Evaluation of parameters for the differentiation of acute from chronic renal failure in the dog

The differentiation of acute (ARF) from chronic (CRF) renal failure is important for therapeutic and prognostic reasons and should be established as soon as possible. In practice this differentiation is often based on history, physical examination and laboratory results. In this retrospective study the diagnostic accuracy of parameters to differentiate ARF from CRF was tested in 19 dogs with ARF and 49 dogs with CRF. The diagnostic accuracy of body condition was 65%, of the hematocrit 78%, of serum potassium levels 28%, of total CO2 48%, of urinary casts 77%, of glucosuria 90% and of the urine protein-to-urine creatinine ratio 43%. Of all the parameters evaluated only glucosuria revealed an acceptable discriminating quality with a sensitivity of 92% and a specificity of 89%. A limitation of this factor is, that glucosuria depends on the cause of ARF. The single parameters tested are not very useful and the diagnosis of ARF or CRF is based on a combination of parameters from history, physical examination, laboratory results and diagnostic imaging. If a diagnosis can't be established immediately, treatment for ARF is recommended. With an immediate, aggressive treatment the possibility of total recovery from ARF is increased.     

A Retrospective Case-Control of Acute Renal Failure in 99 Dogs

The objective of this study was to evaluate retrospectively demographic and clinicopathologic factors that may be associated with the diagnosis and outcome of acute renal failure (ARF) in dogs presented to a large referral hospital. Medical records of dogs presented to the hospital were searched for a diagnosis of ARF. The diagnosis of ARF was based on clinical signs, renal imaging findings, and clinicopathologic data and, in most cases, was confirmed by histopathology, prior serum creatinine concentrations, response to therapy, and known recent nephrotoxin exposure or ischemic event. Demographics, selected clinicopathologic findings, and concurrent disorders that may have been associated with development of ARF were extracted from these records. A reference population was derived from 481 dogs presenting to the same hospital. Demographic data also were collected from these medical records. The demographic factors associated with a diagnosis of ARF and the factors associated with outcome of ARF were assessed by reviewing a series of multiple logistic regression models. Conclusions from this study were as follows: (1) Intact male dogs and nonsporting dogs were more likely to develop ARF and be admitted to the teaching hospital. (2) Dogs with severe azotemia (serum creatinine concentration > 10 mg/dL), hypocalcemia (<8.6 mg/ dL), and proteinuria were less likely to survive ARF and be discharged from the hospital. (3) Dogs that survived in the hospital for more than 5 days were more likely to recover and be discharged from the hospital.     

Acute intrinsic renal failure in cats: 32 cases (1997-2004)

OBJECTIVE: To determine patient demographics, clinicopathologic findings, and outcome associated with naturally acquired acute intrinsic renal failure (ARF) in cats. DESIGN: Retrospective case series. ANIMALS: 32 cats with ARF. PROCEDURES: Cats were considered to have ARF if they had acute onset of clinical signs (< 7 days), serum creatinine concentration > 2.5 mg/dL (reference range, 0.8 to 2.3 mg/dL) and BUN > 35 mg/dL (reference range, 15 to 34 mg/dL) in conjunction with urine specific gravity < 1.025 or with anuria or increasing serum creatinine concentration despite fluid therapy and normal hydration status, and no signs of chronic renal disease. Cases were excluded if cats had renal calculi or renal neoplasia. RESULTS: Causes of ARF included nephrotoxins (n = 18 cats), ischemia (4), and other causes (10). Eighteen cats were oliguric. For each unit (mEq/L) increase in initial potassium concentration, there was a 57% decrease in chance of survival. Low serum albumin or bicarbonate concentration at initial diagnosis was a negative prognostic indicator for survival. Initial concentrations of BUN, serum creatinine, and other variables were not prognostic. Seventeen (53%) cats survived, of which 8 cats had resolution of azotemia and 9 cats were discharged from the hospital with persistent azotemia. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that survival rates of cats with ARF were similar to survival rates in dogs and that residual renal damage persisted in approximately half of cats surviving the initial hospitalization.     

