AZOTEMIA

Azotaemia (elevation in urea, creatinine or both due to decreased glomerular fi ltration rate, GFR)
may be described as pre-renal, renal or post-renal. It should be distinguished from uraemia, which
is a clinical syndrome of ill-health resulting from advanced kidney disease. Pre-renal azotaemia is
most commonly associated with decreased renal blood flow most commonly due to hypovolaemia
and the physical examination is key in determining this likelihood; in this case the patient is
normocardic and has no evidence of dehydration. Furthermore, pre-renal azotaemia is usually
characterised by a greater proportional increase in the magnitude of elevation of urea versus
creatinine, since the former is reabsorbed in the proximal tubule in states of diminished renal blood
flow. It would also be somewhat unusual for creatinine to be elevated to such a degree in such
circumstances. Post-renal azotaemia is usually caused by obstructive disease and the lack of clinical
signs of lower urinary tract disease (such as dysuria, pollakiuria) makes this less likely. An intrinsic
renal problem is therefore suspected. Contemporaneous assessment of urine specific gravity should,
wherever possible, accompany assessment of urea and creatinine in order to elucidate further. Specifi
c gravity varies considerably from hour-to-hour in the dog. It is a common cause of misapprehension
that there really is no such thing as a ‘normal’ urine specific gravity and that specifi c gravity merely
reflects renal tubular ability to respond to antidiuretic hormone. It is more pertinent to consider in the
context of whether it is appropriate for the patient’s physiological fluid-balance circumstances at the
time of assessment. In the dog, urine SG in the range
<1.008 indicates hyposthenuria, 1.008–1.012 represents isosthenuria, 1.013–1.029 represents the range of minimal
concentration and ≥1.030 represents adequate concentrating ability.