Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RUSVM SAM 2 > Chronic Renal Failure > Flashcards

Chronic Renal Failure Flashcards

1
Q

What is chronic kidney disease?

A

Loss of functional renal tissue due to a prolonged process (generally>2months)

Renal insufficiency leading to renal failure and uremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

T/F: chronic kidney disease is progressive but can be reversed

A

False

Usually irreversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the prevalence of chronic kidney disease ?

A

1-3% in cats

0.5-1.5 % in dogs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are degenerative causes of CKD?

A

Chronic interstitial nephritis

Renal infarcts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are developmental causes of CKD?

A

Familial renal dysplasia

PKD (Persians)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What metabolic disorder can cause CKD?

A

Hypercalcemia

-> due to primary or secondary hyperPTH (diet neoplasia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Infectious causes of CKD?

A

Pyelonephritis
Lyme
Leptospirosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are iatrogenic causes of CKD?

A

Vit D supplementation

Nephrotoxic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What percent of nephron loss is there in an animal that has lost the ability to concentrate its urine?

A

66%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What percent of nephron loss is there in an animal that has developed azotemia?

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Failure of excretion of nitrogenous wastes leads to ?

A

Uremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In CKD, the kidney fails to produce what substances that lead to hypocalcemia, anemia,and uremic gastritis ?

A

Calcitriol (Vit D3) -> hypocalcemia and renal secondary hyperPTH

Erythropoietin -> anemia

Failure to catabolism peptide hormone (gastrin) -> uremic gastritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does CKD sometimes result in defective hemostasis?

A

Antithrombin loss —> hypercoagulable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Once CKD develops, what secondary processes are activated that contribute to the renal damage?

A

Systemic and glomerular hypertension
Mineral imbalance
Proteinuria
Renal fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are classical presenting signs for CKD?

A 
PU/PD
GI signs - vomiting, anorexia, weight loss, diarrhea, hypersalivation, and constitution 
Dehydration 
Poor body condition 
Pale mucus membranes 
Small kidney 
Hypertensive retinopathies

Depression and lethargy

Sudden onset of blinds
Pathological fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Isosthenuria range for cats and dogs?

A

Cat SG 1.008 - 1.030

Dog SG 1.008 - 1.022

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are possible sources of an azotemia ?

A

Reduced GFR
Increased catabolism
Gastrointestinal hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What diagnostic tests do you do to confirm CKD?

A 
Biochem 
CBC
UA -with sediment, UPC, culture and sensitivity 
Abdominal imaging 
BP 
Ophthalmoscope 
Blood gas analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What do you expect to see on a biochem of a patient with CKD?

A

Hyperphosphatemia

Hypo/hyperkalemia
Hypo/hypercalcemia

Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What causes a hyperphosphatemia in CKD?

A

Kidney are the primary route of phosphate excretion

Reduced renal function -> phosphate retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

At what stage of CKD is phosphate increased?

A

Stage III and IV

During stage I and II compensatory mechanisms lead to increased phosphate loos from remaining nephrons.

22
Q

What are DDX for hyperphosphatemia?

A 
CKD 
Reduced GFR (pre, renal, post) 
Ruptured bladder 
Tumor lysis syndrome 
Young 
HypoPTH 
VitD toxicity
23
Q

DDX of hypokalemia ?

A

Reduced intake

Increased renal potassium loos

24
Q

What are the consequences to hypokalemia?

A

Neuromuscular weakness
Anorexia
Impaired protein synthesis -> weight loss
Decreased renal fxn
Promotes lymphoplasmacytic interstitial lesions
Promote PU/PD

25
Q

Why do you get a metabolic acidosis in CKD?

A

Reduced excretion of H+ by kidney

26
Q

What are the causes of the anemia seen with CKD?

A 
EPO deficiency 
Decreased RBC life span 
PTH effect on bone marrow and RBC 
Anemia of chronic dz 
GI hemorrhage
27
Q

Why do sediment and culture with CKD?

