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SAM 2 > Chronic Renal Disease > Flashcards

Chronic Renal Disease Flashcards

1
Q

What is chronic kidney disease?

A

Loss of functional renal tissue due to a prolonged process (>2mo) that includes all stages of disease that is usually progressive and irreversible

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2
Q

At what stage does chronic kidney disease typically become clinically apparent?

A

Stage 2 or greater

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3
Q

What is the prevalence rate of CKD in cats and dogs?

A

1-3% of cats

0.5-1.5% of dogs

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4
Q

Can all ages of animals be affected by CKD?

A

Yes, although typically an older animal disease

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5
Q

What is the prognosis of CKD?

A

Prolonged survival is common and treatment can modify progression but will not cure

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6
Q

What are degenerative causes of CKD?

A

Chronic interstitial nephritis and renal infarcts

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7
Q

What are developmental causes of CKD?

A

Familial renal dysplasia and PKD

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8
Q

Will auto-immune disorders cause CKD?

A

Yes

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9
Q

What is a metabolic cause of CKD?

A

Hypercalcemia

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10
Q

What are neoplastic causes of CKD?

A

Renal carcinoma or lymphoma

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11
Q

What are some infectious causes of CKD?

A

Pyelonephritis, Lyme disease, leptospriosis (typically acute)

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12
Q

What are some iatrogenic causes of CKD?

A

Vit D over supplementation or nephrotoxic drugs

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13
Q

Can CKD be immune mediated?

A

Yes- amyloidosis

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14
Q

What percentage of nephron loss will impair concentrating ability?

A

> /= 66%

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15
Q

What percentage of nephron loss will result in azotemia?

A

> /= 75%

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16
Q

What will further progression of damage and azotemia lead to?

A

Clinical signs or uremia

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17
Q

What are clinical manifestations of CKD?

A

Uremia, PU/PD, hypocalcemia and seconday hyperPTHism, anemia, uremic gastitis, hypertension and blindness, defective hemostasis

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18
Q

Why may pathological fractures occur in CKD occur?

A

Hypocalcemia and secondary hyperPTHism

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19
Q

Why does hypertension occur?

A

Activation of the RAAS system

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20
Q

What are clinical signs of CKD?

A

Dehydration, poor bodyweight/condition, pale MM, small irregular kidneys, hypertensive retinopathies

Loose teeth, deformed facial bones, pathologic fractures

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21
Q

What are some diagnostic findings in CKD?

A

Inadequately concentrated urine, azotemia

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22
Q

What are the SG for inadequately concentrated urine in dogs and cats?

A
  1. 008-1.030 in cats

1. 008-1.022 in dogs

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23
Q

What may result in azotemia?

A

Reduced GFR, increased catabolism, GI hemorrhage

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24
Q

What changes will CKD patients have on biochem panels?

A
  • Hyperphosphatemia
  • Hypo/hyperkalemia
  • Hyper/hypocalcemia
  • Metabolic acidosis
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25
Q

Why do CKD patients develop hyperphosphatemia?

A

Impaired ability to excrete phosphate due to reduced renal function

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26
Q

In which stages can the body compensate by increasing phosphate excretion from remaining nephrons?

A

Stage I and II CKD

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27
Q

In which stages can the kidney no longer compensate for decreased phosphate excretion?

A

Stages III and IV CKD

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28
Q

T/F: There are lots of clinical signs directly associated with hyperphosphatemia.

A

False, clinical signs usually due to indirect effects

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29
Q

What is an important condition that is contributed to by hyperphosphatemia?

A

Secondary hyperPTHism

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30
Q

What are some ddx’s for CKD?

A
  • Reduced GFR
  • Ruptured bladder
  • Tumor lysis syndrome
  • Young age
  • Hypoparathyroidism
  • Vit. D toxicity
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31
Q

Why do CKD patients develop hypokalemia?

A

Reduced intake and increased potassium loss

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32
Q

What will result from hypokalemia?

A
  • Neuromuscular weakness
  • Anorexia
  • Impaired protein synthesis
  • Decreased renal function
  • PU/PD
  • Lymphoplasmacytic interstitial lesions
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33
Q

What calcium abnormalities can occur with CKD?

