Chronic Kidney Disease

Question 1

Typically, in Chronic Kidney Disease, azotaemia is only recognised when?

Answer 1

When over 75% of nephrons have been lost

Question 2

What three things does the IRIS Staging Scheme base CKD staging on?

Answer 2

Plasma/ Serum Creatinine
Urine Protein Creatinine Ratio
Blood Pressure

Question 3

What are the three stages in the management of CKD?

Answer 3

Determine underlying cause
Control factors that are important in disease progression
Reduce patient morbidity

Question 4

Chronic Kidney Disease is 3 times ….

Answer 4

more common in cats than dogs

Question 5

Which breeds are predisposed to polycystic kidney disease in cats and what form of inheritance is it?

Answer 5

Persian
Autosomal dominant inheritance

Question 6

What is Obstructive Nephropathy?

Answer 6

Renal dysfunction resulting from urinary tract obstruction

Question 7

When would you expect to see clinical signs in cases of obstructive nephropathy?

Answer 7

obstruction of the first kidney is asymptomatic but clinical signs then present when the second kidney becomes obstructed

Question 8

What is the most common diagnosis in cats with Chronic Kidney Disease?

Answer 8

Tubulointerstitial Nephritis

Question 9

What are the three most common causes of Chronic Kidney Disease in the dog?

Answer 9

Tubulointerstitial Nephritis
Primary glomerular disease
Breed Related disease syndromes

Question 10

When would we be inclined to undertake diagnostic imaging in cases of Chronic Kidney Disease? (4)

Answer 10

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

Question 11

What’s the prognosis for cats with stage 2 disease?
What about dogs?

Answer 11

On average they will live for 2-3 years
In dogs- worse prognosis as progression is more rapid

Question 12

What are the three main mechanisms for progression of Chronic Kidney Disease?

Answer 12

Mineral Bone Disorder (aka secondary renal hyperparathyroidism)
Glomerular Hypertension
Proteinuria induced renal injury

Question 13

How does Mineral Bone Disorder effect the kidney?

Answer 13

Causes calcification in vascular and soft tissues including kidneys as minerals from the breakdown of bone deposit in the soft tissues

Question 14

How can we manage CKD- Mineral Bone Disorder?

Answer 14

Feeding a renal diet reduces the phosphate
Can also use phosphate binders is adjuvant to diet therapy

Question 15

What are the costs versus benefits to the use of Phosphate binders to manage MBD in CKD?

Answer 15

Cheap & effective (esp Aluminium Hydroxide)
May cause Hypercalcaemia & Constipation

Question 16

Why does Glomerular Hypertension develop in cases of CKD?

Answer 16

Occurs due to the hyperfiltration of nephrons in CKD and is further exacerbated by systemic hypertension (high BP)

Question 17

How can we reduce Glomerular Hypertension in CKD?

Answer 17

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

Question 18

What are the risks of using ACE inhibitors or Angiotensin receptor blocker to treat Hypertension in CKD?

Answer 18

Can cause Acute Kidney Injury in cases of severe azotaemia

Question 19

What are some factors of CKD that contribute to morbidity in animals?

Answer 19

UTI’s
Anaemia
Dehydration
Hypokalaemia
Acidosis
Systemic hypertension

Question 20

How does CKD cause Hypokalaemia and what does this result in?

Answer 20

Because CKD causes decreased appetite and increased urinary losses which causes Hypokalaemia and therefore muscle weakness

Question 21

A well hydrated cat with CKD started on IV fluids, will have …..

Consider Urine output, GFR and Creatinine?

Answer 21

Increased Urine output
But unchanged GFR and Creatinine

because kidney is still dysfunctional regardless

Question 22

What can we use as appetite stimulants in animals with CKD?

Answer 22

Maropitant- decreases vomiting but does not improve appetite
Mirtazapine- appetite stimulant and decreases vomiting

Question 23

When may Anaemia develop in cases of CKD?

Answer 23

Very late stages- stage 4

Question 24

How can we treat Anaemia in patients with CKD?

Answer 24

Injection of Recombinant Human Erythropoietin (only for those with symptoms)
Iron dextran IM injection