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SMALL ANIMAL > 12.7.1: Chronic kidney disease > Flashcards

12.7.1: Chronic kidney disease Flashcards

1
Q

Fill in the blanks for CKD

A

K+ normal or decreased
USG <1.035 (inappropriately dilute)

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2
Q

Fill in the blanks for ARF

A

K+ elevated, there is metabolic acidosis
USG usually 1.008-1.015

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3
Q

What are some possible underlying causes for CKD?

A
  • Polycystic kidney disease
  • Pyelonephritis
  • Toxins
  • Glomerulonephritis
  • Neoplasia
  • Amyloidosis
  • FIP

Often no cause is identified - this is age-related degeneration.

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4
Q

Common presenting signs of CKD

A
  • PUPD
  • Anorexia
  • Weight loss
  • Dehydration
  • Pallor
  • Vomiting
  • Diarrhoea
  • Mucosal ulcers
  • Uraemic breath
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5
Q

Comorbidities that might provide renal insult, over time leading to CKD

A
  • Hyperthyroidism
  • Hypercalcaemia
  • Heart disease
  • Periodontal disease
  • Cystitis
  • Urolithiasis
  • Diabetes
  • Previous AKI
  • Nephrotoxic drugs
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6
Q

What are some nephrotoxic drugs?

A
  • NSAIDs
  • Aminoglycosides e.g. gentamicin
  • Sulphonamides
  • Polymixins
  • Chemotherapeutics
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7
Q

True/false: in Chronic Kidney Disease, nephron damage is progressive, but if caught early enough, may be reversible.

A

False
In Chronic Kidney Disease, nephron damage is progressive and irreversible.

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8
Q

Describe how renal hyperparathyroidism (osteodystrophy) could develop in CKD

A
  • Reduce metabolism and excretion of parathyroid hormone -> renal hyperparathyroidism (osteodystrophy)
  • This is uncommon but possible
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9
Q

Explain why you may see anaemia with CKD and which type of anaemia this will be

A
  • Reduced renal function -> reduced EPO production
  • Reduced EPO -> non-regenerative anaemia
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10
Q

Uraemic crisis

A

Build-up of urea and other toxins usually excreted in kidneys to intolerable levels. Due to:
* End-stage CKD
* AKI
* Acute on chronic AKI (e.g. ischaemic/toxic insult exacerbating existing CKD)

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11
Q

Clinical signs of uraemic crisis

A
  • Vomiting/nausea
  • Anorexia
  • Lethargy
  • Depression
  • Oral ulcers
  • Melena (GI ulcers)
  • Anaemia
  • Weakness
  • Hypothermia
  • Muscle tremors
  • Seizures
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12
Q

Renal insufficiency vs renal failure

A

Renal insufficiency: reduced functional ability of the kidneys but they are compensating (coping).
Renal failure: the animal is unable to compensate for its reduced renal function.
These definitions have largely been replaced by IRIS staging.

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13
Q

IRIS staging of CKD

A

Stage 1 - No azotaemia with normal creatinine
Stage 2 - Mild azotaemia with normal/elevated creatinine
Stage 3 - Moderate azotaemia
Stage 4 - Severe azotaemia

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14
Q

What do we use to quantify a patient’s CKD using IRIS staging? Explain both staging and substaging.

A
  • Stage 1-4 based on creatinine or SDMA -> looking for consistent elevation in the hydrated patient
  • Substage is based on proteinuria and systolic BP
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15
Q

What should you do before attempting to IRIS stage a patient?

A
  • Properly hydrate them first
  • Remember that abnormal on IRIS staging may fall within normal lab values so check for this
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16
Q

How could we diagnose early stage CKD?

A
  • Often we don’t pick CKD up this soon
  • Abnormal renal imaging/known insult
  • Persistent elevation/increased creatinine/SDMA
  • Persistent renal proteinuria
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17
Q

How could we diagnose late stage CKD?

A
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18
Q

Which of the following is a marker of GFR?
a) serum phosphate
b) total ionised calcium
c) serum creatinine
d) serum potassium

A

C) Serum creatinine

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19
Q

Describe why serum creatinine is a marker of GFR

A
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20
Q

Describe why SDMA is a marker of GFR

A
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21
Q

Breed predispositions to chronic kidney disease - dogs

A
  • Westies
  • Boxers
  • Shar Pei
  • Bull terriers
  • Cocker spaniels
  • CKCS
22
Q

Breed predispositions to chronic kidney disease - cats

A
  • Persian
  • Abyssinian
  • Siamese
  • Ragdoll
  • Burmese
  • Russian Blue
  • Maine Coon

Almost all purebreds have CKD at higher prevalence than DSHs for example.