A

Total calcium is usually normal while iCa is usually low

Primary hypercalcemia can lead to secondary or primary renal failure

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34
Q

Why do animals with CKD develop metabolic acidosis?

A

Inability to excrete hydrogen ions

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35
Q

Is the metabolic acidosis associated with CKD generally mild or severe?

A

Typically mild, can get worse depending on how severe the disease is

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36
Q

Is the anemia associated with CKD regenerative or non-regenerative?

A

Non-regenerative

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37
Q

What factors contribute the the anemia associated with CKD?

A
  • EPO deficiency
  • Decreased lifespan of RBCs
  • Bone marrow suppression by PTH
  • Anemia of chronic disease
  • GI hemorrhage
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38
Q

Why do RBCs have a decreased lifespan in CKD?

A

Accumulation of toxic byproducts in the blood

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39
Q

What are some clinical signs of anemia?

A

Lethargy, inappetance, hypoxia, pale MM

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40
Q

Why should urine sedimentation be performed on CKD patients?

A

Detection of concurrent UTI

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41
Q

T/F: Proteinuria can both be a due to a cause of and an effect of CKD.

A

True

42
Q

Why are CKD patients at higher risk for UTIs?

A

Low specific gravity/concentration of urine promotes bacterial growth

43
Q

T/F: Concurrent UTIs will not contribute to CKD progression.

A

False- they can make the CKD much worse

44
Q

T/F: Proteinuria increases the risk of developing end-stage kidney disease.

A

True- progressive damage to the renal tubules

45
Q

What are kind of therapies are used to reduce the magnitude of proteinuria?

A

Renoprotective- Ace inhibitors or ARB

46
Q

What is performed to determine the degree of magnitude of proteinuria?

A

Urine protein:creatinine ratios

47
Q

What is radiography useful for in CKD patients?

A

Determining kidney size and identifying tissue minteralization

48
Q

What is ultrasound useful for in CKD patients?

A

Determining kidney size and potentially identifying cause of CKD

Obtaining FNAs

49
Q

T/F: Hypertension can both be a cause and effect of CKD.

A

True

50
Q

What does hypertension lead to in other organ systems?

A

Ocular, cerebral, and cardiovascular damage primarily

51
Q

What percentage of CKD patients will present as hypertensive?

A

~20%

52
Q

T/F: Hypertension only occurs in patients with advanced CKD.

A

False- it can occur at any stage

53
Q

What are the three things that must be closely watched in a CKD patient?

A

Creatinine, proteinuria, and blood pressure

54
Q

What is the goal of managing a stage 1 case?

A

Identify primary disease and start specific therapy to eliminate disease if possible

55
Q

What is the goal of managing a stage 2 or 3 case?

A

Renoprotective therapy to try to slow the progression of the disease

56
Q

What is the goal of managing a stage 3 or 4 late stage patient?

A

Symptomatic management

57
Q

What are the three aims of treatment and management in any CKD case?

A
  1. Treat underlying cause if possible
  2. Improve clinical signs and quality of life
  3. Slow progression (symptomatic treatment)
58
Q

T/F: Pyelonephritis is a common cause of CKD in dogs.

A

False- common cause in cats

59
Q

How long should antibiotics be continued in a pyelonephritis case?

A

4-6 weeks minimum

60
Q

What two characteristics have to be effect in treating pyelonephritis or a UTI?

A

Renal excretion and UUT penetration

61
Q

When should cultures be repeated in UTIs?

A

At least one week post treatment

62
Q

What can be used as short term management of dehydration?

A

IV or SQ fluids

63
Q

What can be used as a long term management of dehydration?

A

Oral fluids, SQ fluids, feeding tube

64
Q

Why can nausea sometimes be difficult to identify in CKD patients?

A

Often are also anorexic so won’t vomit

65
Q

What are some causes of nausea in CKD?

A
  • Uremic gastitis
  • Hypergastinemia
  • Stimulation of CTZ by uremia
66
Q

How do you treat nausea/vomiting in a CKD patient?

