Chronic kidney disease Flashcards
Kidney disease vs. renal failure
cat with polycystic kidney disease - diagnosed with an ultrasound scan at a few months of age but has normal blood test results
Renal insufficiency vs. renal failure
a question of magnitude?
not recommended as the definition is variable
Azotaemia vs. uraemia
Azotaemia - accumulation of non-protein nitrogenous waste products (urea, creatinine) in blood/serum/plasma
Uraemia - constellation of clinical signs that result
chronic kidney disease (CKD) - clinical signs - Hx
2+ weeks duration polyuria (PU) polydipsia (PD) anorexia, weight loss vomiting halitosis, ptyalism constipation
chronic kidney disease (CKD) - clinical signs - PE
abnormal kidneys large bladder dehydration, constipation poor body condition pale mucous membranes end-stage uraemia oral ulceration altered mentation
management of CKD
search for underlying cause
control factors important in disease progression
control factors that incr patient morbidity
causes of CKD in cats - infectious
FIP
pyelonephritis
Polycystic Kidney Disease
Kidneys are palpably enlarged in azotaemic cats
Azotaemia often doesn’t develop until middle-age
Can be detected ultrasonographically before azotaemia occurs (from 8m)
DNA test also available
causes of CKD in cats - metabolic
hypercalcaemic nephropathy
causes of CKD in cats - neoplastic
lymphoma
primary renal tumour
metastatic
causes of CKD in cats - congenital/familial
amyloidosis
polycystic kidney disease
causes of CKD in cats - other
obstructive uropathy
glomerulonephritis
ARF
toxins
causes of CKD in cats - unidentified
chronic tubulointerstitial nephritis
obstructive uropathy
“little kidney, big kidney syndrome”
increasingly prevalent
the obstruction of the first kidney is often asymptomatic
clinical signs when second kidney obstructs
Chronic Tubulointerstitial Nephritis - histological factors
multifocal fibrosis of variable severity infiltration of lymphocytes & plasma cells soft tissue mineralisation tubular dilation and atrophy infrequent glomerular lesions
causes of CKD in dogs - infectious
pyelonephritis
leptospirosis
causes of CKD in dogs - metabolic
hypercalcaemic nephropathy
causes of CKD in dogs - neoplastic
primary renal tumour
lymphoma
metastatic
causes of CKD in dogs - congenital/familial
many breed associated syndromes
amyloidosis
causes of CKD in dogs - other
obstructive disease
glomerulonephritis
ARF
toxins
causes of CKD in dogs - unidentified
tubulointerstitial nephritis
Renal Secondary Hyperparathyroidism - treatment
target phosphorus
phosphate binders - Aluminium hydroxide, Lanthanum carbonate, Calcium carbonate/acetate/citrate, Ipakitin/Epakitin
effects of ACE inhibitors
dilate efferent arterioles - decr glomerular capillary pressure - decr glomerular capillary permeability to protein - decr proteinuria
if severely azotaemic/pre-renal azotaemia may have -ve effect
no benefit to CKD established
Is Proteinuria of Prognostic Significance?
yes
associated with a worse prognosis
Factors Contributing to Morbidity
UTIs Anaemia Dehydration Hypokalaemia Acidosis Systemic hypertension hypertension
effect of UTIs on CKD
Pyelonephritis may cause initiation or progression of renal disease
more important in dogs
high osmolarity of cat urine make it resistant to infection
treating hypokalemia
improves muscle strength
dietary supplements as potassium tablets unpalatable
causes of anaemia in CKD
decr Erythropoietin decr RBC life span Uraemic inhibitors of erythropoiesis External (GI) blood loss Iron deficiency
management of anaemia
recombinant human erythropoiein for moderate/severe anaemia has to be injected give iron supplements simultaneously antibodies can form againt treatment
treating acidosis
acidosis is seen in severely azotaemia
can’t give bicarbonate except in intra-venous fluids
