Approach to CKD

Question 1

Definition of Renal disease

Answer 1

Damage or functional impairment of kidneys
Varying severity

Question 2

Definition of Renal insufficiency

Answer 2

Functional impairment not severe enough to cause azotaemia, but sufficient to cause loss of renal reserve

Question 3

3 stages of cause of CKD

Answer 3

1. Initiating factors
2. Pathological changes
3. Pathophysiological consequence

Question 4

Pathological changes

Answer 4

Hypoxia and inflammation drive inflammatory changes
This results in structural changes to the nephron
Outcome is net nephron loss (glomeruli, tubules, interstitial tissue and/or vessels)

Question 5

Pathophysiology of CKD

Answer 5

As nephrons are lost, remaining nephrons must filter more blood >glomerular hypertension & hyperfiltration
Early: nephrons hypertrophy & single nephron GFR ↑ >compensation
Later: Compensation is overwhelmed > clinical kidney disease

Question 6

What are gastrointestinal consequence of CKD

Answer 6

Nausea / hyporexia
Vomiting / diarrhoea
Weight loss
Gastrointestinal bleeding

Question 7

What are urinary consequence of CKD

Answer 7

Azotaemia / inadequately concentrated urine
PU / PD
Proteinuria (protein losses in urine)
Haematuria

Question 8

What are metabolic consequence of CKD

Answer 8

Low potassium
Low, normal or high calcium
High phosphorous
Metabolic acidosis

Question 9

What are cardiovascular consequence of CKD

Answer 9

Hypertension
Anaemia

Question 10

What kind of anemia would you see in CKD

Answer 10

Non-regenerative, normocytic, normochromic anaemia

Question 11

Effects of Hyperphosphataemia

Answer 11

Unlikely to directly cause clinical signs BUT…
Drives renal secondary hyperparathyroidism (↑PTH)
Leads to reduced survival

Question 12

Summarise Renal secondary hyperparathyroidism

Answer 12

Renal secondary hyperparathyroidism occurs due to impaired kidney function, leading to disrupted calcium and phosphorus balance. Elevated parathyroid hormone levels result in bone and mineral disorders

Question 13

CKD can cause hypokalemia (T/F)

Answer 13

True!
Reduced intake
Reduced renal potassium reabsorption
Renal tubular acidosis
Clinical sign: Neuromuscular weakness

Question 14

What kind of urine would you see with a patient with CKD

Answer 14

Isosthenuria/Protienuria

Question 15

Patients with CKD are likely to have high blood pressure (T/F)

Answer 15

True!

Question 16

How many stages are there in the IRIS classification for CKD

Answer 16

1-4

Question 17

Description of each stage in the IRS classification for CKD

Answer 17

1: Non-Azotaemic
2: Mild azotaemia
3: Moderate Azotaemia
4: Severe Azotaemia

Question 18

Hypertension- Treatment

Answer 18

1. Cats: Amlopidine, Angiotensin receptor blocker-Semintra
2. Dogs: ACE inhibitors-Benazepril
3. Moderate salt restriction
4. Monitor for hypotension

Question 19

Managing proteinuria

Answer 19

Goal: UP:C <0.5 (dog) or 0.4 (cat) or at least a 50% improvement from baseline

Question 20

Treating Hypokalaemia

Answer 20

Supplement intravenous therapy
Consider correcting metabolic acidosis
Renal diets are potassium supplemented
Oral potassium supplements

Question 21

Why does CKD cause anemia

Answer 21

1. Decreased production of erythropoietin by the kidneys, resulting in reduced stimulation of red blood cell production.
2. Iron deficiency can occur as CKD disrupts iron metabolism
3. The shortened lifespan of red blood cells and various metabolic and hormonal changes associated with CKD

Question 22

Why does CKD cause Renal secondary hyperparathyroidism

Answer 22

In CKD, decreased kidney function leads to elevated blood phosphorus levels, causing a calcium-phosphorus imbalance. This imbalance triggers the release of parathyroid hormone (PTH), resulting in secondary hyperparathyroidism and potential complications such as bone resorption and deformities.

Question 23

How many percent of nephron damage/loss to see azotaemia

Answer 23

3/4

Question 24

Why does hypertension happen to CKD patients

Answer 24

Impaired excretion of sodium
Activation of RAAS

Question 25

Prognosis changes as stage changes (T/F)

Answer 25

True!