, anorexia, vomiting, and diarrhea. Oliguria and less frequently anuria were at one time considered signatures of ARF and discriminators for chronic renal failure. Some causes of ARF are due to low blood pressure or a decrease in blood volume, lack of blood supply to the kidneys, a urninary blockage or dogs in-take of some poisonous plants or toxins, most notably the antifreeze ( 95% ethylene glycol) which are catastrophic to the kidneys. Antifreeze is very sweet tasting and is readily licked by both dogs and cats if it spills on the ground when car antifreeze is changed. Ethylene glycol is converted in the liver and kidney to a toxic metabolite that changes the pH of the bloodstream and destroys the kidneys by depositing calcium oxalate crystals in the renal tubules. It is a medical emergency and requires specific and immediate measures if the kidneys are to be saved. Unfortunately, unless a pet owner actually observes their pet licking antifreeze, they don't bring their pet in for care until it is very ill.

Treatment of renal kidney disease is aimed at preventing or slowing further kidney damage. One phase to treat kidney is to "restart" it. The large quantities of intravenous fluids are given to "flush out" the kidneys. This flushing process, called diuresis, helps to stimulate the kidney cells to function again. If enough functional kidney cells remain, they may be able to adequately meet the body's needs for waste removal. Fluid therapy includes replacement of various electrolytes, especially potassium. Other important aspects of initial treatment include proper nutrition and drugs to control vomiting and diarrhea. The possible outcome of these treatment, the kidneys will resume functioning and continue to function for a few weeks to a few years. Also the kidneys will resume functioning during treatment but fail again as soon as treatment stops or maybe the kidney will not return. Another phase of treatment is to keep the kidneys functioning as soon as possible. First method, the dog will undergo a speical diet which the food contains low in protein, low in phosphorus, and not acidified. Another method is a phosphate binder where phosphorous is removed from the body by filtering through the kidneys and once the filtration process is impaired, phosphorous begins to accumulate in the blood. Another process is giving a drug to regulate the parathyroid gland and calcium levels. Calcium and phosphorus must remain at about a 2:1 ratio in the blood. The increase in blood phosphorus level stimulates the parathyroid gland to increase the blood calcium level by removing it from bones. Once the dog is stabilized, fluids can be given under the skin (subcutaneously). This serves to continually "restart" the kidneys as their function begins to fail again. This is done once daily to once weekly, depending on the degree of kidney failure.

Another option is kidney transplants and dialysis and becoming more accessible for pets today, but due to the high costs, aren't practical for most pet owners. Many cases that the dogs with renal failure are successfully managed and live long happy lives. Common prevention of such dog diseases it to have a regular laboratory testing preformed with the yearly vet visit can help to detect early stages of renal failure before they appear, and starting early treatment can help to slow or halt loss of kidney function to improve the pet's quality of life.

ARF is a condition when both kidneys almost suddenly fail to perform their functions. The failure occurs within a few hours/ days. This may result from an acute disease of the kidneys, as a result of allergic manifestation operating gravely on the kidneys, i.e. acute GN, described earlier. Besides, sometimes blood pressure may be so acutely elevated, that it may knock down both the kidneys, resulting in their sudden/ acute failure. Further, an acute infection of the kidneys (pyelonephritis), following some obstructive lesion in the urinary tract, like a urinary stone, or benign enlargement of the prostate, may also cause ARF, if the infection is not controlled promptly. This aspect has already been discussed under the head of UTI urinary tract infection.

ARF may occur due to other conditions in the body, which cause reduced blood flow to the kidneys, so that the excretion of waste products from the blood is greatly hampered. Such conditions are common enough, and one needs to know about these. The most common is dehydration, due to loss of fluids in severe vomiting, diarrhoea, burns, crush injuries, etc. ARF develops when such conditions are not immediately attended to, and intravenous fluids are not administered in time.

Similarly, severe haemorrhage from the body, necessitating immediate blood transfusion, may cause this condition. A similar situation arises when there is a marked fall in blood pressure (hypotension) due to heart attack/failure, shock etc., so that blood supply to the kidneys is adversely affected.

Another important cause of ARF may be the indiscriminate use of drugs, especially those drugs which are toxic for the kidneys. If one studies the causes of renal failure in general, one will find a substantial number - to the extent of 50 per cent in this group. These are called 'iatrogenic' cases, i.e. when the disease has been induced in the body by the person himself, for example, by the unnecessary use of drugs, etc.

How to suspect a case of ARF?

The most important step in the clinical diagnosis of the disease is that, as a result of the acute involvement of the kidneys, both of them become badly affected and their function becomes markedly deranged, to the extent that the kidneys are not able to excrete urine in sufficient/normal quantities. Thus, the patient starts passing less urine, and slowly the excretion of urine becomes so little, that on measuring it in 24 hours, it will be hardly 400 ml, while an individual is expected to pass about 1500-2000 ml of urine per day.

Serum creatinine and blood urea also rise. Serum creatinine is a more sensitive index of kidney function than blood urea, which varies with the intake of food by the patient. Both the levels of these tests rise daily, if timely treatment is not initiated. Levels of serum creatinine have already been mentioned, and to repeat, normal levels of serum creatinine are 0.8 mg/ dl to 1.4 mg/ dl, with an average 1.00 mg/ dl. If the levels of serum creatinine rise more than 8.00 mg/ dl, urgent dialysis is required to save the kidneys/life of the patient.

Article Source : Pg. 55

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Both Hannah & Krishan B Kumar are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Hannah has sinced written about articles on various topics from Pets, Dog Breeds and Pets. If you find these article is helpful, feel free to visit the author's innovative sites: |. Hannah's top article generates over 22200 views. to your Favourites.

Krishan B Kumar has sinced written about articles on various topics from Pets, Other Conditions and Medical Condition. Author sites: , and. Krishan B Kumar's top article generates over 14800 views. to your Favourites.
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