庆大霉素诱导的犬肾衰竭模型治疗期间的NGAL和Cys-C变化

旨在探讨中性粒细胞明胶酶脂质运转蛋白(NGAL)和胱抑素C(Cys-C)在药物诱导的急性肾衰竭(ARF)输液治疗过程中的变化规律和临床意义。每日皮下注射庆大霉素40mg/kg^60mg/kg建立犬的ARF模型,后静脉输注乳酸钠林格注射液。在犬ARF诱导期和恢复期,采集血清进行生化指标、NGAL和Cys-C浓度的测定,同时获取肾脏组织进行病理学分析。结果显示,在治疗过程中,犬的临床症状、尿量和尿比重都逐渐改善和恢复。血清NGAL在开始治疗后的第2天出现下降直至恢复正常,而血清Cyc-C呈现波动性的变化,血清尿素氮(BUN)和肌酐(CREA)浓度在输液第3~4天开始出现下降,但存在明显的波动性变化。组织病理学方面,肾小管细胞坏死的得到缓解和部分恢复。结果证明,乳酸钠林格注射液对庆大霉素诱导的ARF有明确的逆转作用,NGAL和Cys-C的表达规律与肾损伤的程度和肾功能变化有关,其中NGAL的表达变化对犬急性肾衰竭的早期诊断和治疗预后有很好的临床提示意义。     

Ultrasonography of the parathyroid glands as an aid in differentiation of acute and chronic renal failure in dogs

OBJECTIVE: To evaluate whether determination of parathyroid gland size by use of ultrasonography is helpful in differentiating acute renal failure (ARF) from chronic renal failure (CRF) in dogs. DESIGN: Prospective study. ANIMALS: 20 dogs with renal failure in which serum creatinine concentration was at least 5 times the upper reference limit. Seven dogs had ARF, and 13 dogs had CRF. Twenty-three healthy dogs were used as controls. PROCEDURE: Dogs were positioned in dorsal recumbency for ultrasonographic examination of the ventral portion of the neck, A 10-MHz linear-array high-resolution transducer was used. The size of the parathyroid gland was determined by measuring the maximal length of the gland on the screen when it was imaged in longitudinal section. For comparison among groups, the longest linear dimension of any of the parathyroid glands of each dog was used. RESULTS: Size of the parathyroid glands in the control dogs varied from 2.0 to 4.6 mm (median, 3.3 mm). In the dogs with ARF, gland size ranged from 2.4 to 4.0 mm (median, 2.7), which was not significantly different from controls. In dogs with CRF, the glands were more distinctly demarcated from the surrounding thyroid tissue, than those of controls and dogs with ARF. Sizes ranged from 3.9 to 8.1 mm (median, 5.7 mm), which was significantly larger, compared with controls and dogs with ARF. CONCLUSIONS AND CLINICAL RELEVANCE: In dogs with severe azotemia, ultrasonographic examination of the parathyroid glands was helpful in differentiating ARF from CRF Size of the parathyroid glands appeared to be related to body weight.     

Management of acute renal failure in cats using peritoneal dialysis: a retrospective study of six cases (2003-2007)

Information regarding the use and success of peritoneal dialysis (PD) in the management of acute renal failure (ARF) in cats is lacking. The purpose of this retrospective study is to describe the indications, efficacy, complications and outcome of cats undergoing PD for ARF. Six cats that underwent PD for treatment of ARF of various etiologies were included. PD effectively replaced renal function in all cats and allowed renal recovery in 5/6 cats. Five cats were discharged and one cat died. Complications were reported in all cats and included subcutaneous edema (n=5), hyperglycemia (n=4), dialysate retention (n=3), and hypoalbuminemia (n=3). A novel technique consisting of a Blake surgical drain and an intermittent closed suction system was used, which appears to be a viable option for PD in cats. Although complications are common, PD is an effective renal replacement therapy for ARF in cats and carries a reasonable prognosis in selected cases.     

New and unusual causes of acute renal failure in dogs and cats.

This article provides a source for easy reference, summarizing in one location newly recognized and unusual causes of acute renal failure (ARF) in dogs and cats. Several of the causes discussed in this article have been described previously. New or unusual causes of ARF in dogs and cats include infectious diseases (leptospirosis,borreliosis, and babesiosis), nephrotoxicants (aminoglycosides,vitamin D, and nonsteroidal anti-inflammatory drugs), and plant material (lilies and raisins/grapes).     

