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
2
Q
At what stage does chronic kidney disease typically become clinically apparent?
A
Stage 2 or greater
3
Q
What is the prevalence rate of CKD in cats and dogs?
A
1-3% of cats
0.5-1.5% of dogs
4
Q
Can all ages of animals be affected by CKD?
A
Yes, although typically an older animal disease
5
Q
What is the prognosis of CKD?
A
Prolonged survival is common and treatment can modify progression but will not cure
6
Q
What are degenerative causes of CKD?
A
Chronic interstitial nephritis and renal infarcts
7
Q
What are developmental causes of CKD?
A
Familial renal dysplasia and PKD
8
Q
Will auto-immune disorders cause CKD?
A
Yes
9
Q
What is a metabolic cause of CKD?
A
Hypercalcemia
10
Q
What are neoplastic causes of CKD?
A
Renal carcinoma or lymphoma
11
Q
What are some infectious causes of CKD?
A
Pyelonephritis, Lyme disease, leptospriosis (typically acute)
12
Q
What are some iatrogenic causes of CKD?
A
Vit D over supplementation or nephrotoxic drugs
13
Q
Can CKD be immune mediated?
A
Yes- amyloidosis
14
Q
What percentage of nephron loss will impair concentrating ability?
A
> /= 66%
15
Q
What percentage of nephron loss will result in azotemia?
A
> /= 75%
16
Q
What will further progression of damage and azotemia lead to?
A
Clinical signs or uremia
17
Q
What are clinical manifestations of CKD?
A
Uremia, PU/PD, hypocalcemia and seconday hyperPTHism, anemia, uremic gastitis, hypertension and blindness, defective hemostasis
18
Q
Why may pathological fractures occur in CKD occur?
A
Hypocalcemia and secondary hyperPTHism
19
Q
Why does hypertension occur?
A
Activation of the RAAS system
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
21
Q
What are some diagnostic findings in CKD?
A
Inadequately concentrated urine, azotemia
22
Q
What are the SG for inadequately concentrated urine in dogs and cats?
A
- 008-1.030 in cats
1. 008-1.022 in dogs
23
Q
What may result in azotemia?
A
Reduced GFR, increased catabolism, GI hemorrhage
24
Q
What changes will CKD patients have on biochem panels?
A
- Hyperphosphatemia
- Hypo/hyperkalemia
- Hyper/hypocalcemia
- Metabolic acidosis
25
Why do CKD patients develop hyperphosphatemia?
Impaired ability to excrete phosphate due to reduced renal function
26
In which stages can the body compensate by increasing phosphate excretion from remaining nephrons?
Stage I and II CKD
27
In which stages can the kidney no longer compensate for decreased phosphate excretion?
Stages III and IV CKD
28
T/F: There are lots of clinical signs directly associated with hyperphosphatemia.
False, clinical signs usually due to indirect effects
29
What is an important condition that is contributed to by hyperphosphatemia?
Secondary hyperPTHism
30
What are some ddx's for CKD?
- Reduced GFR
- Ruptured bladder
- Tumor lysis syndrome
- Young age
- Hypoparathyroidism
- Vit. D toxicity
31
Why do CKD patients develop hypokalemia?
Reduced intake and increased potassium loss
32
What will result from hypokalemia?
- Neuromuscular weakness
- Anorexia
- Impaired protein synthesis
- Decreased renal function
- PU/PD
- Lymphoplasmacytic interstitial lesions
33
What calcium abnormalities can occur with CKD?
Total calcium is usually normal while iCa is usually low
Primary hypercalcemia can lead to secondary or primary renal failure
34
Why do animals with CKD develop metabolic acidosis?
Inability to excrete hydrogen ions
35
Is the metabolic acidosis associated with CKD generally mild or severe?
Typically mild, can get worse depending on how severe the disease is
36
Is the anemia associated with CKD regenerative or non-regenerative?
Non-regenerative
37
What factors contribute the the anemia associated with CKD?
- EPO deficiency
- Decreased lifespan of RBCs
- Bone marrow suppression by PTH
- Anemia of chronic disease
- GI hemorrhage
38
Why do RBCs have a decreased lifespan in CKD?
Accumulation of toxic byproducts in the blood
39
What are some clinical signs of anemia?
Lethargy, inappetance, hypoxia, pale MM
40
Why should urine sedimentation be performed on CKD patients?
Detection of concurrent UTI
41
T/F: Proteinuria can both be a due to a cause of and an effect of CKD.
True
42
Why are CKD patients at higher risk for UTIs?
Low specific gravity/concentration of urine promotes bacterial growth
43
T/F: Concurrent UTIs will not contribute to CKD progression.
False- they can make the CKD much worse
44
T/F: Proteinuria increases the risk of developing end-stage kidney disease.
True- progressive damage to the renal tubules
45
What are kind of therapies are used to reduce the magnitude of proteinuria?
Renoprotective- Ace inhibitors or ARB
46
What is performed to determine the degree of magnitude of proteinuria?
Urine protein:creatinine ratios
47
What is radiography useful for in CKD patients?
Determining kidney size and identifying tissue minteralization
48
What is ultrasound useful for in CKD patients?
Determining kidney size and potentially identifying cause of CKD
Obtaining FNAs
49
T/F: Hypertension can both be a cause and effect of CKD.
