Approach to CKD Flashcards
Definition of Renal disease
Damage or functional impairment of kidneys
Varying severity
Definition of Renal insufficiency
Functional impairment not severe enough to cause azotaemia, but sufficient to cause loss of renal reserve
3 stages of cause of CKD
- Initiating factors
- Pathological changes
- Pathophysiological consequence
Pathological changes
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)
Pathophysiology of CKD
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
What are gastrointestinal consequence of CKD
Nausea / hyporexia
Vomiting / diarrhoea
Weight loss
Gastrointestinal bleeding
What are urinary consequence of CKD
Azotaemia / inadequately concentrated urine
PU / PD
Proteinuria (protein losses in urine)
Haematuria
What are metabolic consequence of CKD
Low potassium
Low, normal or high calcium
High phosphorous
Metabolic acidosis
What are cardiovascular consequence of CKD
Hypertension
Anaemia
What kind of anemia would you see in CKD
Non-regenerative, normocytic, normochromic anaemia
Effects of Hyperphosphataemia
Unlikely to directly cause clinical signs BUT…
Drives renal secondary hyperparathyroidism (↑PTH)
Leads to reduced survival
Summarise Renal secondary hyperparathyroidism
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
CKD can cause hypokalemia (T/F)
True!
Reduced intake
Reduced renal potassium reabsorption
Renal tubular acidosis
Clinical sign: Neuromuscular weakness
What kind of urine would you see with a patient with CKD
Isosthenuria/Protienuria
Patients with CKD are likely to have high blood pressure (T/F)
True!
How many stages are there in the IRIS classification for CKD
1-4
Description of each stage in the IRS classification for CKD
1: Non-Azotaemic
2: Mild azotaemia
3: Moderate Azotaemia
4: Severe Azotaemia
Hypertension- Treatment
- Cats: Amlopidine, Angiotensin receptor blocker-Semintra
- Dogs: ACE inhibitors-Benazepril
- Moderate salt restriction
- Monitor for hypotension
Managing proteinuria
Goal: UP:C <0.5 (dog) or 0.4 (cat) or at least a 50% improvement from baseline
Treating Hypokalaemia
Supplement intravenous therapy
Consider correcting metabolic acidosis
Renal diets are potassium supplemented
Oral potassium supplements
Why does CKD cause anemia
- Decreased production of erythropoietin by the kidneys, resulting in reduced stimulation of red blood cell production.
- Iron deficiency can occur as CKD disrupts iron metabolism
- The shortened lifespan of red blood cells and various metabolic and hormonal changes associated with CKD
Why does CKD cause Renal secondary hyperparathyroidism
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.
How many percent of nephron damage/loss to see azotaemia
3/4
Why does hypertension happen to CKD patients
Impaired excretion of sodium
Activation of RAAS
Prognosis changes as stage changes (T/F)
True!
