Chronic Kidney Disease Flashcards
what are the causes of chronic kidney disease?
infection
toxins
cardiovascular
hypertension
congenital
aging (not by itself)
other illness
what should you look at when examining the BCS of a potential chronic kidney disease patient?
check for muscle wasting
what are the biomarkers of kidney function?
USG
BUN, creatinine
GFR studies
SDMA
what is SDMA?
symmetric dimethylarginine
how is SDMA eliminated?
primarily by kidneys
what does IRIS look at?
kidney function
proteinuria
blood pressure
phosphorous level
what is remaining kidney function with IRIS stage I?
30%
what is remaining kidney function with IRIS stage II?
20%
what is remaining kidney function with IRIS stage III?
10%
what are the plasma creatinines for felines and canines in IRIS stage III?
2.9-5.0 mg/dl
at what IRIS stages is hyperphosphatemia probable?
stage III
stage IV
a persistent increase in SDMA>_______ suggests reduced kidney function
14 mcg/dl
what is temperature like with chronic kidney disease?
often low to low normal
what can you see in the mouth of patients with chronic kidney disease?
dental calculus, gingivitis, periodontitis
oral ulceration, stomatitis, halitosis, uremic breath
what minimum requirements should be on a geriatric screen?
hematocrit
total solids
urinalysis
creatinine
urea
SDMA?
what may happen with creatinine in hyperthyroid cats?
may have low creatinine
what is hypertension defined as?
blood pressure that causes harm
what organs are most prone to damage from systemic hypertension?
heart
kidneys
brain
eyes
what can be used for hypertension control?
ACE inhibitors
calcium channel blockers
angiotensin receptor blocker
what dietary management should be employed with patients with chronic kidney disease?
protein restricted diet/kidney disease diet
maintain caloric intake
may require feeding tubes
________________ restriction is more important than protein in diets
phosphorous
how does kidney disease lead to reduced calcitriol (active vitamin D)?
reduced nephron mass leads to decreased production of calcitriol from vitamin D
what is an early marker of phosphorous overload in cats with IRIS stage I or II?
fibroblast growth factor 23
how can hyperphosphatemia be managed?
reduced protein diet
low phosphorous diet
phosphate binders
subtotal parathyroidectomy when medical management fails
what are some phosphate binders?
aluminum hydroxide
nutraceutical
calcium salts
sevelamer HCl
lanthanum carbonate
what is the mechanism of action of aluminum hydroxide?
forms insoluble aluminum phosphate
reduces PO4 absorption
what is the mechanism of action of calcium salts?
bind PO4 in alkaline pH of small intestine
what is the mechanism of action of lanthanum carbonate?
noncalcium, nonaluminum PO4 binder
rare earth element not absorbed well from GI
how can you upregulate vitamin D3?
cholecalciferol
calcitriol
what does calcitriol do?
inhibits synthesis and secretion of PTH
regulates calcium absorption from the gut and reabsorption from the kidney
what level is total CO2/bicarbonate at for metabolic acidosis?
<18 mmol/L
how can you manage hyperkalemia?
low potassium diet
diuretics
sodium polystyrene sulfonate
calcium polystyrene sulfonate
patiromer
sodium zirconium cyclosilicate
what can you use to treat anemia?
EPO agents
erythropoieitin
darbopoietin
what leads to decreased production of erythropoietin in CKD?
decreased functional kidney: decreased oxygen consumption leads to increased oxygen availability which leads to decreased erythropoietin production
what is essential in management of protein-losing nephropathies?
feeding protein restricted diet
what are the co-morbidities with chronic kidney disease?
diabetes mellitus
hyperadrenocorticism
hypertension
cardiovascular disease
UTI/USMI
canine cognitive dysfunction
hyperthyroidism (cats)
when does SDMA become elevated?
months to years before creatinine in CKD
correlates strongly with GFR in cats
what are the creatinine levels with IRIS stage I?
canine <1.4 mg/dl
feline <1.6 mg/dl
what are the creatinine levels with IRIS stage II?
canine 1.4-2.8 mg/dl
feline 1.6-2.8 mg/dl
when does hyperphosphatemia become possible in IRIS?
stage II
what is the remaining kidney function in IRIS stage III?
10%
what would be a reason to consider a dog with creatine <1.4 mg/dl or a cat with <1.6 mg/dl to be CKD stage I?
persistent increase in SDMA >14 microg/dl
which cats may have low creatinine?
hyperthyroid cats
which drugs are the most renoprotective for blood pressure control?
ACE inhibitors
what does reduced calcitriol in kidney disease lead to?
parathyroid hyperplasia
reduced calcium absorption in gut and from filtrate
PTH elevation
what can you use to upregulate vitamin D3?
cholecalciferol
calcitriol
what can you use to manage hyperkalemia?
low potassium diet
diuretics
sodium polystyrene sulfonate
calcium polystyrene sulfonate
patiromer
sodium zirconium cyclosilicate