True
50
What does hypertension lead to in other organ systems?
Ocular, cerebral, and cardiovascular damage primarily
51
What percentage of CKD patients will present as hypertensive?
~20%
52
T/F: Hypertension only occurs in patients with advanced CKD.
False- it can occur at any stage
53
What are the three things that must be closely watched in a CKD patient?
Creatinine, proteinuria, and blood pressure
54
What is the goal of managing a stage 1 case?
Identify primary disease and start specific therapy to eliminate disease if possible
55
What is the goal of managing a stage 2 or 3 case?
Renoprotective therapy to try to slow the progression of the disease
56
What is the goal of managing a stage 3 or 4 late stage patient?
Symptomatic management
57
What are the three aims of treatment and management in any CKD case?
1. Treat underlying cause if possible
2. Improve clinical signs and quality of life
3. Slow progression (symptomatic treatment)
58
T/F: Pyelonephritis is a common cause of CKD in dogs.
False- common cause in cats
59
How long should antibiotics be continued in a pyelonephritis case?
4-6 weeks minimum
60
What two characteristics have to be effect in treating pyelonephritis or a UTI?
Renal excretion and UUT penetration
61
When should cultures be repeated in UTIs?
At least one week post treatment
62
What can be used as short term management of dehydration?
IV or SQ fluids
63
What can be used as a long term management of dehydration?
Oral fluids, SQ fluids, feeding tube
64
Why can nausea sometimes be difficult to identify in CKD patients?
Often are also anorexic so won't vomit
65
What are some causes of nausea in CKD?
- Uremic gastitis
- Hypergastinemia
- Stimulation of CTZ by uremia
66
How do you treat nausea/vomiting in a CKD patient?
- Antiemetics (maropitant, metoclopamide, ondansetron)
- Proton pump inhibitors (omeprazole, pantoprazole)
- H2 blockers (famotidine, ranitidine, cimetidine)
- Gastric mucosal protectant (sucralfate)
67
What are three ways to treat anorexia?
Warm/ high palatability food, appetite stimulants, feeding tube placement
68
What can be done to reduce phosphate intake?
Limit phosphate amount in diet or give intestinal phosphate binders
69
What are some phosphate binders?
Ammonium hydroxide/cabonate, calcium carbonate/acetate, lanthanum carbonate
70
T/F: Phosphate binder dosages often need to be increased as disease progression continues.
True
71
What are some characteristics of renal diets?
- Phosphate and sodium restricted
- High energy
- High quality reduced protein
- Potassium, omega-1 and anti-oxidant supplementation
- Increased B vit and soluble fiber
72
At what stage of CKD are renal diets most beneficial?
Stage 2, 3, and 4
73
Renal diets reduce the risk of what end stage CKD sign?
Uremia
74
T/F: Renal diets increase long term survival when used properly in CKD patients.
True
75
What can be done to treat hypokalemia?
IV or Oral supplementation, switching to renal diet
76
What two drugs are used to tread non-regenerative anemia associated with CKD?
Erythropoietin and Darbopoietin
77
What is the advantage of darbo over EPO?
Only have to give once a month versus several times a week
78
Should animals on darbo/EPO therapy be iron supplemented as well?
Yes
79
T/F: There is a risk of producing antibodies against EPO.
True
80
T/F: Anabolic steroids are useful in treating CKD.
False, other drugs will produce same effects without all the negative effects
81
What are some negative side effects of anabolic steroid use in CKD patients?
Increase protein turnover (increase BUN) and increase water retention (decrease renal perfusion)
82
What systolic BP counts as normotensive?
83
What systolic BP counts as borderline hypertensive?
150-159
84
What systolic BP counts as hypertensive?
160-179
85
What systolic BP counts as severely hypertensive?
>/= 180
86
Is hypertension more difficult to control in dogs or cats?
Dogs
87
What dietary adjustments can be made to help control hypertension?
Salt restriction
88
Is emergency therapy usually necessary in hypertensive patients?
No
89
What is the drug of choice for controlling hypertension in dogs?
Ace inhibitors- benazepril most commonly
90
What is the first choice for controlling hypertension in cats?
Ca- channel blockers- Amlodipine
91
Where do Ace inhibitors work?
In the lungs
92
What are the primary effects of ACE-inhibitors?
- Reduce glomerular capillary pressure and glomerular size
- Reduce proteinuria
- Mild anti-hypertensive effect
- Reduce sodium and water retention
- Limit pro-fibrotic effects
93
Are ace inhibitors proven to show improvment in survival?
No
94
T/F: Ace-inhibitors can actually increase serum creatinine in early treatment
True
95
What is telmisartan?
An angiotensin receptor inhibitor
96
What is telmisartan used for?
Reduction of proteinuria associated with CKD in cats
97
What are the side effects of telmisartan?
Mild and transient GI signs
Elevated liver enzymes
Reduction in blood pressure
Decrease RBC count
98
Is the prognosis of CKD better for cats or dogs?
Cats
99
How long do cats with CKD usually survive for?
Average of 2 years
100
How long do dogs with CKD usually survive?
Months to a year or two
101
What is survival time dependent on?
- Serum phosphate
- Magnitude of proteinuria
- Anemia
- Renal diet
102
What is the ethical dilemma of renal transplantation?
You have to take a healthy kidney from another live cat
