Chronic Kidney Disease (CKD)

Question 1

define CKD

Answer 1

progressive declining renal failure

Question 2

Why is it difficult to identify the underlying cause?

Answer 2

initial renal insult is often long past by the time clinical signs develop and CKD can be diagnosed

Question 3

What microscopic changes occurs as a result of chronic inflammation?

Answer 3

• widespread interstitial fibrosis as result of irreversible damage to glomeruli and tubules
• nephrons can’t be replaced in a mature kidney, so the kidney repairs the lost tissue by developing fibrotic tissue
• kidney is smaller than normal
• capsule is pale
• fibrotic tissue retracts and causes pitting on the kidney’s surface

Question 4

List effects of progressive CKD

Answer 4

uremia
toxin retention
systemic hypertension
late in Dz –> dementia, weakness, stupor, seizures

Question 5

Def. uremia

Answer 5

a clinical state describing the effects of the retained toxins and other substances that the kidney is supposed to be eliminating from the body

Question 6

How does uremia present clinically?

Answer 6

as PU/PD

• impairment of renal tubule’s ability to concentrate urine leads to a loss of water into the urine because the tubules can’t reabsorb the water
• PD is compensatory

Question 7

Toxin retention:

• irritates ______________
• stimulates ______________

Answer 7

• irritation of mucosal lining of GI

- stimulation of chemoreceptor trigger zone of brain leading to nausea and V/D

Question 8

What happens when gastrin is retained? How does it manifest?

Answer 8

increases secretion of acid into stomach leading to irritation and gastric or duodenal ulcers; can also mainifest as stomatitis and oral ulceration

Question 9

Why is systemic hypertension caused?

Answer 9

• electrolyte imbalance
• sodium and water retention increases blood pressure (hypertension)
• hypertension contributes to progression of renal dysfunction, retinal hemorrhage and detachment, and neurologic signs

Question 10

CKD CBC alterations and pathophysiologic reason why you see this specific alteration

Answer 10

mild to moderate nonregenerative anima because kidneys aren’t able to produce erythropoietin which in turn means RBC production is decreased

Question 11

CKD Serum Chem alterations

Answer 11

• Azotemia w/ isosthenuria
• elevated urea and creatinine
• hyperphophatemia (phosphorus isn’t excreted properly)
• hypokalemia (loss of potassium)

Question 12

CKD UA alterations

Answer 12

• isosthenuria due to lac of concentrating ability of renal tubules
• proteinuria due to increased loss of protein in urine

Question 13

Goal of CKD nursing strategies

Hint: Not asking for Tx, but rather what the general goal of Tx is for these patients

Answer 13

• minimize uremia via dietary management and fluid support

- eliminate or minimize vomiting, anorexia, hypokalmeia, hyperphosphatemia, anemia, and hypertension

Question 14

List therapeutic CKD strategies

Hint: This is a list of Tx that can be used for CKD patients; 9 in total if you get them all right

Answer 14

• dietary management
• fluid therapy
• H2 blockers
• antiemetics
• oral potassium
• oral phosphate binding meds
• meds for hypertension
• blood transfusion
• human erythropoietin

Question 15

What dietary adjustments can be made for CKD?

Answer 15

• decrease phosphorus content –> decreases phosphorus retention
• decrease protein content –> urea is a metabolite of protein degradation, so you don’t want to make more of something the kidney’s can’t properly excrete; decreases azotemia as a result
• decrease sodium –> minimizes sodium retention and thus hypertension
• increase potassium –> to make up for potassium losses
• calorie dense so pet doesn’t have to eat as much

Question 16

Purpose of fluid therapy in CKD

Answer 16

maintain normal hydration in face of PU b/c pet usually doesn’t drink enough to compensate for losses

Question 17

Reason for using H2 blockers

Answer 17

decreases anorexia, vomiting, and nausea from excessive gastric acidity

Question 18

When is oral potassium used?

Answer 18

when dietary potassium isn’t enough to address hypokalemia on its own

Question 19

When are oral phosphate binders used?

Answer 19

helps decrease hyperphosphatemia if dietary restriction isn’t enough

Question 20

What drugs help with hypertension? What does decreasing hypertension do?

Answer 20

amlodipine (cat)
enalapril (dog)

slows down disease progression and enhances QoL

Question 21

Risks of using human erythropoietin in cat/dog patients

Answer 21

• body will eventually create antibodies that will destroy the administered erythropoietin, thus not letting it do its job
• antibodies can also end up destroying endogenous erythropoietin, too, creating a more significant anemia

Question 22

What do blood transfusions help with? How long do they last?

Answer 22

• to reverse weakness, tachypnea, and tachycardia caused by anemia due to decreased RBC count
• temporary relief

Question 23

Pros of renal transplant

Answer 23

• cats tolerate renal transplant without needing an exact tissue type match
• additional 1-2yrs of goo quality life for recipient cat

Question 24

Cons of renal transplant

Answer 24

• significant anesthetic and surgical risk to both donor and patient
• high cost of Sx and post-op meds/labs for the remainder of pet’s life