Chronic Kidney Disease

Question 1

What is functional kidney disease?

Answer 1

A measurable reduction in renal function

Question 2

What is structural kidney disease?

Answer 2

Renal disease which is identifiable via a scan

Question 3

Can chronic kidney disease be reversed?

Answer 3

No - irreversible, progressive and irreparable

Question 4

What are the aims of CKD management?

Answer 4

Protecting remaining nephrons

Managing clinical consequences/symptoms

Question 5

What is chronic interstitial nephritis?

Answer 5

Swelling between kidney tubules - end stage of many pathological processes

Question 6

What is glomerulonephropathy?

Answer 6

Disease of the glomerulus/glomerular function

Question 7

What are the possible causes of CKD?

Answer 7

Chronic interstitial nephritis

Glomerulonephropathy

Undiagnosed/untreated infection

Chronic obstructive disease

Congenital (PKD, renal dysplasia)

Neoplasm

Question 8

What are the signs/symptoms of CKD?

Answer 8

Polyuria/polydipsia

Weight loss, inappetence

Lethargy/weakness

Vomiting/diarrhoea/haematemesis/melaena

Signs associated with hypertension (blindness, neurological)

Question 9

What can you expect to find upon clinical examination in a patient with CKD?

Answer 9

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

Question 10

What are some of the consequences of systemic hypertension?

Answer 10

Damage to 'target organs' - 
Ocular (hypertensive retinopathy; retinal oedema and haemorrhages) 
Renal 
Cardiac 
Neurological 

Epistaxis (nosebleeds)

Question 11

What is a ‘normal’ systolic blood pressure?

Answer 11

120-140mmHg

10-20mmHg higher in sight/deerhounds

Question 12

Why is the value for sight/deerhounds blood pressure higher?

Answer 12

In-hospital situational hypertension

Question 13

How many blood pressure readings should be taken to achieve a reliable result?

Answer 13

5-7 consistent readings, repeat 2 hours after

Exclude first reading/any before plateau

Question 14

What parameters are you looking for in blood and urine to diagnose CKD?

Answer 14

Inappropriately concentrated urine WITH azotemia (increased urea and creatinine)

Anaemia

Hyperphosphataemia

Hypokalaemia

Hypertension common

Question 15

What should be involved in the initial management of CKD?

Answer 15

Discontinue any nephrotoxic drugs

Find and treat any underlying correctible cause

Correct and maintain fluid balance

Question 16

What are the underlying correctible causes of kidney disease?

Answer 16

Hypertension

UTI, possibly causing pyelonephritis

Ureteroliths

Question 17

What methods can be used for rehydrating CKD patients?

Answer 17

Encourage oral intake

Wet/slurry/soaked food

Subcut fluids

Oesophageal tube

Question 18

Why shouldn’t you introduce a prescribed renal diet in practice?

Answer 18

Could create food aversions - always introduce at home

Question 19

What is the formula for calculating RER?

Answer 19

30(BW in kg) + 70

Question 20

What is the aim of a renal diet?

Answer 20

Minimise uraemic episodes

Minimise uraemic crises/mortality

Prolong survival

Question 21

What component of diet are restricted in renal food?

Answer 21

Protein
Phosphorus
Sodium

Question 22

How can we encourage eating in patients with CKD?

Answer 22

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)

Question 23

What additional management may need to be taken with CKD?

Answer 23

Phosphate binders if hyperphosphataemic

Potassium supplements if hypokalaemic

Manage systemic hypertension with medication (amlodipine in cats, ACEi in dogs)

Question 24

How often should a patient with CKD monitored in clinic?

Answer 24

Nurse clinics every 3 months

Question 25

What should be checked in a monitoring appointment for CKD?

Answer 25

Appetite, demeanour 
Body weight 
Blood pressure 
Urinalysis 
PCV (haematology) 
Urea/creatinine/phosphorous/calcium/Na/K

Question 26

What is nephrotic syndrome?

Answer 26

Condition where albumin crosses into bowman’s capsule (protein-losing nephropathy) and is excreted in urine

Question 27

What is the consequence of nephrotic syndrome?

Answer 27

Hypoalbuminaemia results in lower oncotic pressure, leading to effusions and oedema

Question 28

How is nephrotic syndrome managed?

Answer 28

As for CKD

ACEi to lower proteinuria

Omega-3 PUFAs are renoprotective

Clopidogrel/aspirin to protect against thromboembolic disease