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RUSVM SAM II > Chronic Kidney Disease (Rolph) > Flashcards

Chronic Kidney Disease (Rolph) Flashcards

1
Q

What is chronic kidney disease and who does it affect?

A

Common cause of illness and mortality in feline patients

  • Approx. 10% of cats older than 10 years
  • 30% of cats older than 15 years
  • Less common in dogs but stil affects 0.5-1.5% of dogs
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2
Q

How is chronic kidney diseases diagnosed?

A

Based on anything that suggests kidney failure has been present for an extended time (typically more than 2 mos.)

  • History
  • Physical exam
  • Lab findings
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3
Q

What are the clinical signs of chronic kidney disease?

A
  • PU/PD (most common sign)
  • Anorexia
  • Hypersalivation (due to oral ulceration, tongue tip necrosis)
  • Constipation (2o to chronic dehydration, vomiting)
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4
Q

What might the vomiting or chronic dehydration cause other than constipation?

A
  • Uremic gastritis
  • Poor body condition
  • Poor hair coat
  • Small kidneys
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5
Q

What’s seen on clinical examination with chronic kidney disease?

A
  • Dehydrated
  • Poor body condition/underweight
  • Pale mucus membranes
  • Small kidneys
  • Hypertensive retinopathies
  • (Loose teeth, deformed maxilla/mandible/fractures)
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6
Q

What are the consequences of renal dysfunction?

A
  • Failure of excretion of nitrogenous wastes → uremia → ulceration (oral and Gi) and shortened RBC lifespan
  • Failure or urine concentration → PU/PD → predisposes to UTIs and volume depletion → constipation
  • Failure to syntheized calcitriol (VitD3) → renal 2o hyperparathyroidism → decreased bone density
  • Failure to synthesize erythropoeitin → anemia
  • Failure to catabolize peptide hormones (e.g. gastrin) → uremic gastritis
  • Activation of RAAS → systemic hypertension
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7
Q

What should be looked at on bloodwork assessing chronic kidney disease?

A
  • Urea
  • Creatinine
  • I-phosphate
  • Calcium
  • Potassium
  • Albumin
  • PTH
  • SDMA in early cases and possible if concerns reclassification
  • HCT
  • WBC
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8
Q

What’s assessed with urine analysis in chronic kidney disease?

A
  • Specific gravity
  • Dipstick
  • Sediment examination
  • Protein:creatinine ratio
  • Culture and sensitivity
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9
Q

What further diagnostics should be done with chronic kidney disease?

A
  • Blood pressure measurement
  • Retinal examination
  • Abdominal ultrasound
  • Blood gas (pH)
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10
Q

What’s the etiology of chronic kidney disease?

A

In most cases, cause of CKF not identified

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11
Q

What does histopathology demonstrate with chronic kidney disease?

A

Chronic interstitial nephritis

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12
Q

What is chronic interstitial nephritis and what’s it seen in?

A
  • Idiopathic intrinsic degenerative disease
  • Occurs mainly in older animals
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13
Q

What is chronic interstital nephritis thought to be the result of?

A
  • Previous toxic insults
  • Immune-mediated processes
  • Result of chronic inflammatory disease
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14
Q

What diseases can occur as a result of na identificable ause regarding chronic kidney disease?

A
  • Congenital deformities (i.e. renal dysplasia, PKD)
  • Infarctions
  • Infiltration w/ neoplastic cells (i.e. lymphoma)
  • Obstructive disease (‘Big kidney, little kidney’)
  • Infections (i.e. leptospirosis, pyelonephritis)
  • Secondary to hypercalcemia
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15
Q

What are the IRIS stages of chronic kidney disease and their respective blood creatinine levels for dogs and cats?

A
  • At risk
    • Dogs: < 125 µmol/L or < 1.4 mg/dl
    • Cats: < 140 µmol/L < 1.6 mg/dl
  • 1
    • Dogs: < 125 µmol/L or < 1.4 mg/dl
    • Cats: < 140 µmol/L or < 1.6 mg/dl
  • 2
    • Dogs: 125-180 µmol/L or 1.4-2.0 mg/dl
    • Cats: 140-250 µmol/L or 1.6-2.8 mg/dl
  • 3
    • Dogs: 181-440 µmol/L or 2.1-5.0 mg/dl
    • Cats: 251-440 µmol/L or 2.9-5.0 mg/dl
  • 4
    • Dogs: > 440 µmol/L or > 5.0 mg/dl
    • Cats: > 440 µmol/L or > 5.0 mg/dl
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16
Q

What’s important about the IRIS staging?

