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The concept of acute renal failure (ARF) has undergone significant re-examination in recent years. Practitioners traditionally used the term to refer to patients presenting with clinical manifestations of uremic syndrome and severe acute azotaemia, and it was often considered to be synonymous with acute kidney disease (AKD). However, it is now accepted that AKD is more than just ARF.
AKD represents a spectrum of diseases associated with a sudden onset of renal parenchymal injury, which are clinically imperceptible at the earliest stages and often end in severe ARF requiring renal replacement therapy. As such, animals diagnosed with ARF represent only the subset of AKD patients with the highest morbidity and mortality.1, 2
In an attempt to better reflect the broad spectrum of AKD, the term ‘acute kidney injury’ (AKI) was coined, first in human medicine and then in veterinary medicine. In order to define and stratify the severity of AKI, several grading schemes have been proposed in human nephrology,3 and these have subsequently been adapted for veterinary patients (Table 1).1, 4 These grading systems also include prerenal and postrenal conditions that may be independent of, or coexistent with, intrinsic kidney disease.
In contrast to the ‘stability’ of chronic kidney disease (CKD) stages, AKI grades represent a moment in the course of the disease, and the grading will change as the condition worsens, improves or transitions to CKD.2 Therefore, serial assessment and sequential grading are needed to monitor the course of the disease and to update therapeutic decisions and outcomes.2
Although AKI in companion animals typically develops outside of the hospital setting, there …
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