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Small Animal Medicine > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What are the most common familial and congenital causes of CKD?

A
  • Fanconi’s
  • renal dysplasia
  • glomerulophropathies
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2
Q

What are the most common acquired causes of CKD?

A
  • chronic tubulointerstitial nephritis (cats)
  • glomerulonephritis (dogs)
  • tubular injury from renal glucosuria and Fanconi’s
  • AKI
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3
Q

What is the most common cause of CKD?

A

idiopathic

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4
Q

What are the 3 most common times CKD is found?

A
  1. routine wellness or anesthetic blood work
  2. patient presents with signs of illness
  3. patient had AKI or known nephrotoxicant
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5
Q

What 3 diagnostics are used to diagnose CKD?

A
  1. blood work - BUN, creatinine, SDMA
  2. UA - UGS, proteinuria
  3. UT imaging - strutural changes
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6
Q

What parts of the physical exam are used to diagnose CKD?

A
  • renal and bladder palpation
  • rectal exam: GI bleeding secondary to renal dz
  • hydration statys
  • BCS and MCS: muscle wasting can decrease creatinine
  • ocular or fundic exam
  • attitude and strength
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7
Q

What are the 3 essential diagnostics for CKD?

A
  1. CBC
  2. chemistry
  3. urinalysis
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8
Q

What are the 8 most common findings on CBC and chemistry in CKD?

A
  1. azotemia
  2. hyperphosphatemia
  3. hypokalemia, hyperkalemia in end stages
  4. metabolic acidosis
  5. hypercalcemia, hypocalcemia
  6. hypermagnesemia
  7. normocytic, normochromic, non-regenerative anemia
  8. hypoalbuminemia
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9
Q

What 4 additional diagnostics are recommended when diagnosing CKD?

A
  1. assess for proteinuria
  2. urine culture if poorly concentrated, bacteriuria, or pyuria
  3. blood pressure
  4. assess for complications, need for therapy, and stage of the disease
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10
Q

IRIS staging of CKD:

A
  • can be stage 1 without increased creatinine
  • can track progression and if therapy is helping
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11
Q

What UPC values are indicative of proteinuria in dogs and cats?

A
  • non-proteinuric = <0.2
  • borderline proteinuric = 0.2-0.5; 0.2-0.4
  • proteinuric = >0.5; >0.4
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12
Q

What are the 4 stages of blood pressure in CKD patients? What is the risk of future target organ damage?

A
  1. normotensive - <140 mmHg; minimal
  2. prehypertensive - 140-159 mmHg; low
  3. hypertensive - 160-179 mmHg; moderate
  4. severely hypertensive - >180 mmHg; high
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13
Q

What are 7 aspects of general management of CKD?

A
  1. look for underlying or correctable causes
  2. stop nephrotoxic drugs
  3. diet*
  4. hydration
  5. address complications
  6. treat symptomatically
  7. monitor every 3 months once stable to implement changes sooner rather than later
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14
Q

What are 5 complications associated with CKD?

A
  1. hypertension
  2. electrolytes - hypokalemia, hyperphosphatemia
  3. acid-base disturbance - acidosis
  4. anemia
  5. GI signs
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15
Q

What are the main 2 ways of treating hypertension in CKD patients?

A
  1. calcium channel blockers
  2. RAAS inhibitors - ACEi, ARBs
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16
Q

What calcium channel blocker is used to treat hypertension in CKD patients?

A

Amlodipine —> first-line therapy for cats, best use in patients with severe hypertension

17
Q

What 2 RAAS inhibitors are used to treat hypertension in CKD patients?

A
  1. ACEi - Benazepril, Analapril (dogs!)
  2. ARBs - Telmisartan
18
Q

How do Benazepril and Enalapril differ?

A

BENAZEPRIL = 50% excretion in kidneys, 50% i biliary system

ENALAPRIL = mostly renal excretion

19
Q

What target organs are affected by hypertension? How do these organs try to compensate?

A
  • eye
  • brain
  • kidney
  • heart

eye, brain, and kidneys use vascular autoregulation to change vascular resistance

20
Q

What are the 4 treatment goals in treating hypertension in CKD patients?

A
  1. aim at treating underlying disease = CKD, hyperthyroidism, Cushing’s
  2. antihypertensives - decrease CO, TPR
  3. avoidance of TOD
  4. close to 150 mmHg systolic
21
Q

How has diet been shown to benefit patients in CKD?

A

proven to help with IRIS stage 3+ and is commonly given at earlier stages to promote eating of diet

22
Q

What 4 aspects of a kidney diet aid with CKD? What does it not have an effect on? What is typically added to feline diets?

A
  1. restricted phosphorus
  2. restricted, but high quality protein (filtration damages kidneys)
  3. omega 3 PUFA
  4. antioxidants

acid/base

potassium

23
Q

What are the 3 most common effects on electrolytes in CKD?

A
  1. hypokalemia (cats) - due to inadequate intake, inappetence
  2. hyperphosphatemia - decreased renal excretion
  3. hypo/hypercalcemia - low vitamin D, increased excretion or maintenance of calcium, binding to phosphorus, PTH
24
Q

How are electrolyte differences treated in patients with CKD?

A
  • hypokalemia - renal diet, IV/SQ supplementation, oral K gluconate
  • hyperphosphatemia - renal diet, phosphate binders
  • hyper/hypocalcemia - renal diet, phosphorus control, calcitriol
25
Q

What is required for phosphate binders to work? When are they most commonly used?

A

patient needs to be eating (no inappetence!), since it binds phosphorus in the diet to avoid GIT absorption

if phosphorus is still high on a renal diet

26
Q

How does CKD affect acid-base balance? How is this treated?

A

metabolic acidosis - kidneys usually absorb bicarb and H+ in the proximal tubule, but H+ excretion is not performed in the distal tubule

  • diet and adequate hydration
  • rarely need to give an alkalinizing agent, like K citrate or sodium bicarb
27
Q

What are the 5 major drugs used to control GI signs associated with CKD? What do they do?

A
  1. PPI - gastritis, ulcers
  2. Sucralfate - ulcers
  3. Maropitant - nausea, vomiting, inappetence
  4. Ondansetron - nausea, vomiting
  5. Mirtazapine, Capromorelin - appetite stimulants
28
Q

What are the 2 major treatment options for CKD patients with anemia? How do they compare?

A
  1. human recombinant EPO - can create autoantibodies that destroy RBCs
  2. Darbepoetin - less likely to cause reactions
29
Q

What is the general principle of fluid therapy in patients with CKD? How is it addressed?

A

only to maintain hydration status

  • SQ fluids if patient is not drinking (can add KCl)
  • available water sources at all times
  • canned diets can add moisture (Purina Hydrocare)

Small Animal Medicine (52 decks)

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