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A. Small Animal Medicine and Surgery > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

what are the causes of chronic kidney disease?

A

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

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2
Q

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

A

check for muscle wasting

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3
Q

what are the biomarkers of kidney function?

A

USG
BUN, creatinine
GFR studies
SDMA

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4
Q

what is SDMA?

A

symmetric dimethylarginine

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5
Q

how is SDMA eliminated?

A

primarily by kidneys

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6
Q

what does IRIS look at?

A

kidney function
proteinuria
blood pressure
phosphorous level

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7
Q

what is remaining kidney function with IRIS stage I?

A

30%

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8
Q

what is remaining kidney function with IRIS stage II?

A

20%

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9
Q

what is remaining kidney function with IRIS stage III?

A

10%

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10
Q

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

A

2.9-5.0 mg/dl

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11
Q

at what IRIS stages is hyperphosphatemia probable?

A

stage III
stage IV

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12
Q

a persistent increase in SDMA>_______ suggests reduced kidney function

A

14 mcg/dl

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13
Q

what is temperature like with chronic kidney disease?

A

often low to low normal

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14
Q

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

A

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

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15
Q

what minimum requirements should be on a geriatric screen?

A

hematocrit
total solids
urinalysis
creatinine
urea
SDMA?

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16
Q

what may happen with creatinine in hyperthyroid cats?

A

may have low creatinine

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17
Q

what is hypertension defined as?

A

blood pressure that causes harm

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18
Q

what organs are most prone to damage from systemic hypertension?

A

heart
kidneys
brain
eyes

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19
Q

what can be used for hypertension control?

A

ACE inhibitors
calcium channel blockers
angiotensin receptor blocker

20
Q

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

A

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

21
Q

________________ restriction is more important than protein in diets

A

phosphorous

22
Q

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

A

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

23
Q

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

A

fibroblast growth factor 23

24
Q

how can hyperphosphatemia be managed?

A

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

25
Q

what are some phosphate binders?

A

aluminum hydroxide
nutraceutical
calcium salts
sevelamer HCl
lanthanum carbonate

26
Q

what is the mechanism of action of aluminum hydroxide?

A

forms insoluble aluminum phosphate
reduces PO4 absorption

27
Q

what is the mechanism of action of calcium salts?

A

bind PO4 in alkaline pH of small intestine

28
Q

what is the mechanism of action of lanthanum carbonate?

A

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

29
Q

how can you upregulate vitamin D3?

A

cholecalciferol
calcitriol

30
Q

what does calcitriol do?

A

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

31
Q

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

A

<18 mmol/L

32
Q

how can you manage hyperkalemia?

A

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

33
Q

what can you use to treat anemia?

A

EPO agents
erythropoieitin
darbopoietin

34
Q

what leads to decreased production of erythropoietin in CKD?

A

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

35
Q

what is essential in management of protein-losing nephropathies?

A

feeding protein restricted diet

36
Q

what are the co-morbidities with chronic kidney disease?

A

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

37
Q

when does SDMA become elevated?

A

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

38
Q

what are the creatinine levels with IRIS stage I?

A

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

39
Q

what are the creatinine levels with IRIS stage II?

A

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

40
Q

when does hyperphosphatemia become possible in IRIS?

A

stage II

41
Q

what is the remaining kidney function in IRIS stage III?

A

10%

42
Q

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?

A

persistent increase in SDMA >14 microg/dl

43
Q

which cats may have low creatinine?

A

hyperthyroid cats

44
Q

which drugs are the most renoprotective for blood pressure control?

A

ACE inhibitors

45
Q

what does reduced calcitriol in kidney disease lead to?

A

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

46
Q

what can you use to upregulate vitamin D3?

A

cholecalciferol
calcitriol

47
Q

what can you use to manage hyperkalemia?

A

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

A. Small Animal Medicine and Surgery (71 decks)

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