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Acute Reual Failure

What is acute reual failure? (ARF)

As we all know the importance of kidney to the health and vitality of human beings and it is not an exception in dog’s case. The kidney plays many vital roles in the body and performs many functions, one of which is the removal of toxin and waste from the body. When kidney fail, they cannot remove the toxin produced in the body. Acute kidney failure means the problem develop relatively quickly. So sudden interruption of efficient reual filtration cause acute reual failure.

 What cause Acute Reual Failure in dogs?

Many things can cause acute reual failure. There are many poison which can damage the kidney such as antifreeze which contain ethylene glycol, raisin and grapes and certain medication such as pain killer like aspirin or ibuprofen.

Similarly, severe infection in the kidney from bacteria can also cause kidney failure such as leptospura. Beside these there is preexisting condition in dog that reduce the animal’s ability to fight infection easily (such as kidney stone, partial urine blockage or chorine kidney disease). Dog get leptospirosis from urine or water contaminated by infected animal like deer, cattle, mice or other dogs.

Other cause of the acute reual failure is shock in which there is decrease blood flow through kidney. Similarly revere dehydration from any because such as revere vomiting and diarrhea, heat stroke can also cause ARF. Beside this bee stings or snake bite which causes massive damage to blood vessel can lead to kidney failure.

Vet usually classify the causes of kidney failure as:

Prerenal: it arises from the condition outside the kidney, such as shock that then affect blood flow or pressure in the kidney.

Reual: affecting the kidney themselves such as infection of the kidney, tumor

Post reual: resulting from partial or complete urinary tract obstruction causing a backup of urine and consequent kidney damage.

Beside these, there are certain drug that cause ARF like Amphotericin B ( an autistic that is toxic to the kidney) Geutamicum and certain no steroidal  autoflammatory drug ( NSAID)

What are risk for Acute Reual Failure (ARF) in dog?

ARF is not a breed specific condition, but does seem to occur more often on older animals. Sadly kidney disease typically goes undetected until approximately 70% of the nephron in kidney is no longer functioning. So periodic blood check of the dog is advised by the vet for the early detection of this condition.

Risk factors for ARF:

  • Preexisting reual disease
  • Decreased cardiac output
  • Dehydration
  • Hypomagnesemica
  • Advanced age
  • Hypotension
  • Fever
  • Hypernatremia
  • Sepsis
  • Acidosis
  • Con current use of potential Nephrotoxius
  • Trauma
  • Pancreatitis
  • Systemic Hypotension
  • Hypo albuminuria
  • Anesthesia and Surgery
  • Hypo adrenocortism
  • Vascuities
  • Trauma
  • Disseminated intravascular coagulation
  • Heat stroke
  • Hyper viscosity syndrome (multiple myeloma polycythemia)

What are the signs of ARF?

The general sign of acute reual failure are quite obvious but do not specifically indicate the source of illness, when reual failure is acute symptoms comes on quickly and are often reverse. The top three signs are

  • Vomiting
  • Complete loss of appetite
  • Marked lethargy and weakness

Other symptoms that pet owner might notice:

  • Straining to urinate and decrease urine production
  • Disorientation
  • Problem with co-ordination
  • Diarrhea

In early stage there is excessive thirst and urine volume but in severe kidney failure, the amount of urine may actually decrease on the dog sometimes even stop the production of urine. Because there are so many underlying causes of ARF, these sign are mixed with those of triggering condition. There is seldom any weight loss or change in hair or coat. Dogs are below normal (hypothermia). There may be ulcer in mouth, stomach and intestine which will result in either black and tany stool and vomiting of digested blood (which looks like coffee color). There is also typically sweet (uremic) smell may be bloodshed. Dogs with acute reual failure breathe faster and have faster heart rate (tachycardia) than normal.

If you notice any sign of these, you should contact your vet which will perform many test to find out the cause of illness.

ARF is very serious and life threating condition and prompt action should/must be taken in order to save the dog’s life.

There is no time to waste if your pet is in ARF.

