Chronic Kidney Disease

Question 1

what are the causes of chronic kidney disease?

Answer 1

infection
toxins
cardiovascular
hypertension
congenital
aging (not by itself)
other illness

Question 2

what should you look at when examining the BCS of a potential chronic kidney disease patient?

Answer 2

check for muscle wasting

Question 3

what are the biomarkers of kidney function?

Answer 3

USG
BUN, creatinine
GFR studies
SDMA

Question 4

what is SDMA?

Answer 4

symmetric dimethylarginine

Question 5

how is SDMA eliminated?

Answer 5

primarily by kidneys

Question 6

what does IRIS look at?

Answer 6

kidney function
proteinuria
blood pressure
phosphorous level

Question 7

what is remaining kidney function with IRIS stage I?

Answer 7

30%

Question 8

what is remaining kidney function with IRIS stage II?

Answer 8

20%

Question 9

what is remaining kidney function with IRIS stage III?

Answer 9

10%

Question 10

what are the plasma creatinines for felines and canines in IRIS stage III?

Answer 10

2.9-5.0 mg/dl

Question 11

at what IRIS stages is hyperphosphatemia probable?

Answer 11

stage III
stage IV

Question 12

a persistent increase in SDMA>_______ suggests reduced kidney function

Answer 12

14 mcg/dl

Question 13

what is temperature like with chronic kidney disease?

Answer 13

often low to low normal

Question 14

what can you see in the mouth of patients with chronic kidney disease?

Answer 14

dental calculus, gingivitis, periodontitis
oral ulceration, stomatitis, halitosis, uremic breath

Question 15

what minimum requirements should be on a geriatric screen?

Answer 15

hematocrit
total solids
urinalysis
creatinine
urea
SDMA?

Question 16

what may happen with creatinine in hyperthyroid cats?

Answer 16

may have low creatinine

Question 17

what is hypertension defined as?

Answer 17

blood pressure that causes harm

Question 18

what organs are most prone to damage from systemic hypertension?

Answer 18

heart
kidneys
brain
eyes

Question 19

what can be used for hypertension control?

Answer 19

ACE inhibitors
calcium channel blockers
angiotensin receptor blocker

Question 20

what dietary management should be employed with patients with chronic kidney disease?

Answer 20

protein restricted diet/kidney disease diet
maintain caloric intake
may require feeding tubes

Question 21

________________ restriction is more important than protein in diets

Answer 21

phosphorous

Question 22

how does kidney disease lead to reduced calcitriol (active vitamin D)?

Answer 22

reduced nephron mass leads to decreased production of calcitriol from vitamin D

Question 23

what is an early marker of phosphorous overload in cats with IRIS stage I or II?

Answer 23

fibroblast growth factor 23

Question 24

how can hyperphosphatemia be managed?

Answer 24

reduced protein diet
low phosphorous diet
phosphate binders
subtotal parathyroidectomy when medical management fails

Question 25

what are some phosphate binders?

Answer 25

aluminum hydroxide nutraceutical calcium salts sevelamer HCl lanthanum carbonate

Question 26

what is the mechanism of action of aluminum hydroxide?

Answer 26

forms insoluble aluminum phosphate reduces PO4 absorption

Question 27

what is the mechanism of action of calcium salts?

Answer 27

bind PO4 in alkaline pH of small intestine

Question 28

what is the mechanism of action of lanthanum carbonate?

Answer 28

noncalcium, nonaluminum PO4 binder rare earth element not absorbed well from GI

Question 29

how can you upregulate vitamin D3?

Answer 29

cholecalciferol calcitriol

Question 30

what does calcitriol do?

Answer 30

inhibits synthesis and secretion of PTH regulates calcium absorption from the gut and reabsorption from the kidney

Question 31

what level is total CO2/bicarbonate at for metabolic acidosis?

Answer 31

<18 mmol/L

Question 32

how can you manage hyperkalemia?

Answer 32

low potassium diet diuretics sodium polystyrene sulfonate calcium polystyrene sulfonate patiromer sodium zirconium cyclosilicate

Question 33

what can you use to treat anemia?

Answer 33

EPO agents erythropoieitin darbopoietin

Question 34

what leads to decreased production of erythropoietin in CKD?

Answer 34

decreased functional kidney: decreased oxygen consumption leads to increased oxygen availability which leads to decreased erythropoietin production

Question 35

what is essential in management of protein-losing nephropathies?

Answer 35

feeding protein restricted diet

Question 36

what are the co-morbidities with chronic kidney disease?

Answer 36

diabetes mellitus hyperadrenocorticism hypertension cardiovascular disease UTI/USMI canine cognitive dysfunction hyperthyroidism (cats)

Question 37

when does SDMA become elevated?

Answer 37

months to years before creatinine in CKD correlates strongly with GFR in cats

Question 38

what are the creatinine levels with IRIS stage I?

Answer 38

canine <1.4 mg/dl feline <1.6 mg/dl

Question 39

what are the creatinine levels with IRIS stage II?

Answer 39

canine 1.4-2.8 mg/dl feline 1.6-2.8 mg/dl

Question 40

when does hyperphosphatemia become possible in IRIS?

Answer 40

stage II

Question 41

what is the remaining kidney function in IRIS stage III?

Answer 41

10%

Question 42

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?

Answer 42

persistent increase in SDMA >14 microg/dl

Question 43

which cats may have low creatinine?

Answer 43

hyperthyroid cats

Question 44

which drugs are the most renoprotective for blood pressure control?

Answer 44

ACE inhibitors

Question 45

what does reduced calcitriol in kidney disease lead to?

Answer 45

parathyroid hyperplasia reduced calcium absorption in gut and from filtrate PTH elevation

Question 46

what can you use to upregulate vitamin D3?

Answer 46

cholecalciferol calcitriol

Question 47

what can you use to manage hyperkalemia?

Answer 47

low potassium diet diuretics sodium polystyrene sulfonate calcium polystyrene sulfonate patiromer sodium zirconium cyclosilicate