Chronic Kidney Failure Flashcards
What is Chronic Kidney Failure
Damage to the kidney occurring for months to years before clinical signs are seen
What do the kidneys do?
Kidney filter blood, regulate potassium and sodium, conserve water, manage blood pressure, make hormone erythropoietin to stimulate the bone marrow to make more red blood cells, and remove waste from the blood.
According to IRIS ( International Renal Interest Society) how many stages of CKF are there and what is it based on?
International Renal Interest Society (IRIS) outlines 4 stages of CKD depending on SDMA, Creat, UPC Ration and BP levels
What are the signs of CKF?
The most common changes seen are weight loss, poor hair quality, halitosis (bad breath), variable appetite which may be associated with mouth ulcers, lethargy, and depression. Less common signs include increased drinking or urinating, vomiting, diarrhea, and anemia.
What is the new test for early kidney failure?
SDMA
What is SDMA?
Symmetric dimethylarginine (SDMA) is a methylated arginine amino acid excreted by the kidneys
What are the causes of CRF?
- Congenital malformations of the kidneys - such as polycystic kidney disease in long haired cats
- Pyelonephritis - bacterial kidney infections
- Glomerulonephritis - inflammation and damage to the kidney’s filtration membrane
- Neoplasia - various tumors of the kidney, most commonly lymphosarcoma
- Amyloidosis - this is the build-up of an unusual protein in the kidney that prevents the kidney from functioning normally
- Viral infections such as feline leukemia virus (FeLV) or feline infectious peritonitis virus (FIP)
- Kidney stones or ureteral stones
How is CRF diagnosed?
CBC, Chem – increased BUN, Creat, SDMA is an new test that helps with early detection, urinalysis – proteinuria, USG – low (diluted urine), BP, UPC ratio - measures how much protein is being lost through the kidneys, urine culture – r/o UTI, x-rays, ultrasound
What are the treatments for CRF?
Renal diets (preferred can food) - less protein, sodium, and phosphorus, and increased omega-3 fatty acids, Supplements (Epakitin – lowers the amount of phosphorus absorbed through the gut wall, or azodyl – slows the buildup of uremic toxins preventing additional damage to the kidneys),
SQ Fluids,
Appt stimulants (mirtazapine, Entyce),
For hypertension – amlodipine,
Anti-emetics – cerenia, ondansetron, famotidine, omeprazole, Vit B supplements,
Treatment for anemia - erythropoietin-stimulating agents (ESAs) or blood transfusion.
What are the four goals for managing CRF?
Control the clinical signs associated with accumulating waste products in the blood
Minimize problems with fluid and mineral balance
Sustain adequate nutrition
Modify/slow the progression of CKD
Why is water so important to CRF patients?
Diseased kidneys are not as effective at excreting waste products from the body through the urine. One consequence of CKD is a decreased ability of the kidneys to concentrate the urine. In order to continue to rid the body of its toxins despite more dilute urine, the body compensates by stimulating greater thirst. This makes it critical for you to provide your cat with an unlimited supply of fresh water. Canned food can help increase your cat’s intake of moisture. To encourage more water intake, change your pet’s water several times a day, clean your pet’s water bowl daily, and consider the use of a running water fountain to increase water interest.
Why is decreased protein so important in the CRF diet?
Decreased dietary protein may slow the progression of CKD by decreasing the workload on the kidneys to excrete protein waste products. Less protein also means less need for the excretion of protein itself through the filtration mechanism of the kidney, which helps preserve kidney function. The recommended range of protein on a dry matter basis for cats with CKD is 28-35%. If protein intake is too low however, CKD will start to break down muscle mass.
Why is decreased phosphorus so important?
Limiting dietary phosphorus in cats with CKD appears to help delay the progression of CKD, although the precise mechanism is unknown.
Why is decreased sodium important?
Dietary sodium levels are mildly restricted to reduce the workload on the kidneys. This in turn helps to maintain reasonable blood pressure.
Why are omega 3 fatty acids important?
They reduce protein loss in the urine (proteinuria), reducing hypertension at the level of the kidney, and decreasing inflammatory changes within renal tissues