A
  • Antiemetics (maropitant, metoclopamide, ondansetron)
  • Proton pump inhibitors (omeprazole, pantoprazole)
  • H2 blockers (famotidine, ranitidine, cimetidine)
  • Gastric mucosal protectant (sucralfate)
67
Q

What are three ways to treat anorexia?

A

Warm/ high palatability food, appetite stimulants, feeding tube placement

68
Q

What can be done to reduce phosphate intake?

A

Limit phosphate amount in diet or give intestinal phosphate binders

69
Q

What are some phosphate binders?

A

Ammonium hydroxide/cabonate, calcium carbonate/acetate, lanthanum carbonate

70
Q

T/F: Phosphate binder dosages often need to be increased as disease progression continues.

A

True

71
Q

What are some characteristics of renal diets?

A
  • Phosphate and sodium restricted
  • High energy
  • High quality reduced protein
  • Potassium, omega-1 and anti-oxidant supplementation
  • Increased B vit and soluble fiber
72
Q

At what stage of CKD are renal diets most beneficial?

A

Stage 2, 3, and 4

73
Q

Renal diets reduce the risk of what end stage CKD sign?

A

Uremia

74
Q

T/F: Renal diets increase long term survival when used properly in CKD patients.

A

True

75
Q

What can be done to treat hypokalemia?

A

IV or Oral supplementation, switching to renal diet

76
Q

What two drugs are used to tread non-regenerative anemia associated with CKD?

A

Erythropoietin and Darbopoietin

77
Q

What is the advantage of darbo over EPO?

A

Only have to give once a month versus several times a week

78
Q

Should animals on darbo/EPO therapy be iron supplemented as well?

A

Yes

79
Q

T/F: There is a risk of producing antibodies against EPO.

A

True

80
Q

T/F: Anabolic steroids are useful in treating CKD.

A

False, other drugs will produce same effects without all the negative effects

81
Q

What are some negative side effects of anabolic steroid use in CKD patients?

A

Increase protein turnover (increase BUN) and increase water retention (decrease renal perfusion)

82
Q

What systolic BP counts as normotensive?

A
83
Q

What systolic BP counts as borderline hypertensive?

A

150-159

84
Q

What systolic BP counts as hypertensive?

A

160-179

85
Q

What systolic BP counts as severely hypertensive?

A

> /= 180

86
Q

Is hypertension more difficult to control in dogs or cats?

A

Dogs

87
Q

What dietary adjustments can be made to help control hypertension?

A

Salt restriction

88
Q

Is emergency therapy usually necessary in hypertensive patients?

A

No

89
Q

What is the drug of choice for controlling hypertension in dogs?

A

Ace inhibitors- benazepril most commonly

90
Q

What is the first choice for controlling hypertension in cats?

A

Ca- channel blockers- Amlodipine

91
Q

Where do Ace inhibitors work?

A

In the lungs

92
Q

What are the primary effects of ACE-inhibitors?

A
  • Reduce glomerular capillary pressure and glomerular size
  • Reduce proteinuria
  • Mild anti-hypertensive effect
  • Reduce sodium and water retention
  • Limit pro-fibrotic effects
93
Q

Are ace inhibitors proven to show improvment in survival?

A

No

94
Q

T/F: Ace-inhibitors can actually increase serum creatinine in early treatment

A

True

95
Q

What is telmisartan?

A

An angiotensin receptor inhibitor

96
Q

What is telmisartan used for?

A

Reduction of proteinuria associated with CKD in cats

97
Q

What are the side effects of telmisartan?

A

Mild and transient GI signs
Elevated liver enzymes
Reduction in blood pressure
Decrease RBC count

98
Q

Is the prognosis of CKD better for cats or dogs?

A

Cats

99
Q

How long do cats with CKD usually survive for?

A

Average of 2 years

100
Q

How long do dogs with CKD usually survive?

A

Months to a year or two

101
Q

What is survival time dependent on?

A
  • Serum phosphate
  • Magnitude of proteinuria
  • Anemia
  • Renal diet
102
Q

What is the ethical dilemma of renal transplantation?

A

You have to take a healthy kidney from another live cat

SAM 2 (21 decks)

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