Acute on chronic kidney disease in dogs: Etiology, clinical and clinicopathologic findings, prognostic markers, and survival

Abstract

Background: Chronic kidney disease (CKD) and acute exacerbation of CKD (ACKD) are common in dogs. Objective: To characterize the etiology, clinical and laboratory findings, and shortand long-term prognosis of dogs with ACKD. Animals: One hundred dogs with ACKD. Methods: Medical records of dogs diagnosed with ACKD admitted to a veterinary teaching hospital were retrospectively reviewed. Results: The most common clinical signs included anorexia (84%), lethargy (77%), vomiting (55%) and diarrhea (37%). Presumptive etiology included inflammatory causes (30%), pyelonephritis (15%), ischemic causes (7%), other (3%), or unknown (45%). Median hospitalization time was 5 days (range, 2-29 days) and was significantly longer in survivors (6 days; range, 2-29 days) compared with nonsurvivors (4 days; range, 2-20 days; P < .001). Mortality rate was 35%. International Renal Interest Society (IRIS) acute kidney injury (AKI) grade at presentation was associated (P = .009) with short-term survival, but presumptive etiology was not (P = .46). On multivariable analysis; respiratory rate (P = .01), creatine kinase (CK) activity (P = .005) and serum creatinine concentration (SCR; P = .04) at presentation were associated with short-term outcome. Median survival time of dogs discharged was 105 days (95% confidence interval [CI], 25-184), with 35 and 8 dogs surviving up to 6 and 12 months, respectively. Presumptive etiology (P = .16) and SCR (P = .59) at discharge were not predictors of long-term survival. Conclusion and Clinical Importance: Short-term outcome of dogs with ACKD is comparable to those with AKI but long-term prognosis is guarded. The IRIS AKI grade at presentation is a prognostic indicator of short-term outcome.

Effect of alprostadil in the treatment of intensive care unit patients with acute renal injury

“…The ICU is a place to rescue severely ill patients, and most patients suffer from multiple organ failure. It has been reported that the mortality rate of patients with more than 2 failed organs is more than 50%, and that of patients with more than 4 failed organs is 100%, which seriously affects the quality of life and safety of patients[ 3 , 4 ]. Studies have shown that the release of proinflammatory mediators is increased in severely ill patients, and then tissue replacement downregulates the release of proinflammatory mediators.…”

Comparative quantitation of aquaporin-2 and arginine vasopressin receptor-2 localizations among chronic kidney disease and healthy kidney in dogs

“…Mutations or dysfunction of AQP2 and AVPR2 could cause nephrogenic diabetes insipidus (NDI), which disrupted water balance and resulted in the excretion of large amounts of dilute urine [18,19]. Previous research has shown that AQP2 inadequacy can affect water balance in the kidney, which is common in humans and animals such as dogs, rats, mice, horses, and young beef cattle [1,[20][21][22][23]. Furthermore, the structure of the canine kidney is unipyramidal, which differs from that of a human [24].…”

“…Chronic kidney disease (CKD) is a typical disease in senior dogs and cats. The estimated CKD incidence in dogs and cats is 0.5-1.5%, with more than 10% of dogs and 30% of cats over the age of 15 being diagnosed with CKD [ 1 , 2 ]. CKD is defined as impairment and irreversible renal dysfunction and/or structure that results in progressive disease [ 3 ].…”

“…Renal tubules are dilated and filled with pink casts, give the appearance of “thyroidization” (colloid-like hyaline cast formation) [ 7 ]. Azotemia, uremia, proteinuria, hypertension, polyuria, and water and electrolyte imbalance were the clinical signs [ 1 ]. The most common disorder caused by the kidney’s failure to conserve water is polyuria [ 8 ].…”

“…However, there are a few studies of AQP2 and AVPR2 in companion animals, including dogs and cats [ 1 , 8 ]. Moreover, the relationship between AQP2 and AVPR2 and the localization of these proteins’ expression in dogs with renal disease have rarely been investigated.…”