Chronic kidney disease Flashcards

Question

When is an animal classified as stage 1 CKD?

Answer 1

For an animal to be classified in Stage I, some other abnormality must be detected to create the suspicion that a disease is present in kidney tissue

Answer 2

- Inadequate urinary concentrating ability in the absence of an identifiable extra-renal cause,, - Detection of renal proteinuria - Abnormal size or shape of the kidneys on palpation, confirmed by diagnostic imaging - Abnormal kidney biopsy findings - Increasing creatinine concentrations (even if they remaining within the laboratory reference range) on serial sampling

Answer 3

- Stop all potentially nephrotoxic drugs. - Identify and eliminate any on-going specific diseases if present - Often none can be identified - Measure blood pressure and UPCR.

Answer 4

- Control dehydration - Control hypertension (Goal is to reduce SBP to < 160 mmHg) - Reduce proteinuria

Answer 5

Feed a wet diet Supply drinking fountains/dripping taps Give cats a large bowl and fill it right up Can try chicken/fish flavoured water

Answer 6

ACEi Telmisartan = Angiotensin receptor blocker Amlodipine

Answer 7

If proteinuria >0.5, start ACE inhibitor (correct dehydration before using ACE inhibitor) and a renal diet - RAAS inhibition plus dietary protein reduction - Antiplatelet drugs (low-dose aspirin, or clopidogrel) - NO ACE INHIBITOR IN DEHYDRATED OR HYPOVALEMIC PATIENT

Answer 8

Same as Stage 1 plus the following: - Start a renal diet - Supplement potassium if needed - Control phosphate to <1.5 mmol/l (diet, +/- phosphate binders to effect)

Answer 9

- Protein restriction - Phosphate restriction - Ω-3 fatty acids - Fibre - ↓ sodium - Water soluble vitamins

Answer 10

Ameliorates clinical signs Reduced risk of uraemic crisis Reduces proteinuria Reduces PUPD Reduces acid load

Answer 11

- Dogs in stage III and IV CKD - Cats in stage II, III and IV CKD - Dogs in stage II CKD when phosphate >1.5 mmol/L - All dogs with proteinuric CKD - Reduces c/s and prolongs life!

Answer 12

Educate the owner Implement early Introduce slowly Don’t introduce them during times of stress Consider temperature, texture… Add flavour enhancers Try another brand

Answer 13

Reduce protein intake first (use a renal diet!) Add phosphate binder if diet alone isn’t enough

Answer 14

Supplement IVFT with KCl Oral supplements - Potassium gluconate - Potassium citrate

Answer 15

Any standard diet Not a renal diet – this is for long term use, don’t want to cause food aversion by feeding in the hospital

Answer 16

Same as stage 2 plus: - Control vomiting/nausea/poor appetite - Manage anaemia

Answer 17

- Antiemetics - Appetite stimulants (Mirtazapine, Capromorelin) - Reduce gastric acid secretion - Sucralfate - Consider a feeding tube

Answer 18

- Avoid excessive blood sampling - Minimise GI blood loss (omeprazole/H2 antagonists/sucralfate) - Treat iron deficiency (oral ferrous sulphate) - Transfusions - EPO replacement

Answer 19

Supplement iron if you give EPO Side effects of EPO treatment: seizures, hypertension, local reactions, antibodies

Answer 20

Same as stage 3 plus: - Control phosphate to <1.9 mmol/l (higher levels more tolerated than stage 3) - Intensify efforts to provide nutrition - More likely to require extra fluids (SC or via tube) - Consider euthanasia

Answer 21

1. Use a renal diet 2. Control phosphate 3. Control proteinuria 4. Control blood pressure

Answer 22

Unpredictable time course of the disease. Hard to give a Px- depends on rate of progression and animal’s ability to tolerate azotaemia. Diet seems to be most important Proteinuria = Risk factor for uraemia and death

Answer 23

Creatinine Phosphate Potassium

Answer 24

ACE inhibitors