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
