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Renal > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

How does kidney disease differ from renal failure?

A

CKD can be diagnosed before patients become azotaemic

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2
Q

How is proteinuria confirmed according to the IRIS staging scheme?

A

<0.2 dogs and cats - Non-proteinuric

0.2-0.4 (cats) and 0.2-0.5 (dogs) - Borderline

> 0.4 (cats) and >0.5 (dogs) - Proteinuric

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3
Q

Outline the stages of CKD according to the IRIS scheme?

A

Stage ONE
+ <125 creatinine dogs
+ <140 creatinine cats
NONE unless associated with specific underlying disease

Stage TWO
125-180 Dogs
140-250 Cats
Clinical signs other than PU/PD usually very mild

Stage THREE
181-440 Dogs
240-440 Cats
PU/PD usually noted. Extrarenal clinical signs (vomiting, dehydration, weight loss)

Stage FOUR
>440 in both
Extrarenal clinical signs are likely

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4
Q

What are important causes of CKD in cats?

A
  • Polycystic kidney disease
  • Obstructive nephropathy
  • Chronic tubulointersitial nephritis
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5
Q

What factors are considered in IRIS staging kidney disease?

A

Serum creatinine levels
Urine protein to creatinine ratio
Blood pressure

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6
Q

How is polycystic kidney disease diagnosed?

A

Enlarged kidneys with azotaemia
US from 8mos
DNA test

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7
Q

What causes polycystic kidney disease?

A

Inherited in Persians and related breeds.

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8
Q

What causes obstructive nephropathy? When do clinical signs occur?

A

Ca oxalate uroliths

Once both kidneys are obstructed.

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9
Q

How is obstructive nephropathy treated?

A

Ureteral bypass

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10
Q

What is tubulointerstitial nephritis?

A

Histological description of end stage appearance of CKD - common in cats

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11
Q

What are the most common causes of CKD in dogs?

A 
Tubulointerstitial nephritis
Breed-related syndromes
1' glomerular disease
Pyelonephritis
Post-acute renal failure
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12
Q

What is the prognosis of renal disease in dogs and cats?

A

Dogs: approx 1 year
Cats: 2-3 years

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13
Q

What mechanisms are involved in the progression of renal disease?

A 
CKD-mineral bone disorder
Glomerular hypertension
Proteinuria --> renal injury
Acidosis
Hypokalaemia
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14
Q

What is CKD-Mineral bone disease?

A

Abnormalities of Ca, Ph, PTH or Vit D metabolism
Abnormailities in boen turner
Vascular or soft tissue calcification

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15
Q

What is the role of FGF-23 and how does it related to renal disease?

A

Increase Ph clearance

Plays a role in the development of CKD - mineral bone disorder: stims PTH production

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16
Q

What can prolong survival time in SA with CKD-mineral bone disorder?

A

Feeding a renal diet low in Ph

17
Q

What is the target Ph level and how is it achieved in renal disease?

A

In lower half of the ref range

  • Diet
  • Phosphate blockers
18
Q

Name 4 phosphate binders

A

Aluminum hydroxide
Ianthanum carbonate
Calcium carbonate
Chitosan

19
Q

How is blood pressure related to proteinuria?

A

System hypertension and renal injury lead to glomerular capillary hypertension and thus proteinuria.

20
Q

What classes of drugs can be used for dilation of the glomerular arterioles?

A

ACE-i/angiotensin receptor blockers

Calcium channel blockers

21
Q

What is important when considering ACE-i for treatment of renal disease?

A

Only effective when used long term
Only necessary for patients with high UPC
Aim is to slow progession

22
Q

What factors can increase morbidity in animals with CKD?

A
  • UTIs
  • Anaemia
  • Dehydration
  • Hypokalaemia
  • Acidosis
  • Systemic hypertension
23
Q

Which stages of CKD in SA do UTIs most commonly occur?

A

Cats: 2-4
Dogs: All stages

24
Q

Which species does hypokalaemia most commonly occur in? What are the causes?

A

Cats

  • Decreased appetite
  • Increased urinary losses
  • Hyperaldosteronism
25
Q

What are the clinical signs of hypokalaemia?

A

Flattened stance due to muscle weakness

26
Q

What should fluids be used for?

A

Correct pre-renal azotaemia
Treat dehydration
Expand plasma vol.

27
Q

Which species does constipation occur in most commonly? How is it treated?

A

Cats

  • Hydration, mobility
  • Lactulose
  • Polytheylene glycol
28
Q

Which appetite stimulants can be used to reduced V+ in CKD?

A

Maropitant

Mirtazapine

29
Q

Which stage of CKD does anaemia also occur? How is it treated?

A

Stage 4

  • Human EPO
  • Iron supplement
30
Q

Which stage of CKD does acidosis occur in? How is it treated?

A

4 or dehydrated

IVFT

31
Q

What neurological signs can be caused by CKD?

A 
Depression
Seizures
Head tilt
Vestibular signs
Ataxia
Death
32
Q

What cardiac signs occur with CKD?

A

Exacerbation of preexisting conditions
Murmurs
LV hypertrophy

33
Q

How is hypertension treated in cats?

A

Calcium channel blockers - amlodipine

34
Q

How is hypertension treated in dogs?

A

ACE-i +/- amlodipine (calcium channel blocker)

Renal (12 decks)

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