Chronic Kidney Disease Flashcards
What are the most common familial and congenital causes of CKD?
- Fanconi’s
- renal dysplasia
- glomerulophropathies
What are the most common acquired causes of CKD?
- chronic tubulointerstitial nephritis (cats)
- glomerulonephritis (dogs)
- tubular injury from renal glucosuria and Fanconi’s
- AKI
What is the most common cause of CKD?
idiopathic
What are the 3 most common times CKD is found?
- routine wellness or anesthetic blood work
- patient presents with signs of illness
- patient had AKI or known nephrotoxicant
What 3 diagnostics are used to diagnose CKD?
- blood work - BUN, creatinine, SDMA
- UA - UGS, proteinuria
- UT imaging - strutural changes
What parts of the physical exam are used to diagnose CKD?
- 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
What are the 3 essential diagnostics for CKD?
- CBC
- chemistry
- urinalysis
What are the 8 most common findings on CBC and chemistry in CKD?
- azotemia
- hyperphosphatemia
- hypokalemia, hyperkalemia in end stages
- metabolic acidosis
- hypercalcemia, hypocalcemia
- hypermagnesemia
- normocytic, normochromic, non-regenerative anemia
- hypoalbuminemia
What 4 additional diagnostics are recommended when diagnosing CKD?
- assess for proteinuria
- urine culture if poorly concentrated, bacteriuria, or pyuria
- blood pressure
- assess for complications, need for therapy, and stage of the disease
IRIS staging of CKD:
- can be stage 1 without increased creatinine
- can track progression and if therapy is helping
What UPC values are indicative of proteinuria in dogs and cats?
- non-proteinuric = <0.2
- borderline proteinuric = 0.2-0.5; 0.2-0.4
- proteinuric = >0.5; >0.4
What are the 4 stages of blood pressure in CKD patients? What is the risk of future target organ damage?
- normotensive - <140 mmHg; minimal
- prehypertensive - 140-159 mmHg; low
- hypertensive - 160-179 mmHg; moderate
- severely hypertensive - >180 mmHg; high
What are 7 aspects of general management of CKD?
- look for underlying or correctable causes
- stop nephrotoxic drugs
- diet*
- hydration
- address complications
- treat symptomatically
- monitor every 3 months once stable to implement changes sooner rather than later
What are 5 complications associated with CKD?
- hypertension
- electrolytes - hypokalemia, hyperphosphatemia
- acid-base disturbance - acidosis
- anemia
- GI signs
What are the main 2 ways of treating hypertension in CKD patients?
- calcium channel blockers
- RAAS inhibitors - ACEi, ARBs
What calcium channel blocker is used to treat hypertension in CKD patients?
Amlodipine —> first-line therapy for cats, best use in patients with severe hypertension
What 2 RAAS inhibitors are used to treat hypertension in CKD patients?
- ACEi - Benazepril, Analapril (dogs!)
- ARBs - Telmisartan
How do Benazepril and Enalapril differ?
BENAZEPRIL = 50% excretion in kidneys, 50% i biliary system
ENALAPRIL = mostly renal excretion
What target organs are affected by hypertension? How do these organs try to compensate?
- eye
- brain
- kidney
- heart
eye, brain, and kidneys use vascular autoregulation to change vascular resistance
What are the 4 treatment goals in treating hypertension in CKD patients?
- aim at treating underlying disease = CKD, hyperthyroidism, Cushing’s
- antihypertensives - decrease CO, TPR
- avoidance of TOD
- close to 150 mmHg systolic
How has diet been shown to benefit patients in CKD?
proven to help with IRIS stage 3+ and is commonly given at earlier stages to promote eating of diet
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?
- restricted phosphorus
- restricted, but high quality protein (filtration damages kidneys)
- omega 3 PUFA
- antioxidants
acid/base
potassium
What are the 3 most common effects on electrolytes in CKD?
- hypokalemia (cats) - due to inadequate intake, inappetence
- hyperphosphatemia - decreased renal excretion
- hypo/hypercalcemia - low vitamin D, increased excretion or maintenance of calcium, binding to phosphorus, PTH
How are electrolyte differences treated in patients with CKD?
- hypokalemia - renal diet, IV/SQ supplementation, oral K gluconate
- hyperphosphatemia - renal diet, phosphate binders
- hyper/hypocalcemia - renal diet, phosphorus control, calcitriol
What is required for phosphate binders to work? When are they most commonly used?
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
How does CKD affect acid-base balance? How is this treated?
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
What are the 5 major drugs used to control GI signs associated with CKD? What do they do?
- PPI - gastritis, ulcers
- Sucralfate - ulcers
- Maropitant - nausea, vomiting, inappetence
- Ondansetron - nausea, vomiting
- Mirtazapine, Capromorelin - appetite stimulants
What are the 2 major treatment options for CKD patients with anemia? How do they compare?
- human recombinant EPO - can create autoantibodies that destroy RBCs
- Darbepoetin - less likely to cause reactions
What is the general principle of fluid therapy in patients with CKD? How is it addressed?
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)
