Chronic kidney disease

Question 1

What 2 clinical findings in CKD are strong risk factor for progression (negative prognostic indicators)?

Answer 1

Proteinuria

Systemic hypertension

Question 2

Name some clinical signs that may be seen with CKD

Answer 2

PUPD
Vomiting
Anorexia
Weight loss
Constipation
Poor coat
Neuro disease
Hypertension
Rubber jaw - osteodystrophy of mandible
Oedema/ascites - if protein losing

Question 3

How does chronic kidney disease affect: mucus membrane colour, temperature and breath?

Answer 3

Pale mucus membranes
Hypothermia
Uraemic breath, oral ulceration

Question 4

Chronic kidney disease can be congenital or acquired. Do cats and dogs get glomerular disease or idiopathic tubulointerstitial nephritis?

Answer 4

Cats - idiopathic tubulointerstitial nephritis

Dogs - glomerular disease

Question 5

What 3 parameters are measured for IRIS CKD staging?

Answer 5

Plasma creatinine concentration
Proteinuria
Blood pressure

Question 6

How does CKD affect potassium levels?

Answer 6

Causes normal or hypokalaemia

Hyperkalaemia = end stage CKD (or AKI)

Question 7

What type of anaemia is seen with CKD?

Answer 7

Normocytic, normochromic non-regenerative anaemia

Question 8

What USG is described as isosthenuria?

Answer 8

1.008-1.012

Question 9

What is the treatment for stage 1 CKD?

Answer 9

Nephrotoxic drugs - stop them
Hypertension control - telmisartan, amlodipine
Anti-platelet drugs - clopidogrel, aspirin
ACEi - benazepril
Dehydration correction

Question 10

What is the treatment for stage 2 CKD?

Answer 10

Same as for stage 1, plus:
Phosphate <1.5mmol/l - calcium binders (aluminium hydroxide, calcium acetate)
K - potassium supplementation
D - renal diet (high fat, high protein)

Question 11

What is the treatment for stage 3 CKD?

Answer 11

Same as stages 1 and 2, plus:
Fluids
Acidosis correction - sodium or potassium citrate
EPO replacement - darbepoietin, iron
GI symptom control - maropitant, metoclopramide, mirtazapine, carpromelin

Question 12

How do you treat Stage 4 CKD?

Answer 12

Same as stages 1, 2, 3 plus: 
Phosphate binders - <1.9mmol/l
Fluid therapy
Nutrition intensifying - O tube etc, high fat high protein diet
Euthanasia

Question 13

At what stage of CKD would you add in a renal diet?

Answer 13

Stage 2

Question 14

What do you want to have phosphate below with CKD? (different for different stages)

Answer 14

Stage 2 - <1.5mmol/l

Stage 4 - <1.9mmol/l

Question 15

At what stage of CKD do you treat nausea, vomiting, add in darbepoeitin and control metabolic acidosis?

Answer 15

Stage 3