Use of dopamine in acute renal failure

Objective: To review the current understanding of dopamine and its use in the prevention and treatment of acute renal failure (ARF). Data sources: Original research articles and scientific reviews. Human data synthesis: Low‐dose dopamine administration has been shown to increase natriuresis and urinary output in both healthy individuals and in a few small studies in human patients with renal insufficiency. However, in several large meta‐analyses, dopamine treatment did not change mortality or the need for dialysis. Due to the potential side effects, the use of dopamine for prevention and treatment of ARF is no longer recommended in human medicine. Veterinary data synthesis: Low‐dose dopamine increases urinary output in healthy animals and animal models of ARF if given before the insult. There are no available studies looking at the effect of low‐dose dopamine therapy in naturally occurring ARF in dogs or cats. Conclusion: Due to the potential side effects of low‐dose dopamine therapy, the results from large human trials, and the lack of information in veterinary medicine, the use of dopamine for treatment of ARF in veterinary patients should be further evaluated.     

Serum concentrations of 1,25-dihydroxycholecalciferol and 25-hydroxycholecalciferol in clinically normal dogs and dogs with acute and chronic renal failure

OBJECTIVE: To compare serum concentrations of 1,25-dihydroxycholecalciferol (1,25-[OH]2D3) and 25-hydroxycholecalciferol (25-[OH]D3) in healthy control dogs and dogs with naturally occurring acute renal failure (ARF) and chronic renal failure (CRF). ANIMALS: 24 control dogs, 10 dogs with ARF, and 40 dogs with CRF. PROCEDURE: Serum concentrations of 1,25-(OH)2D3 were measured by use of a quantitative radioimmunoassay, and serum concentrations of 25-(OH)D3 were measured by use of a protein-binding assay. RESULTS: Mean +/- SD serum concentration of 1,25-(OH)2D3 was 153 +/- 50 pmol/L in control dogs, 75 +/- 25 pmol/L in dogs with ARF, and 93 +/- 67 pmol/L in dogs with CRF. The concentration of 1,25-(OH)2D3 did not differ significantly between dogs with ARF and those with CRF and was in the reference range in most dogs; however, the concentration was significantly lower in dogs with ARF or CRF, compared with the concentration in control dogs. Mean +/- SD concentration of 25-(OH)D3 was 267 +/- 97 nmol/L in control dogs, 130 +/- 82 nmol/L in dogs with ARF, and 84 +/- 60 nmol/L in dogs with CRF. The concentration of 25-(OH)D3 was significantly lower in dogs with ARF or CRF, compared with the concentration in control dogs. CONCLUSIONS AND CLINICAL RELEVANCE: The concentration of 1,25-(OH)2D3 was within the reference range in most dogs with renal failure. Increased serum concentrations of parathyroid hormone indicated a relative deficiency of 1,25-(OH)2D3. A decrease in the serum concentration of 25-(OH)D3 in dogs with CRF appeared to be attributable to reduced intake and increased urinary loss.     

Utilization of continuous renal replacement therapy in a case of feline acute renal failure

Objective: To introduce and investigate the application, efficacy, and potential clinical complications of a continuous renal replacement therapy (CRRT) in a feline acute renal failure (ARF) patient. Case summary: A domestic short‐haired cat presented for continued management of ARF of a presumed toxic etiology. Severe azotemia and uremic complications had been identified on initial presentation to a local urgent care facility, and the cat had been referred for renal replacement therapy following approximately 9 hours of conservative management. Continuous venovenous hemodiafiltration was performed over an approximately 25‐hour period, and a significant resolution of the cat's uremic derangements was obtained. Major complications included significant hypothermia and a single episode of hypocalcemia associated with utilization of citrate anticoagulation. All complications identified were readily managed. Following hospital discharge, long‐term medical support was not required, and no evidence of significant illness was noted 6 months following therapy. New or unique information provided: CRRT represents a collection of extracorporeal blood purification techniques that utilize extended treatment periods for gradual, physiologically balanced correction of uremic toxicity. These therapies demonstrate significant promise in the treatment of ARF cats with actual or potential hemodynamic compromise, and prior advances in therapeutic administration have made these techniques readily accessible within the intensive care unit setting.     

