Chronic kidney disease

Question 1

Kidney disease vs. renal failure

Answer 1

cat with polycystic kidney disease - diagnosed with an ultrasound scan at a few months of age but has normal blood test results

Question 2

Renal insufficiency vs. renal failure

Answer 2

a question of magnitude?

not recommended as the definition is variable

Question 3

Azotaemia vs. uraemia

Answer 3

Azotaemia - accumulation of non-protein nitrogenous waste products (urea, creatinine) in blood/serum/plasma
Uraemia - constellation of clinical signs that result

Question 4

chronic kidney disease (CKD) - clinical signs - Hx

Answer 4

2+ weeks duration
polyuria (PU)
polydipsia (PD)
anorexia, weight loss
vomiting
halitosis, ptyalism
constipation

Question 5

chronic kidney disease (CKD) - clinical signs - PE

Answer 5

abnormal kidneys
large bladder
dehydration, constipation
poor body condition
pale mucous membranes
end-stage uraemia
oral ulceration
altered mentation

Question 6

management of CKD

Answer 6

search for underlying cause
control factors important in disease progression
control factors that incr patient morbidity

Question 7

causes of CKD in cats - infectious

Answer 7

FIP

pyelonephritis

Question 8

Polycystic Kidney Disease

Answer 8

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

Question 9

causes of CKD in cats - metabolic

Answer 9

hypercalcaemic nephropathy

Question 10

causes of CKD in cats - neoplastic

Answer 10

lymphoma
primary renal tumour
metastatic

Question 11

causes of CKD in cats - congenital/familial

Answer 11

amyloidosis

polycystic kidney disease

Question 12

causes of CKD in cats - other

Answer 12

obstructive uropathy
glomerulonephritis
ARF
toxins

Question 13

causes of CKD in cats - unidentified

Answer 13

chronic tubulointerstitial nephritis

Question 14

obstructive uropathy

Answer 14

“little kidney, big kidney syndrome”
increasingly prevalent
the obstruction of the first kidney is often asymptomatic
clinical signs when second kidney obstructs

Question 15

Chronic Tubulointerstitial Nephritis - histological factors

Answer 15

multifocal fibrosis of variable severity
infiltration of lymphocytes & plasma cells
soft tissue mineralisation
tubular dilation and atrophy
infrequent glomerular lesions

Question 16

causes of CKD in dogs - infectious

Answer 16

pyelonephritis

leptospirosis

Question 17

causes of CKD in dogs - metabolic

Answer 17

hypercalcaemic nephropathy

Question 18

causes of CKD in dogs - neoplastic

Answer 18

primary renal tumour
lymphoma
metastatic

Question 19

causes of CKD in dogs - congenital/familial

Answer 19

many breed associated syndromes

amyloidosis

Question 20

causes of CKD in dogs - other

Answer 20

obstructive disease
glomerulonephritis
ARF
toxins

Question 21

causes of CKD in dogs - unidentified

Answer 21

tubulointerstitial nephritis

Question 22

Renal Secondary Hyperparathyroidism - treatment

Answer 22

target phosphorus

phosphate binders - Aluminium hydroxide, Lanthanum carbonate, Calcium carbonate/acetate/citrate, Ipakitin/Epakitin

Question 23

effects of ACE inhibitors

Answer 23

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

Question 24

Is Proteinuria of Prognostic Significance?

Answer 24

yes

associated with a worse prognosis

Question 25

Factors Contributing to Morbidity

Answer 25

UTIs
Anaemia
Dehydration
Hypokalaemia
Acidosis
Systemic hypertension
hypertension

Question 26

effect of UTIs on CKD

Answer 26

Pyelonephritis may cause initiation or progression of renal disease
more important in dogs
high osmolarity of cat urine make it resistant to infection

Question 27

treating hypokalemia

Answer 27

improves muscle strength

dietary supplements as potassium tablets unpalatable

Question 28

causes of anaemia in CKD

Answer 28

decr Erythropoietin
decr RBC life span
Uraemic inhibitors of erythropoiesis
External (GI) blood loss
Iron deficiency

Question 29

management of anaemia

Answer 29

recombinant human erythropoiein
for moderate/severe anaemia
has to be injected
give iron supplements simultaneously
antibodies can form againt treatment

Question 30

treating acidosis

Answer 30

acidosis is seen in severely azotaemia

can’t give bicarbonate except in intra-venous fluids