A

Gives more information on treatments and prognoses

17
Q

What are the caveats regarding IRIS staging?

A
  • Can’t stage/evaluate when dehydrated or sick
  • Stage when the animal/patient is stable
18
Q

What is the basis for an ‘at risk’ IRIS staging?

A
  • History suggests animal is at an increased risk of developing CKS in future due to multiple factors, i.e.:
    • Exposure to nephrotoxic drugs
    • Breed
    • High prevalence of infectious disease in the area
    • Old age
19
Q

What’s the basis for a ‘stage 1’ IRIS staging?

A
  • Nonazotemic
  • Some other renal abnormality present, i.e.
    • Inadequate urinary concentrating ability w/o identifiable renal cause
    • Abnormal renal palpation or renal imaging findings
    • Proteinuria of renal origin
    • Abnormal renal biopsy results
    • Increasing blood creatinine concentrations in samples collected serially
20
Q

What’s the basis for a ‘stage 2’ IRIS staging?

A
  • Mild renal azotemia
  • Clinical signs usually mild or absent
21
Q

With an IRIS ‘stage 2’ staging, what’s important about the mild renal azotemia present?

A

Lower end of range lies w/n reference ranges for many labs, but insensitivity of creatinine concentration as a screening test means that animals w/ creatinine values close to the upper referecne limit often have excretory failure

22
Q

What’s the basis for a ‘stage 3’ IRIS staging?

A
  • Moderate renal azotemia
  • Many extrarenal clinical signs may be present
23
Q

What’s the basis of a ‘stage 4’ IRIS staging?

A

Increasing risk of systemic clinical signs and uremic crises

24
Q

What is the role of angiotensin II in chronic renal disease?

A
25
Q

What are the pathological processes leading to proteinuria?

A
26
Q

How are dogs and cats classified in each of the IRIS stages?

A

According to urine protein concentration

27
Q

What are the subclassifications for proteinuria of renal origin and their UP/C values?

A
  • Non-proteinuric (dogs <0.2, cats: <0.2)
  • Borderline proteinuric (dogs: 0.2-0.5, cats: 0.2-0.4)
  • Proteinuric (dogs: > 0.5, cats: >0.4)
28
Q

What is the effect of proteinuria on survival?

A

Study w/ hypertensive cats

  • UP/C > 0.4 poorer prognosis vs. UP/C < 0.4
  • UP/C < 0.2 decreased mortality vs. UP/C > 0.2
29
Q

What’s important about the urine protein creatinine ratio being a prognostic indicator and how can it be treated?

A

UP/C, irrespective of if increased protein in urine because of hypertension or CKD, is a negative prognostic indicator

  • Can treat w/ drugs
30
Q

What effect does blood pressure have on the glomerulus?

A

If blood pressure increased, the glomerulus and kidney can be damaged and cause further problems

31
Q

What percent of cardiac output do the kidneys receive?

A

25%

32
Q

What’s the purpose of high, constant blood flow through the kidney?

A
  • Allows for excretion and homeostasis
  • High blood flow needed for metabolic requirements and to maintain GFR
33
Q

What’s the percentage of oxygen consumption by the kidneys?

A

8%

34
Q

What finding in regards to blood pressure is associated with CKD and which occurs first?

A

CKD associated w/ elevated BP (RAAS activation)

  • In many cases, unclear which occurs first
35
Q

What drugs can help with the damage inflicted on the kidneys by hypertension?

A
  • Have drugs that can inhibit RAAS
  • Decrease effects of hypertension on kidneys and decrease mechanism that damage kidneys
36
Q

What are the mechanisms of renal damage in hypertension?

A
  • Glomerular hypertension
    • Hyperfiltration
  • Glomerular barrier dysucntion
    • Proteinuria
  • Mesangial cell hyperplasia
  • Intrarenal inflammatory processes
  • Endothelial dysfunction
  • VSMC proliferation
37
Q
A

RUSVM SAM II (4 decks)

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