Chronic Kidney Disease

Question 1

definition of chronic kidney disease

Answer 1

structural and/or functional abnormalities of one or both kidneys that have been present for 3 months or longer

Question 2

how do you confirm a diagnosis of CKD?

Answer 2

confirm chronicity (>3 mths) with hx, examination, lab abnormalities, or imaging

early CKD:
1. increasing creatinine or SDMA with no prerenal cause
2. increased SDMA >14ug/dl
3. abnormal kidney imaging
4. persistent renal proteinuria

advanced CKD:
1. increased creatinine and SDMA plus urine specific graavity <1.030 (K9) and < 1.035 (cats)

Question 3

how would you differentiate expected clinical signs between a patient with AKI v CKD

Answer 3

1. in cases of AKI the kidneys may be enlarged and painful on PE and urine output is variable. There may be crystals, cast,etc on urinalysis
2. in cases of CKD the kidneys are small/irregular on PE and the animal will have a decreased BCS with a dull hair coat and may be polyuric. CBC may show non-regenerative anemia and typically there is no active sediment on urinalysis. Rads may show diminished renal architecture

Question 4

IRIS stage 1

Answer 4

No azotemia
- normal creatinine = <1.4 (K9) and 1.6 (Fe)
- Less than 18 SDMA

Question 5

IRIS Stage 2

Answer 5

Mild azotemia
- normal to mildly elevated creatinine = 1.4-2.8 (K9) and 1.6-2.8 (Fe)
- SDMA is 18-35

Question 6

IRIS Stage 3

Answer 6

moderate azotemia
- creatine 2.9 -5.0
- SDMA 36 -54 (k9) and 26-38 (Fe)

Question 7

IRIS Stage 4

Answer 7

severe azotemia
- creatinine 5.0
- SDMA 54 (k9) and 38 (Fe)

Question 8

IRIS CKD Sub-staging

Answer 8

look at hypertension and proteinuria

Question 9

indications for renal biopsy of CKD

Answer 9

persistent and severe proteinuria

Question 10

treatments of CKD

Answer 10

1. diet therapy
2. hypertension (ACEi and amlodipine)
3. proteinuria (telmisartin + thrombophylaxis +/- ACEi)
4. Hyperphosphatemia (binders)
5. anemia (darbepoetin)
6. fluid therapy

Question 11

CKD diet therapy has the __ benefits. what do these diets include?

Answer 11

greatest!

low sodium, restricted protein and phosphorus, added B vitamins, Omega 3’s, antioxidants, neutral acid-base effects, increased and caloric density and potassium supplementation

Question 12

the goal of hypertension tx is to be below __ for animals with CKD and is treated with __ for dogs and __ for cats

Answer 12

160mmHg , ACEi’s, amlodipine

Question 13

the goal of treating proteinuria in cats with CKD is to __ UPC as much as possible without causing harm. This is treated with __ in dogs and cats +/- ACEi’s

Answer 13

reduce, telmisartan

Question 14

hyperphosphatemia binders should be given with __

Answer 14

food

Question 15

what is the main cause of anemia in p’s with CKD?

Answer 15

decreased EPO production
tx with erythrocyte-stimulating agents for p’s with stage III+

Question 16

in general, cats with CKD have a __ prognosis than dogs

Answer 16

better

Question 17

what factors predict a dogs prognosis with CKD?

Answer 17

IRIS stage, creatinine, hyperphosphatemia, UPC, hypoalbuminemia, hypertension, and poor BCS

Question 18

what factors predict a cats prognosis with CKD?

Answer 18

IRIS stage, creatinine, hyperphosphatemia, UPC, leukocytosis and weight loss