Chronic Kidney Disease Flashcards
How many nephrons need to be lost before azotaemia occurs?
75%
What happens to the remaining nephrons when other nephrons die?
Hyperfiltrate - increase their GFR to preserve overall renal function
Is it possible to have chronic kidney disease without azotaemia?
Yes
IRIS stage 1 and some stage 2
What can IRIS staging be based on?
1 to 4
Createnine
UPC
blood pressure
How is blood pressure affected by CKD?
Hypertension
What is a basic management approach for CKD?
Determine underlying cause
Control factors important in disease progression
Reduce patient morbidity
What causes CKD in cats?
Lymphoma PKD FIP Amyloidosis Primary Glomerular disease Pyelonephritis Toxins Recovery from AKI Obstructive nephropathy Chronic tubulointerstitial nephritis
How can you diagnose polycystic kidney disease?
Breed predisposition - Persians
Kidneys palpably enlarged in azotaemic cat
Can be detected via US before Azotaemia occurs (usually middle age)
DNA test possible
What is obstructive nephropathy known as colloquially?
Big kidney little kidney syndrome
First Blocked kidney -> little
What tends to obstruct cats in obstructive nephropathy ?
When are clinical signs seen?
Calcium oxalate
When obstruction bilateral
What is tubulointerstitial nephritis in cats?
Histologically description
End stage appearance of CKD regardless of inciting cause
Nephrons have died and been replaced by fibrosis and inflammatory infiltrate is present
What are the key causes of chronic kidney disease in dogs?
Tubulointerstitial nephritis
Familial (breed related) disease syndromes
Primary glomerular disease
(Pyelonephritis, post AKI)
When would you perform diagnostic imaging on CKD patients?
Young animals Dogs - harder to palpate Asymmetric kidneys Large kidneys Severe proteinuria Uncertain chronicity
What are the putative mechanisms for progression of renal disease?
CKD - mineral bone disorder
Glomerular hypertension
Direct proteinuria induced renal injury
Other mechanisms - acidosis, hypokalaemia
How can we reduce MBD and increase survival time in CKD patients?
Dietary phosphate restriction
How can systemic hypertension affect urine parameters?
Glomerular capillary hypertension
PROTEINURIA
How can proteinuria be minimised in CKD patients?
Reduce glomerular pressure with ACE inhibitors or ARBs
When should ACE inhibitors be considered?
Proteinuric patients
Earlier in CKD
=Preserves nephrons long term but will be dangerous for advanced stage patients
What factors contribute to morbidity in CKD?
UTIs Anaemia Dehydration Hypokalaemia Acidosis Systemic hypertension
Which patients are more likely to be hypokalaemic?
What causes this?
What CS?
Cats
Decreased appetite, increased urinary losses, hyperaldosteronism esp if hypertensive.
Muscle weakness