Evaluation of adding diltiazem therapy to standard treatment of acute renal failure caused by leptospirosis: 18 dogs (1998–2001)

Objective: To assess efficacy and safety of intravenous (IV) diltiazem as a treatment for acute renal failure (ARF) secondary to leptospirosis in dogs. Design: Retrospective study Animals: Eighteen dogs with ARF caused by Leptospira spp treated during the months of September to December (1998–2001). Procedure: All dogs treated for ARF caused by Leptospira spp were enrolled in the study and were treated with standard care consisting of IV fluids, +/? furosemide, and antibiotics. With owner consent some dogs were treated with diltiazem at 0.1–0.5 mg/kg (0.045–0.22 mg/lb) IV slowly, followed by 1–5 μg/kg/minutes (0.45–2.2 mg/lb/minutes) constant rate infusion. Outcome measures were compared between the 2 groups (diltiazem versus standard). Diltiazem was administered within 60 hours of admission until serum creatinine fell into the normal range or stabilized. The primary outcome measurement of safety was systolic blood pressure (SBP). The primary measurement of efficacy outcome was the rate and magnitude of reduction of serum creatinine Results: Eleven out of 18 dogs received diltiazem. The rate of reduction in creatinine in the diltiazem group was 1.76 times faster than the standard group (P=0.054). Recovery of renal function showed a trend towards significant association with treatment group (exact P=0.08, odds ratio=3.62). This effect may be clinically relevant. Diltiazem had no clinically relevant effect on SBP. Conclusions and clinical relevance: Renal recovery in dogs with acute renal failure secondary to leptospirosis is improved with the administration of diltiazem in addition to ‘standard’ therapy.     

Safety and efficacy of high‐dose fomepizole compared with ethanol as therapy for ethylene glycol intoxication in cats

Objective – To determine the safety and efficacy of high‐dose fomepizole compared with ethanol (EtOH) in cats with ethylene glycol (EG) toxicosis. Design – Prospective study. Setting – University veterinary research laboratory. Animals – Thirteen cats. Interventions – Two cats received injections of high‐dose fomepizole (Study 1). Three cats received lethal doses of EG and fomepizole treatment was initiated 1, 2, or 3 hours later (Study 2). Eight cats received a lethal dose of EG and were treated with fomepizole or EtOH (Study 3). Cats treated with fomepizole received 125 mg/kg IV initially, then 31.25 mg/kg at 12, 24, and 36 hours. Cats treated with EtOH received 5 mL of 20% EtOH/kg IV initially, then every 6 hours for 5 treatments, then every 8 hours for 4 treatments. Cats also received fluids and supportive therapy as needed. Measurements and Main Results – Clinical signs were monitored and serial blood analyses performed. Cats receiving fomepizole experienced mild sedation but no biochemical evidence of toxicity. Cats receiving fomepizole for EG intoxication survived if therapy was initiated within 3 hours of EG ingestion. One of the 6 developed acute renal failure (ARF) but survived. Only 1 of the 3 cats treated with EtOH 3 hours following EG ingestion survived; 2 developed ARF and were euthanized. Cats treated 4 hours following EG ingestion developed ARF, whether treated with EtOH or fomepizole. Conclusions – Fomepizole is safe when administered to cats in high doses, prevents EG‐induced fatal ARF when therapy is instituted within 3 hours of EG ingestion, and is more effective than treatment with EtOH.     

Intermittent peritoneal dialysis for the treatment of acute renal failure in two horses

Acute renal failure (ARF) in the horse is most commonly due to decreased renal perfusion or a nephrotoxic insult. Conventional therapy includes the administration of i.v. fluids, frusemide, mannitol and/or dopamine, as well as general supportive care. However, not all horses with ARF will respond to these treatments. In these cases, peritoneal dialysis is a viable therapeutic option. This case report describes 2 horses with ARF that was refractory to conventional therapy. Intermittent peritoneal dialysis was used effectively in both cases for treatment of the ARF. Dialysis was easy to perform and associated only with minor complications. To the authors' knowledge, this is the first report describing the successful use of intermittent peritoneal dialysis in the treatment of ARF in the horse.     

ARF基因干扰表达对不同发育阶段和贮藏条件马铃薯酶活性的影响

以前期研究获得的马铃薯栽培品种“甘农薯2号”ADP核糖基化因子(ARF)基因干扰表达转化植株为材料,用qRT-PCR法对转基因植株的ARF基因表达量进行了测定,结果表明,不同发育阶段转基因叶片中ARF基因的相对表达量先降低,生长后期略有增加,表明ARF基因干扰表达量随马铃薯生长发育发生改变。ARF基因干扰表达影响马铃薯叶片中酶活性,不同发育阶段转基因叶片与对照相比,多酚氧化酶(polyphenol oxidase, PPO)活性升高11.61%~27.84%,硝酸还原酶(nitrate reductase, NR)活性提高21.10%~41.32%,磷脂酶D(phospholipase D, PLD)活性降低2.88%~57.64%,蔗糖磷酸合成酶(sucrose phosphate synthase, SPS)活性提高29.00%~39.57%;不同温度(4℃和室温)贮藏的块茎中ARF基因的相对表达量变化趋势一致:均先降低,再升高,但前者较后者ARF基因相对表达量显著降低。室温较4℃贮藏的转基因块茎PPO活性升高30.44%~56.28%,NR活性提高17.41%~40.92%,PLD活性降低24.39%~85.11%,SPS活性提高30.89%~45.78%。室温较4℃贮藏的非转基因块茎PPO活性升高25.11%~70.66%,NR活性提高36.07%~89.62%,PLD活性降低11.35%~72.64%,SPS活性提高27.31%~61.33%。本研究通过探讨ARF基因干扰表达对马铃薯生理生化特性的影响,为进一步研究ARF基因在马铃薯生长发育调控中的作用提供一定的理论基础。     

