Understanding and nursing acute kidney injury: a patient care report

An unvaccinated, indoor-outdoor, 9-year-old male neutered Oriental cat presented with a 2 day history of lethargy, anorexia and vomiting. On examination the normally bright and vocal cat was dull and unresponsive. Body condition score was normal at 6/9. Mucous membranes were tacky, and oral lesions were observed in addition to halitosis. On auscultation the patient was bradycardic with a heart rate of 128 beats per minute (bmp) (normal range 110–220, Jack and Watson, 2008), but pulses were matching. Systolic blood pressure was recorded initially by indirect Doppler measurement (CAT Doppler, Thanes Medical) and found to be 130 mmHg (reference range: 120–170 mmHg, Jack and Watson, 2008). On abdominal palpation the anterior abdomen was tender and his bladder empty. Rectal temperature was slightly low at 37.0°C (normal range 38.0–39.0, Jack and Watson, 2008). Blood tests were collected for full haemotology and biochemistry with electrolytes and a 24G intravenous (IV) canula was placed in the cephalic vein immediately. IV fluid therapy (Hartmanns, Aqupharm, animalcare) was started at twice maintenance. In-house blood results indicated severe hyperkalaemia and azotaemia (Table 1), as well as a stress leucogram (neutrophilia with lymphopenia); IV fluid therapy was changed to 0.9% saline. The owner knew of no possible toxin exposure and did not report any other significant events such as trauma or recent illness. The patient had last been seen at the hospital 2 years previously for pre-anaesthetic blood tests (all normal) and dental treatment including extractions. The blood results along with clinical signs and history suggested acute kidney injury (AKI), although other possible differential diagnoses included acute decompensation of pre-existing kidney disease (acute-on-chronic), ruptured bladder or (very rarely in cats) hypoadrenocorticism (DiBartola, 2006). To rule out Addison's disease an adrenocorticotropic hormone (ACTH) test was performed once the patient was stable; the results subsequently came back normal.