Chronic Kidney Disease Flashcards
How does kidney disease differ from renal failure?
CKD can be diagnosed before patients become azotaemic
How is proteinuria confirmed according to the IRIS staging scheme?
<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
Outline the stages of CKD according to the IRIS scheme?
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
What are important causes of CKD in cats?
- Polycystic kidney disease
- Obstructive nephropathy
- Chronic tubulointersitial nephritis
What factors are considered in IRIS staging kidney disease?
Serum creatinine levels
Urine protein to creatinine ratio
Blood pressure
How is polycystic kidney disease diagnosed?
Enlarged kidneys with azotaemia
US from 8mos
DNA test
What causes polycystic kidney disease?
Inherited in Persians and related breeds.
What causes obstructive nephropathy? When do clinical signs occur?
Ca oxalate uroliths
Once both kidneys are obstructed.
How is obstructive nephropathy treated?
Ureteral bypass
What is tubulointerstitial nephritis?
Histological description of end stage appearance of CKD - common in cats
What are the most common causes of CKD in dogs?
Tubulointerstitial nephritis Breed-related syndromes 1' glomerular disease Pyelonephritis Post-acute renal failure
What is the prognosis of renal disease in dogs and cats?
Dogs: approx 1 year
Cats: 2-3 years
What mechanisms are involved in the progression of renal disease?
CKD-mineral bone disorder Glomerular hypertension Proteinuria --> renal injury Acidosis Hypokalaemia
What is CKD-Mineral bone disease?
Abnormalities of Ca, Ph, PTH or Vit D metabolism
Abnormailities in boen turner
Vascular or soft tissue calcification
What is the role of FGF-23 and how does it related to renal disease?
Increase Ph clearance
Plays a role in the development of CKD - mineral bone disorder: stims PTH production
What can prolong survival time in SA with CKD-mineral bone disorder?
Feeding a renal diet low in Ph
What is the target Ph level and how is it achieved in renal disease?
In lower half of the ref range
- Diet
- Phosphate blockers
Name 4 phosphate binders
Aluminum hydroxide
Ianthanum carbonate
Calcium carbonate
Chitosan
How is blood pressure related to proteinuria?
System hypertension and renal injury lead to glomerular capillary hypertension and thus proteinuria.
What classes of drugs can be used for dilation of the glomerular arterioles?
ACE-i/angiotensin receptor blockers
Calcium channel blockers
What is important when considering ACE-i for treatment of renal disease?
Only effective when used long term
Only necessary for patients with high UPC
Aim is to slow progession
What factors can increase morbidity in animals with CKD?
- UTIs
- Anaemia
- Dehydration
- Hypokalaemia
- Acidosis
- Systemic hypertension
Which stages of CKD in SA do UTIs most commonly occur?
Cats: 2-4
Dogs: All stages
Which species does hypokalaemia most commonly occur in? What are the causes?
Cats
- Decreased appetite
- Increased urinary losses
- Hyperaldosteronism
