Practical relevance: Acute kidney injury (AKI) is a frequently recognized disease process in cats that requires immediate and aggressive intervention. A thorough understanding of the pathophysiologic processes underlying AKI and familiarity with the most common etiologies are essential for providing the most effective and timely therapy. Possessing this knowledge will also allow a more accurate prognosis to be given, and afford the best chance of a favorable outcome.
Clinical challenges:Feline patients often present with vague signs of AKI, which may delay treatment and adversely affect the prognosis. Their response to injury and treatment is often different to that of other species.Audience: This two-part review article is directed at small animal practitioners as well as specialists. Part 1 reviews mechanisms underlying AKI in the cat, as well as etiologies and treatments related to some specific causes of AKI.
New terminology -and a new emphasisAcute kidney injury (AKI) is a relatively new term in the nephrology literature that largely replaces the use of 'acute renal failure' (ARF). Originally introduced in the human literature, AKI allows for greater stratification of cases with regard to severity and prognosis. By suggesting that a patient has injury, rather than failure, one can recognize the potential for earlier treatment and recovery. In human medicine, the older term 'ARF' refers only to patients requiring renal replacement therapy (RRT). Additionally, the more common term 'kidney', rather than 'renal', facilitates communication with and understanding by clients of AKI. The incidence of AKI in cats is not known, but it is not uncommon and can be caused by a variety of different insults. A uniform definition for AKI does not exist in the veterinary literature and varies among publications. Generally accepted criteria include an abrupt reduction in kidney function resulting in alterations in glomerular filtration, urine production and tubular function. These alterations result in an inability to maintain fluid, electrolyte and acid-base balance, and may lead to azotemia.
PathophysiologyThe pathophysiology of AKI is complex, but can be described by four stages: initiation, extension, maintenance and recovery.