Evaluation of the potential of animal streptococcal isolates belonging to serogroups C and G to elicit acute rheumatic fever

OBJECTIVE: To determine whether groups C and G streptococci (GCS-GGS) isolated from animals have rheumatogenic traits associated with human GCS-GGS isolates, particularly the potential of the bacteria to interact with human collagen type IV (collagen-IV), known to be targeted during acute rheumatic fever (ARF). SAMPLE POPULATION: 64 GCS and GGS bacterial strains isolated from infected animals. PROCEDURES: Bacteria were analyzed for their ability to bind and aggregate collagen-IV and for the presence of collagen binding factors, such as the hyaluronic acid capsule, cne gene, and emm gene. RESULTS: Collagen-IV binding ability was detected in 19% (n = 12) of the isolates studied. Of the collagen-IV binding strains, 5 expressed hyaluronic acid capsule. Furthermore, emm was detected in the genome of 1 isolate, whereas all remaining collagen-IV binding isolates possessed the cne gene. Of the collagen binding factors investigated, the hyaluronic capsule was the only factor for which collagen-IV interaction could be detected. Investigation of the potential of these strains to aggregate collagen-IV revealed that animal isolates had a nonaggregating phenotype. CONCLUSIONS AND CLINICAL RELEVANCE: Despite efficiently binding collagen-IV via hyaluronic acid, animal isolates lacked the ability to initiate aggregation of this protein. Because collagen-IV aggregation is associated with all collagen-IV-binding rheumatogenic strains, this suggested a lack of rheumatogenic potential among animal-derived GCS and GGS and, therefore, a low chance of acquiring ARF through animal contact.     

Association of racing performance with specific abnormal radiographic findings in Thoroughbred yearlings sold in Texas

The objective of this prospective study was to determine the association between presence of abnormal radiographic findings attributed to orthopedic disorders of development (ARF) with subsequent performance among yearlings in Texas. The study population was 348 yearlings offered for sale at the Texas Summer Yearling Sale during 2002 and 2003 for which presale radiographs of limbs were available for review. Radiographs of yearlings were reviewed and presence of ARF were recorded. Additionally, the following data were recorded for each horse: identifiers [name of dam, name of sire, hip number, and name (when available)], year of sale, state of birth, and sales price. Subsequent performance data were obtained for each horse at the conclusion of their 2^nd and 3^rd years of life. Results indicated that no ARF was significantly associated with performance outcomes. Lesions of the proximal dorsal aspect of the sagittal ridge of the 3^rd metacarpus/metatarsus resulted in significantly lower sales prices than either horses without this ARF or horses without any ARF. In conclusion, multiple radiographic abnormalities of Thoroughbred yearlings were not associated with reduced performance during the first 2 years of the racing careers of horses studied. Presence of some abnormalities, however, may be associated with reduced sales price.     

Decreases in podocin, CD2-associated protein (CD2AP) and tensin2 may be involved in albuminuria during septic acute renal failure