Diagnosis (How ARF is diagnosed)

Urinalysis and urine sediment examination are performed. A high urine concentration strongly suggest that kidney problem is secondary to another disorder arising elsewhere in body. Urine culture is carried out to rule urinary tracts infection and urine routine test is done to evaluate the kidneys ability to concentrate urine. If the urine has very specific gravity (or very dilute urine) then the condition of ARF is suspected. While blood cell cast, and other matter in urine indicate damage in kidney themselves or elsewhere in the urinary tract. Blood test are carried out to check the increased value that indicate kidney dysfunction. In blood chemistry there is marked increase in creatinine & BUN (blood area nitrogen). As creatinine is the waste product generated in the body & it should be excreted via kidney in urine. If the kidney cannot perform its function then there is increase of creatinine & BUN in blood. A complete blood count (CBC) is carried out to evaluate if there is any infection and metabolic disease or enough red blood cell (RBC). X-ray and ultrasound scanning can help the vet to determine the nature of changes in the kidney or to see if there any obstruction in urinary tract. Sometime a scopsy of kidney may also be necessary.

What are the treatment option available for dog suffering from ARF?

The initial objective of treatment is to sustain life and to eliminate the cause of kidney failure. The initial treatment for ARF is whavenous (IV) fluid administration. The goal of this therapy is to replace fluid losses, maintain good fluid balance, and promote urine formation. If dog starts to urinate, it is responding to treatment however urine production should be carefully monitored.

Diuretic drug such as furosemide are effective when used early in acute kidney/ Reual failure. Mouth which caused by uremia (increase area in blood) are treated with chlorhexidine mouthwash several times daily. Moat affected dogs are unwilling or unable to eat so nourishment is added to the inhaveuous drip. Alternatively, food may be given by stomach tube if there is no vomiting.

In addition to fluid therapy, other medication are commonly used. Antacid such famotidine, ramtidine or parentally (IV) because reual failure frequently induce increased gastric acid production. Antibiotic are given if the cause of ARF is known or suspected to be infection but dose should be calculation and must be optimum.

As mentioned earlier, the condition of ARF can change rapidly so careful monitoring is necessary. This may include blood test, body weight, urine production amount of IV fluid administrated, blood pressure and electrocardiogram. It may be necessary to place a urinary catheter to measure urine volume.

Potassium is the electrolyte urine normally found in blood in low level with ARF potassium level tend to increase to a dangerous level (hyperkalemia) unlike chronic reual failure where potassium level tends to decrease. This increase in potassium level slows the heartbeat and can cause heart to stop. Alternatively, very high blood pressure (hypertension) could also develop because of reual failure so blood pressure medication may be needed. Similarly, fluid retention may occur if urine production is less than IV fluid administrated. This may manifest itself as increased body weight, belly bloating, swollen legs or shortness of breath if fluid buildup or accumulate in lung. s

Not all animal respond to the fluid therapy. So where facilities exist, acute reual failure is treated with dialysis, in peritoneal dialysis caurty (inside the abdomen) that draws waste material out through the peritoneal living. After a period of time, waste fluid is removed and frest fluid is added. In this way, the peritoneal living temporarily takes on the function of the kidney. Repeat session are needed in some cases 24 hour a day we have to keep flushing. In haeurodylisis, the blood is filtered through a machine. Haemodylisis is very expensive and is available only in few veterinary hospitals in the foreign developed countries. Unfortunately, in Nepal this facilities us not available in Veterinary sector and is limited to only human medicine practices.

Dietary management is also plays a crucial role. The main aim of it is to reduce the pressure on kidney. Now-a-days a variety of flow phosphorus low protein reual support diet are available through veterinary clinic. Consult the vet about the dose and aiming of feeding schedule.

What are the prognosis of dog suffering from ARF?

The prognosis depends on the cause of the kidney failure and on the aggressiveness and efficiency of treatment. Unfortunately, most dogs, 60 percent in recent study do not recover of those who do, many go on to develop of chronic reual failure.