Chronic Kidney Disease

Question 1

At what percentage of impaired renal function do you get a loss of concentrating ability?

Answer 1

60% nephron loss/decrease in GFR

Question 2

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

Answer 2

75% Nephron loss/decrease in GFR

Question 3

How define chronic kidney disease?

Answer 3

Any structural or functional abnormality in one or both kidneys that has been present for more than 3 months

Question 4

True or false: CKD is reversible?

Answer 4

False, it is irreversible

Question 5

What are some signs of CKD?

Answer 5

-Decreased BCS
-PU/PD
-Inappetant/hyporexia
-Pale MM
-Rubbery/soft jaw

Must be stable and with proper hydration to properly diagnose

Question 6

Lab values that support CKD diagnosis

Answer 6

Isosthenuria, azotemia, elevated SDMA, proteinuria, hypertension, and electrolyte abnormalities

Look at each value separately to make sure it isn’t due to something else

Question 7

What is SDMA?

Answer 7

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

Question 8

CKD categorized by stages

Answer 8

Stages are based on at least 2 values of serum CRE in a well-hydrated patient over 2 months

Question 9

Why is grey zone urine (1.013-1.029/1.034) a problem?

Answer 9

If they are azotemic and less than 1.035 its a problem, unless its something else

Question 10

What can cause a hyposthenuria? <1.008

Answer 10

Drinking too much
Non-renal azotemia

Question 11

Did you study the required CKD Staging chart?

Answer 11

Yes: Good for you
No: WTF

Question 12

CKD sub staging involves blood pressure and proteinuria monitoring. Why is this important?

Answer 12

You must control both blood pressure and proteinuria or the problem will be exacerbated.

Question 13

First steps to dealing with CKD

Answer 13

1. Treat any active kidney disease like pyelonephritis, urinary obstruction, dialysis, transplantation
2. Conservative medical management in the diet, prevent complications of kidney disease, and minimizing the loss of kidney function

SAVE THE NEPHRONS

Question 14

Treatment of CKD:
What is the benefit of a kidney diet?

Answer 14

1. Phosphorus and sodium restriction
2. Reduced protein
3. Buffering
4. Omega 3 fatty acids

Question 15

Treatment of CKD:
What is the benefit of anti-hypertensive therapy?

Answer 15

It helps reduce the target organ damage
-Kidneys
-Eyes
-Brain
-Heart

Question 16

Treatment of CKD:
What are some examples of anti-hypertensive therapy?

Answer 16

Amlodipine: Go to first unless they are proteinuric (then use an ace inhibitor first)

Semintra (telmisartan) is an Ang II antagonist to decrease BP

Question 17

Treatment of CKD:
What is the goal of anti-proteinuric therapies?

Answer 17

Reduce loss of albumin, anti-thrombin, reduces further damage to the glomerulus and tubules

Question 18

Treatment of CKD:
What are some anti-proteinuric therapies?

Answer 18

Ace inhibitors like benazepril or enalapril

Angiotensin II receptor antagonists like Telmisartan or Losartan to decrease blood pressure

Question 19

Treatment of CKD:
What is the deal with gastric protectants

Answer 19

Mat or may not help

They reduce hyperacidity and likely helps with nausea

Use omeprazole NOT famotidine

Question 20

Treatment of CKD:
Calcitriol therapy

Answer 20

Vit. D replacement that helps promote GI Ca absorption and decreases PTH production. Reduces risk of renal 2* hyperparathyroidism

Not routinely used

Question 21

Treatment of CKD:
Erythropoietin

Answer 21

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%)

Question 22

Treatment of CKD:
Phosphate binders

Answer 22

Decrease phosphorus to prevent secondary renal hyperparathyroidism

Question 23

Treatment of CKD:
Anti-oxidants

Answer 23

Omega 3 fatty acids

Question 24

Treatment of CKD:
Maintaining hydration

Answer 24

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

Question 25

Prognosis for CKD patients

Answer 25

Dogs IRIS stage 3-4 survive months to 1-2 years

Cats IRIS stage 3-4 survive 2+ years