Chronic Kidney Disease Flashcards
At what percentage of impaired renal function do you get a loss of concentrating ability?
60% nephron loss/decrease in GFR
At what percentage of impaired renal function do you get an azotemia with Cre >1.4 in a dog and >1.7 in a cat
75% Nephron loss/decrease in GFR
How define chronic kidney disease?
Any structural or functional abnormality in one or both kidneys that has been present for more than 3 months
True or false: CKD is reversible?
False, it is irreversible
What are some signs of CKD?
-Decreased BCS
-PU/PD
-Inappetant/hyporexia
-Pale MM
-Rubbery/soft jaw
Must be stable and with proper hydration to properly diagnose
Lab values that support CKD diagnosis
Isosthenuria, azotemia, elevated SDMA, proteinuria, hypertension, and electrolyte abnormalities
Look at each value separately to make sure it isn’t due to something else
What is SDMA?
A serum test for symmetric dimethylarginine that is an early indicator of renal dysfunction. It can increase with 25-40% of nephron or GFR loss.
It can be affected by dehydration or anything that causes the GFR to go up
CKD categorized by stages
Stages are based on at least 2 values of serum CRE in a well-hydrated patient over 2 months
Why is grey zone urine (1.013-1.029/1.034) a problem?
If they are azotemic and less than 1.035 its a problem, unless its something else
What can cause a hyposthenuria? <1.008
Drinking too much
Non-renal azotemia
Did you study the required CKD Staging chart?
Yes: Good for you
No: WTF
CKD sub staging involves blood pressure and proteinuria monitoring. Why is this important?
You must control both blood pressure and proteinuria or the problem will be exacerbated.
First steps to dealing with CKD
- Treat any active kidney disease like pyelonephritis, urinary obstruction, dialysis, transplantation
- Conservative medical management in the diet, prevent complications of kidney disease, and minimizing the loss of kidney function
SAVE THE NEPHRONS
Treatment of CKD:
What is the benefit of a kidney diet?
- Phosphorus and sodium restriction
- Reduced protein
- Buffering
- Omega 3 fatty acids
Treatment of CKD:
What is the benefit of anti-hypertensive therapy?
It helps reduce the target organ damage
-Kidneys
-Eyes
-Brain
-Heart
Treatment of CKD:
What are some examples of anti-hypertensive therapy?
Amlodipine: Go to first unless they are proteinuric (then use an ace inhibitor first)
Semintra (telmisartan) is an Ang II antagonist to decrease BP
Treatment of CKD:
What is the goal of anti-proteinuric therapies?
Reduce loss of albumin, anti-thrombin, reduces further damage to the glomerulus and tubules
Treatment of CKD:
What are some anti-proteinuric therapies?
Ace inhibitors like benazepril or enalapril
Angiotensin II receptor antagonists like Telmisartan or Losartan to decrease blood pressure
Treatment of CKD:
What is the deal with gastric protectants
Mat or may not help
They reduce hyperacidity and likely helps with nausea
Use omeprazole NOT famotidine
Treatment of CKD:
Calcitriol therapy
Vit. D replacement that helps promote GI Ca absorption and decreases PTH production. Reduces risk of renal 2* hyperparathyroidism
Not routinely used
Treatment of CKD:
Erythropoietin
CKD leads to the kidneys decreased ability to secrete erythropoietin to make new RBCs from the bone marrow. Darbopoetin is the therapy. Can develop anti-bodies to it so only start when patients are clinical for anemia (<22-25%)
Treatment of CKD:
Phosphate binders
Decrease phosphorus to prevent secondary renal hyperparathyroidism
Treatment of CKD:
Anti-oxidants
Omega 3 fatty acids
Treatment of CKD:
Maintaining hydration
Encourage drinking
Canned diets
Use a feeding tube if needed
SQ fluids may not help since you are giving them more fluids to deal with
Prognosis for CKD patients
Dogs IRIS stage 3-4 survive months to 1-2 years
Cats IRIS stage 3-4 survive 2+ years
