What is acute kidney injury?
Acute kidney injury (AKI; previously called acute renal failure) is the sudden failure of the kidneys to perform normal filtration duties. This condition is not the same as chronic kidney disease (CKD), which is much more common.
AKI leads to accumulation of toxins and other waste products in the bloodstream, dehydration, electrolyte imbalances, and disturbances in the acid-base balance of the blood. AKI is potentially reversible if diagnosed early and treated aggressively. Older cats are at higher risk for developing AKI.
What are the clinical signs of AKI?
Clinical signs of AKI usually happen suddenly and can include:
- Sudden anorexia (not eating)
- Listlessness
- Vomiting (the vomited material may have blood in it)
- Diarrhea (may contain blood)
- A strange breath odor
- Ulcers in the mouth
- Low blood pressure
- Rapid heart rate or slower than normal heart rate
- Seizures
- Changes in urine production (some cats urinate more frequently, while others may not produce any urine)
There may be a recent history of toxin ingestion (e.g., antifreeze) or recent trauma, surgery, or illness. Many cats are in shock by the time they reach the veterinary hospital. The veterinarian often finds enlarged and painful kidneys during the physical examination.
What causes AKI?
There are numerous causes of AKI. Some of the common causes include:
- Ureteral or urethral obstruction (i.e., the cat cannot urinate)
- Antifreeze poisoning (ethylene glycol toxicity)
- Systemic shock
- Congestive heart failure
- Liver failure
- Low blood pressure (hypotension)
- Blood clotting disorders
- Ingestion of drugs such as NSAIAs (nonsteroidal anti-inflammatory analgesics – aspirin-type drugs) or certain antibiotics
- Insect or snake bites
- Ingestion of heavy metals such as lead, mercury, arsenic, and thallium
- Ingestion of toxic plants, especially lilies
- Trauma, burns, or heatstroke
- Ingestion of rodenticides (rat poison)
- Pyelonephritis (a bacterial infection of the kidney)
- Feline infectious peritonitis (FIP)
How is AKI diagnosed?
Diagnosis is based on medical history, clinical signs, and the results of blood and urine tests. Other diagnostic tests may include urine bacterial culture testing, abdominal radiographs (X-rays), abdominal ultrasound, fine needle aspiration (sampling the kidney using a long needle), surgical biopsy of the kidneys, and possibly magnetic resonance imaging (MRI) or computed tomography (CT).
What is the treatment for AKI?
Treatment is focused on removing the circulating toxins as quickly as possible and restoring electrolyte balance. This goal is usually accomplished by administering intravenous fluids for 24 to 96 hours (1 to 4 days).
Rarely, peritoneal dialysis and hemodialysis may be performed (purifying the blood of toxins, similar to the procedure for a human waiting for a kidney transplant). If toxin exposure or a drug reaction is suspected, it is recommended that the cat’s stomach be emptied immediately and then the cat should be given activated charcoal to prevent further absorption of toxins.
Nutritional support may be required in cats with persistent or uncontrollable vomiting. Other supportive measures include medications to control vomiting, treat diarrhea, and prevent gastrointestinal ulceration. Diuretics and certain blood pressure medications may also be used to increase blood flow to the kidneys. Your veterinarian will recommend an aggressive treatment plan to give your cat the best chance of recovering from AKI.
What is the prognosis for a cat diagnosed with AKI?
The initial prognosis is guarded (uncertain) for all cases of AKI. If it is caused by infection, the prognosis may be better than if caused by a toxic substance. The long-term prognosis for recovery depends on the amount of kidney damage that has occurred. The kidney, unfortunately, has very little capacity to regenerate or heal itself, leading to the guarded prognosis. Your veterinarian will provide you with a more accurate prognosis based on your cat's clinical signs, results of laboratory tests, and individual condition.