23
Q

Broad treatment principles for CKD

A
  • Treat the underlying cause if possible/ known
  • Slow progression by managing risk factors
  • Focus on controlling proteinuria, hypertension, and hyperphophataemia as these are linked to worse prognosis
  • Diet is very important Stage 2 onwards
  • Later stages: treat secondary anaemia, acidosis, nausea; maintain hydration and adequate nutrition
  • See recommendations for each substage
24
Q

Treatment of a uraemic crisis

A
25
Q

Causes of CKD aside from ageing / fibrosis

A
26
Q

Primary causes of hypertension

A
  • Stress / environment
  • Idiopathic (prevalence >12% in healthy cats >10 y.o.)
27
Q

Secondary causes of hypertension

A
  • Iatrogenic (e.g. glucocorticoids)
  • Systemic disease including CRF, Cushing’s, hyperT4, hypoT4, DM, obesity, phaeochromocytoma, primary hyperaldosteronism
28
Q

Hypertension can result in end organ damage. Which organs are affected?

A
  • Eyes
  • Heart
  • Brain
  • Kidneys
29
Q

Describe how hypertension affects chronic renal failure

A
30
Q

Treatment of hypertension and CRF

A
31
Q

How quickly should we aim to reduce blood pressure if an animal is hypertensive?

A
  • Aim to reduce to <150 mmHg over a few weeks
  • Quicker (in hours) if there are severe ocular / CNS signs
32
Q

Which drugs would we start with when treating hypertension in the dog? How is this different in the cat?

A
33
Q

You started a hypertensive patient on treatment. When should you recheck and what will you look for? How will you continue to monitor them?

A
34
Q

Pyelonephritis

A

bacterial infection of the renal pelvis and parenchyma.

35
Q

Prevalence and diagnosis of pyelonephritis

A
36
Q

Which antibiotics would you use to treat UTIs / pyelonephritis? Which should you avoid in the patient with CKD?

A
37
Q

Clinical presentation and diagnosis of polycystic kidney disease (PKD)

A
38
Q

Characteristics of renal neoplasia and how this could lead to signs associated with CKD

A
39
Q

Causes, clinical signs and treatment of Fanconi syndrome

A
40
Q

Clinical signs and diagnosis of protein losing nephropathy

A
41
Q

Which species is primary glomerular disease more common in: dogs or cats? What are some possible causes of this in cats?

A

More common in dogs.
When seen in cats, often caused by:
* Neoplasia
* Systemic inflammatory disease
* Chronic FeLV
* FIV
* FIP

42
Q

Examples of primary glomerular disease seen in dogs

A
43
Q

Diagnosis of primary glomerular disease

A
44
Q

Pathogenesis and clinical presentation of nephrotic syndrome

A
45
Q

Treatment of nephrotic syndrome

A
46
Q

Treatment of glomerular disease

A
47
Q

Factors that inform prognosis of chronic renal failure

A
48
Q

Indications for renal biopsy

A

Only perform a renal biopsy if it will alter patient management (generally not CKD) - for example:
* Protein losing nephropathy (if unexpected / doesn’t respond to treatment)
* AKI - causes and prognosis
* Mass lesions

49
Q

Contraindications for renal biopsy

A
  • Late stage CKD
  • Severe anaemia / azotaemia
  • Uncontrolled hypertension / coagulopathy
  • Severe hydronephrosis / many large cysts
  • Pyelonephritis / perirenal abscess
  • NSAIDs in the last 5 days
50
Q

CKD is a very common condition especially in older cats. It can be the result of aging change or have an underlying cause (if the latter, treat this if possible). What does IRIS staging allow us to do?

A

IRIS staging allows us to:
Identify CKD and advise appropriate treatment focusing on:
* Appropriate nutrition and hydration
* Controlling hypertension
* Minimising proteinuria
* Controlling serum phosphate

It also allows us to offer information regarding prognosis.
Best results = close monitoring, patient compliance, owner commitment.

SMALL ANIMAL (90 decks)

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