Acute on chronic kidney disease in cats: Etiology, clinical and clinicopathologic findings, prognostic markers, and outcome

J Vet Intern Med. 2020 Jul;34(4):1496-1506. doi: 10.1111/jvim.15808. Epub 2020 May 22.

Abstract

Background: Chronic kidney disease (CKD) and acute decompensation of CKD (ACKD) are common in cats.

Objectives: To characterize the etiology, clinical and clinicopathologic findings, and the short- and long-term prognosis of feline ACKD.

Animals: One hundred cats with ACKD.

Methods: Retrospective study, search of medical records for cats with ACKD.

Results: Common clinical signs included anorexia (85%), lethargy (60%), weight loss (39%), and vomiting (27%). Suspected etiologies included ureteral obstruction (11%), renal ischemia (9%), pyelonephritis (8%), others (6%), or unknown (66%). Hospitalization duration was longer in survivors versus nonsurvivors (median = 7 days, range = 2-26 versus median = 3 days, range = 2-20, respectively, P < .001). The survival rate to discharge was 58%. Age, serum creatinine, urea, and phosphorous concentrations were higher and venous blood pH was lower in nonsurvivors. However, only serum phosphorus remained associated with the short-term outcome in the multivariable model (P = .02; 95% confidence interval = 1.03-1.39). Survivors had a median survival time of 66 days after discharge. Serum creatinine concentrations at presentation as well as at discharge were associated with long-term survival (P < .002 for both).

Conclusions: The short-term prognosis of ACKD is comparable to acute kidney injury, while the long-term prognosis is guarded.

Keywords: acute kidney injury; azotemia; renal failure; survival; uremia.

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / veterinary*
  • Animals
  • Cat Diseases / blood
  • Cat Diseases / etiology*
  • Cat Diseases / pathology
  • Cats
  • Creatinine / blood
  • Female
  • Hospitalization / statistics & numerical data
  • Ischemia
  • Kidney / blood supply
  • Male
  • Phosphorus / blood
  • Prognosis
  • Protons
  • Pyelonephritis / veterinary
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / veterinary*
  • Retrospective Studies
  • Urea / blood
  • Ureteral Obstruction / veterinary

Substances

  • Protons
  • Phosphorus
  • Urea
  • Creatinine