Difference between revisions of "Azotaemia"

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==Clinical Significance==
 
==Clinical Significance==
 
Azotaemia may cause the clinical syndrome of [[Uraemia|'''uraemia''']], affecting multiple organ systems.  The causes of azotaemia are usually divided into pre-renal, renal and post-renal:
 
Azotaemia may cause the clinical syndrome of [[Uraemia|'''uraemia''']], affecting multiple organ systems.  The causes of azotaemia are usually divided into pre-renal, renal and post-renal:
−
*'''Pre-renal azotaemia''' occurs when the kidney receives insufficient oxygen to maintain its metabolism:
+
===Pre-renal azotaemia===
−
**'''Dehydration/hypovolaemia''', reducing renal blood flow.
+
This occurs when the kidney receives insufficient oxygen to maintain its metabolism:
−
**'''Heart failure''' results in a reduced cardiac output, reducing renal blood flow.
+
*'''Dehydration/hypovolaemia''', reducing renal blood flow.
−
**'''Anaemia''' reduces the amount of oxygen delivered to the kidneys.
+
*'''Heart failure''' results in a reduced cardiac output, reducing renal blood flow.
−
**'''Portal hypertension''' may result in splanchnic pooling of blood and reduced renal blood flow.
+
*'''Anaemia''' reduces the amount of oxygen delivered to the kidneys.
−
*'''Renal azotaemia''' results from direct insults to the kidney:
+
*'''Portal hypertension''' may result in splanchnic pooling of blood and reduced renal blood flow.
−
**'''Exogenous toxins''' including heavy metals, [[Aminoglycosides|aminoglycosides]], [[Tetracyclines|tetracyclines]], polymixin B, cisplatin, lilies in cats and grapes in dogs.
+
===Renal azotaemia===
−
**'''Endogenous toxins''' including haemoglobin, myoglobin and calcium.
+
This occurs following a direct insult to the kidney:
−
**Infection as in '''pyelonephritis''', '''interstitial nephritis''' (as caused by [[Leptospirosis - Cats and Dogs|''Leptospira spp.'']] or '''granulomatous nephritis''' (as caused by the dry form of [[Feline Infectious Peritonitis]]).
+
*'''Exogenous toxins''' including heavy metals, [[Aminoglycosides|aminoglycosides]], [[Tetracyclines|tetracyclines]], polymixin B, cisplatin, lilies in cats and grapes in dogs.
−
**'''Glomerulonephritis''' and '''[[Amyloidosis|amyloidosis]]'''.
+
*'''Endogenous toxins''' including haemoglobin, myoglobin and calcium.
−
**'''Neoplasia''', including adenocarcinoma in dogs and lymphoma in cats.
+
*Infection as in '''pyelonephritis''', '''interstitial nephritis''' (as caused by [[Leptospirosis - Cats and Dogs|''Leptospira spp.'']] or '''granulomatous nephritis''' (as caused by the dry form of [[Feline Infectious Peritonitis]]).
−
*'''Post-renal azotaemia''' results from obstructions to the urinary tract:
+
*'''Glomerulonephritis''' and '''[[Amyloidosis|amyloidosis]]'''.
−
**'''[[Urolithiasis - Small Animal|Urolithiasis]]'''
+
*'''Neoplasia''', including adenocarcinoma in dogs and lymphoma in cats.
−
**'''Rupture of the urinary tract''', often due to trauma and causing [[Uroabdomen|uroabdomen]].
+
===Post-renal azotaemia===
−
**'''Neoplasia''', including transitional cell carcinoma of the bladder and prostatic neoplasia.
+
This occurs following obstructions within the urinary tract:
 +
*'''[[Urolithiasis - Small Animal|Urolithiasis]]'''
 +
*'''Rupture of the urinary tract''', often due to trauma and causing [[Uroabdomen|uroabdomen]].
 +
*'''Neoplasia''', including transitional cell carcinoma of the bladder and prostatic neoplasia.
  
  
 
[[Category:Blood Biochemistry Changes]]
 
[[Category:Blood Biochemistry Changes]]

Revision as of 11:02, 3 November 2010

Introduction

Azotaemia refers to an increase in the blood concentrations of urea and creatinine. Azotaemia occurs almost exclusively with renal failure that results in an inability to excrete these two metabolic products. Urea and Creatinine vary in the extent of the increase induced by renal pathologies (creatinine can show substantial increases from baseline, whereas smaller increases in urea are significant as levels generally increase by a much smaller factor) and also the timing of the increase - creatinine levels will rise and fall more quickly than changes in urea and can therefore be more useful in monitoring response to treatment.

Clinical Significance

Azotaemia may cause the clinical syndrome of uraemia, affecting multiple organ systems. The causes of azotaemia are usually divided into pre-renal, renal and post-renal:

Pre-renal azotaemia

This occurs when the kidney receives insufficient oxygen to maintain its metabolism:

  • Dehydration/hypovolaemia, reducing renal blood flow.
  • Heart failure results in a reduced cardiac output, reducing renal blood flow.
  • Anaemia reduces the amount of oxygen delivered to the kidneys.
  • Portal hypertension may result in splanchnic pooling of blood and reduced renal blood flow.

Renal azotaemia

This occurs following a direct insult to the kidney:

  • Exogenous toxins including heavy metals, aminoglycosides, tetracyclines, polymixin B, cisplatin, lilies in cats and grapes in dogs.
  • Endogenous toxins including haemoglobin, myoglobin and calcium.
  • Infection as in pyelonephritis, interstitial nephritis (as caused by Leptospira spp. or granulomatous nephritis (as caused by the dry form of Feline Infectious Peritonitis).
  • Glomerulonephritis and amyloidosis.
  • Neoplasia, including adenocarcinoma in dogs and lymphoma in cats.

Post-renal azotaemia

This occurs following obstructions within the urinary tract:

  • Urolithiasis
  • Rupture of the urinary tract, often due to trauma and causing uroabdomen.
  • Neoplasia, including transitional cell carcinoma of the bladder and prostatic neoplasia.
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