Chronic Kidney Disease Flashcards
What is functional kidney disease?
A measurable reduction in renal function
What is structural kidney disease?
Renal disease which is identifiable via a scan
Can chronic kidney disease be reversed?
No - irreversible, progressive and irreparable
What are the aims of CKD management?
Protecting remaining nephrons
Managing clinical consequences/symptoms
What is chronic interstitial nephritis?
Swelling between kidney tubules - end stage of many pathological processes
What is glomerulonephropathy?
Disease of the glomerulus/glomerular function
What are the possible causes of CKD?
Chronic interstitial nephritis
Glomerulonephropathy
Undiagnosed/untreated infection
Chronic obstructive disease
Congenital (PKD, renal dysplasia)
Neoplasm
What are the signs/symptoms of CKD?
Polyuria/polydipsia
Weight loss, inappetence
Lethargy/weakness
Vomiting/diarrhoea/haematemesis/melaena
Signs associated with hypertension (blindness, neurological)
What can you expect to find upon clinical examination in a patient with CKD?
Reduced body condition
Dehydration
Weakness (/neck ventroflexion, hypokalaemic myopathy)
Uraemic ulcers/uraemic halitosis
Hypertensive retinopathy
Kidneys small and irregular on palpation
‘Rubber jaw’ in young animals
What are some of the consequences of systemic hypertension?
Damage to 'target organs' - Ocular (hypertensive retinopathy; retinal oedema and haemorrhages) Renal Cardiac Neurological
Epistaxis (nosebleeds)
What is a ‘normal’ systolic blood pressure?
120-140mmHg
10-20mmHg higher in sight/deerhounds
Why is the value for sight/deerhounds blood pressure higher?
In-hospital situational hypertension
How many blood pressure readings should be taken to achieve a reliable result?
5-7 consistent readings, repeat 2 hours after
Exclude first reading/any before plateau
What parameters are you looking for in blood and urine to diagnose CKD?
Inappropriately concentrated urine WITH azotemia (increased urea and creatinine)
Anaemia
Hyperphosphataemia
Hypokalaemia
Hypertension common
What should be involved in the initial management of CKD?
Discontinue any nephrotoxic drugs
Find and treat any underlying correctible cause
Correct and maintain fluid balance
What are the underlying correctible causes of kidney disease?
Hypertension
UTI, possibly causing pyelonephritis
Ureteroliths
What methods can be used for rehydrating CKD patients?
Encourage oral intake
Wet/slurry/soaked food
Subcut fluids
Oesophageal tube
Why shouldn’t you introduce a prescribed renal diet in practice?
Could create food aversions - always introduce at home
What is the formula for calculating RER?
30(BW in kg) + 70
What is the aim of a renal diet?
Minimise uraemic episodes
Minimise uraemic crises/mortality
Prolong survival
What component of diet are restricted in renal food?
Protein
Phosphorus
Sodium
How can we encourage eating in patients with CKD?
Don’t syringe feed!
Ensure hydrated and normokalaemic
Offer according to their environmental preferences
Antiemetics if nauseous Appetite stimulants (mirtazepine)
Tube feeding as last resort (naso-oesophageal)
What additional management may need to be taken with CKD?
Phosphate binders if hyperphosphataemic
Potassium supplements if hypokalaemic
Manage systemic hypertension with medication (amlodipine in cats, ACEi in dogs)
How often should a patient with CKD monitored in clinic?
Nurse clinics every 3 months
What should be checked in a monitoring appointment for CKD?
Appetite, demeanour Body weight Blood pressure Urinalysis PCV (haematology) Urea/creatinine/phosphorous/calcium/Na/K
What is nephrotic syndrome?
Condition where albumin crosses into bowman’s capsule (protein-losing nephropathy) and is excreted in urine
What is the consequence of nephrotic syndrome?
Hypoalbuminaemia results in lower oncotic pressure, leading to effusions and oedema
How is nephrotic syndrome managed?
As for CKD
ACEi to lower proteinuria
Omega-3 PUFAs are renoprotective
Clopidogrel/aspirin to protect against thromboembolic disease
