Chronic Kidney Disease Flashcards
Typically, in Chronic Kidney Disease, azotaemia is only recognised when?
When over 75% of nephrons have been lost
What three things does the IRIS Staging Scheme base CKD staging on?
Plasma/ Serum Creatinine
Urine Protein Creatinine Ratio
Blood Pressure
What are the three stages in the management of CKD?
Determine underlying cause
Control factors that are important in disease progression
Reduce patient morbidity
Chronic Kidney Disease is 3 times ….
more common in cats than dogs
Which breeds are predisposed to polycystic kidney disease in cats and what form of inheritance is it?
Persian
Autosomal dominant inheritance
What is Obstructive Nephropathy?
Renal dysfunction resulting from urinary tract obstruction
When would you expect to see clinical signs in cases of obstructive nephropathy?
obstruction of the first kidney is asymptomatic but clinical signs then present when the second kidney becomes obstructed
What is the most common diagnosis in cats with Chronic Kidney Disease?
Tubulointerstitial Nephritis
What are the three most common causes of Chronic Kidney Disease in the dog?
Tubulointerstitial Nephritis
Primary glomerular disease
Breed Related disease syndromes
When would we be inclined to undertake diagnostic imaging in cases of Chronic Kidney Disease? (4)
Dogs- because you can’t palpate the kidneys as well as you can in cats
When kidneys feel large- imaging will help differentiate between true hypertrophy or fluid filled
In young animals
In cases with severe proteinuria
What’s the prognosis for cats with stage 2 disease?
What about dogs?
On average they will live for 2-3 years
In dogs- worse prognosis as progression is more rapid
What are the three main mechanisms for progression of Chronic Kidney Disease?
Mineral Bone Disorder (aka secondary renal hyperparathyroidism)
Glomerular Hypertension
Proteinuria induced renal injury
How does Mineral Bone Disorder effect the kidney?
Causes calcification in vascular and soft tissues including kidneys as minerals from the breakdown of bone deposit in the soft tissues
How can we manage CKD- Mineral Bone Disorder?
Feeding a renal diet reduces the phosphate
Can also use phosphate binders is adjuvant to diet therapy
What are the costs versus benefits to the use of Phosphate binders to manage MBD in CKD?
Cheap & effective (esp Aluminium Hydroxide)
May cause Hypercalcaemia & Constipation
Why does Glomerular Hypertension develop in cases of CKD?
Occurs due to the hyperfiltration of nephrons in CKD and is further exacerbated by systemic hypertension (high BP)
How can we reduce Glomerular Hypertension in CKD?
Treat with ACE inhibitors or Angiotensin receptor blocker- inhibit the renin‐angiotensin system which in tern decreases sodium (salt) reabsorption, water reabsorption and vascular tone
What are the risks of using ACE inhibitors or Angiotensin receptor blocker to treat Hypertension in CKD?
Can cause Acute Kidney Injury in cases of severe azotaemia
What are some factors of CKD that contribute to morbidity in animals?
UTI’s
Anaemia
Dehydration
Hypokalaemia
Acidosis
Systemic hypertension
How does CKD cause Hypokalaemia and what does this result in?
Because CKD causes decreased appetite and increased urinary losses which causes Hypokalaemia and therefore muscle weakness
A well hydrated cat with CKD started on IV fluids, will have …..
Consider Urine output, GFR and Creatinine?
Increased Urine output
But unchanged GFR and Creatinine
because kidney is still dysfunctional regardless
What can we use as appetite stimulants in animals with CKD?
Maropitant- decreases vomiting but does not improve appetite
Mirtazapine- appetite stimulant and decreases vomiting
When may Anaemia develop in cases of CKD?
Very late stages- stage 4
How can we treat Anaemia in patients with CKD?
Injection of Recombinant Human Erythropoietin (only for those with symptoms)
Iron dextran IM injection