Podocytes have a peculiar structure constituting slit diaphragm (SD) and foot process (FP), and play essential roles in the glomerular filtration barrier. There is now ample evidence that SD- and FP-associated molecules, such as podocin and CD2-associated protein (CD2AP), are down-regulated during albuminuria of chronic kidney disease. However, it is still unclear whether these molecules are altered during acute renal failure (ARF) with albuminuria. Using lipopolysaccharide (LPS)-treated mice as a model of septic ARF, we provide evidence that the expression of SD- and FP-associated molecules becomes faint, along with albuminuria. In the LPS-treated mice, urinary albumin levels gradually increased, associated with the elevation of blood urea nitrogen levels, indicating the successful induction of albuminuria during septic ARF. In this pathological process, glomerular podocin expression became faint, especially at 36 hr post-LPS challenge (i.e., a peak of albuminuria). Likewise, LPS treatment led to a significant decrease in CD2AP, an anchorage between podocin and F-actin. With regard to this, tensin2 is a novel molecule that stabilizes F-actin extension. Interestingly, glomerular tensin2 expression levels were also decreased during the albuminuric phase, associated with losses of glomerular F-actin and synaptopodin under septic states. As a result, there were some lesions of podocytic FP effacement, as shown by electron microscopy. Based on these data, we emphasize the importance of concomitant decreases in podocin, CD2AP and tensin2 during septic ARF-associated proteinuria.     

Applications and Outcome of Hemodialysis in Cats: A Review of 29 Cases

Hemodialysis (HO) has been used in the management of renal failure in dogs, but its feasibility has not been reported for uremic cats. Therefore, we investigated the technical possibility, efficacy, and complications of intermittent HD in cats with severe uremia. A total of 160 HD treatments were performed on 29 cats with acute renal failure (ARF) (n = 15), chronic renal failure (CRF) (n = 6), or acute on CRF (n =8) between November 1993 and June 1996. Hemodialysis treatments were performed with transcutaneous dialysis catheters using a bicarbonate-based delivery system, sodium modeling, and volumetric-controlled ultrafiltration. Presenting serum chemistries (mean ± SD) for all cats were creatinine, 16.4 ± 7.5 mg/dL; blood urea nitrogen (BUN), 229 ± 87 mg/dL; phosphate, 15.4 ± 5.4 mg/dL; potassium, 6.0 ±1.6 mEq/L; and HCO^-₃, 16.0 ± 4.4 mEq/L. For intensive HD treatments, pre-HD versus post-HD creatinine changed from 10.3 ± 4.4 to 1.6 ± 0.9 mg/dL and BUN from 105 ± 33 to 8 ±10 mg/dL. One or more adverse events occurred during 111 (69%) treatments. Dialysis-related events included hypotension, dialysis dysequilibrium, clotting, and bleeding. Nine of 15 (60%) cats with ARF and 1 cat with CRF recovered sufficiently to survive without ongoing need for HD. For the remaining cats, the proximate causes of death were dialysis related in 9 cats, uremia related in 6 cats, and iatrogenic or unknown in 4 cats. Hemodialysis is technically feasible and effectively controls the biochemical disturbances of uremic cats. It is especially valuable for the management of severe ARF, permitting recovery in a large number of cats refractory to conventional therapy. Technical complications and chronic debility, however, may limit its usefulness for cats with advanced CRF.     

Strategies for management of acute renal failure.

Acute renal failure (ARF) is often defined as the sudden inability of the kidneys to regulate water and solute balance. ARF may be more broadly defined as rapid deterioration of renal function resulting in the accumulation of nitrogenous wastes such as urea and creatinine. Clinically, oliguria is defined as urine flow of less than 2 mL/kg/h and anuria has no measurable urine production. In animals, the most common cause of ARF is nephrotoxicity; ischemia ranks second, with interstitial and glomerular diseases following.     

Fluid therapy for acute and chronic renal failure

Animals with renal failure have a number of fairly predictable metabolic abnormalities. They are commonly presented to the veterinarian in a state of negative water balance, although prior fluid therapy in an oliguric patient may result in overhydration. Animals with oliguric ARF have sodium retention; those with polyuric ARF have increased urinary sodium loss. Chronic renal failure does not necessarily affect the ability of the renal tubule to conserve or excrete sodium, although the response to changes in sodium load is much slower than in the normal animal. Potassium retention occurs in oliguric ARF and potassium wasting in polyuric ARF; potassium balance is approximately normal in animals with CRF. Both ARF and CRF cause metabolic acidosis, although the acid-base status in a given animal will be affected by respiratory compensation, as well as other problems such as vomiting. Calcium levels are usually normal to slightly decreased in renal failure, whereas phosphorus levels are generally increased. The basic principles of fluid therapy should be used when constructing a plan for such therapy in an animal with renal failure. Intravenous administration of fluids is almost always necessary. The choice of the type of fluid, solutes, and electrolytes to be administered is based on the predicted abnormalities associated with renal failure as well as the laboratory abnormalities in the animal. Careful monitoring of the patient and periodic assessment of various laboratory parameters are necessary in order to make appropriate adjustments in fluid therapy.