A

Concurrent UTI? -> increased risk

Concurrent infection can lead to disease progression

28
Q

T/F: proteinuria is a potential cause of renal injury

A

True

-> increases risk of developing end-strange CKD

29
Q

What are therapies that can reduce the magnitude of proteinuria ?

A

ACEi (benazepril) or ARB (telmisartan)

30
Q

What would you see in radiographs that would indicate CKD?

A

Small renal size

Tissue mineralization

31
Q

How does BP relate to CKD?

A

Hypertension can be a result of CKD or can be the cause

-> leads to ocular, cerebral or cardiovascular damage

32
Q

When you suspect a diagnosis of CKD what lab data is important for staging/prognosis the disease?

A

Creatinine
Proteinuria
Blood pressure

33
Q

How do the goals of management change with stage of CKD??

A

Stage 1 - find underlying disease and eliminate if possible
Stage 2/3 - renoprotective therapy and slow progression
Stage 3/4- symptomatic

34
Q

What is the treatment for pyelonephritis ?

A

Antibiotics for 4-6weeks

  • based on culture and sensitivity
  • renally excreted (nitrofurans)

Avoid aminoglycosides and tetracycline in renal failure

35
Q

In an animal with CKD what are possible causes of vomiting/nausea?

A

Uremic gastritis
Hypergastinemia
Stimulation of the CTZ by uremic toxin

36
Q

How can vomiting/nausea be treated?

A

Antiemetic

  • maropitant (NK1 antagonsit)
  • metoclopramide (dopamine and serotonin receptor antagonist)
  • ondasetron (serotonin antagonist)

Proton pump inhibitors (omeprazole/pantoprazole)

H2 blockers (famotidine/ranitidine/cimedtdine)

Gastric mucosal protectants (sucralfate)

37
Q

Treatment for anorexia associated with CKD?

A

Warm food, hand fed, quiet environment

Appetite stimulants

  • cyproheptadine (cats) - serotonin antagonist antihistamine
  • mirtazapine -serotonin antagonist/ tricyclics antidepressant

Feeding tube

38
Q

Treatment for hyperphosphatemia??

A

IV fluids

Restrict phosphate intake
-dietary restriction
-intestinal phosphate binder (aluminum, calcium, lanthanum - carbonate)
—> mix with food and give with every meal
—> titration dose to effect

39
Q

What are the features of renal diets?

A 
Phosphate restricted 
High energy 
High quality reduced protein 
Sodium restricted 
Potassium supplemented 
Increased vit B

Neutral effect on acid-base
Omega 3 supplemented
Increased soluble fiber
Anti-oxidant supplemented

40
Q

Why are renal diets so important in CRF?

A

Reduce risk of uremic crisis
Increase long term survival

for long term benefit

41
Q

When should renal diets be started ?

A

Cat - IRIS stage II and higher

Dog - IRIS stage III and higher

Hyperphosphatemic animals
Metabolic acidosis
Hypertensive animals

42
Q

How do you treat hypokalemia?

A

Iv supplementation
Renal diets are potassium supplemented
Oral potassium supplements

43
Q

Patients with non-regenerative anemia due to CRF can receive EPO therapy. At what PCV should you initiate this therapy?

A

<20%

Exclude and treat other causes of anemia
When survival is suspected to be <6months

risk of production of neutralizing antibodies to EPO

44
Q

How can you treat hypertension in CRF?

A

Moderate salt restriction
Emergency therapy

Long term

  • ACE inhibitors
  • Amlodipine (first choice in cats)

Monitor

45
Q

What are the benefits of ACE inhibitors for treatment of hypertension due to CRF?

A

Reduce glomerular capillary pressure and glomerular size
Reduce proteinuria

Mild anti-hypertensive effect
Reduce sodium and water reteion

Limit pro-fibrotic effect of angiotensin II on kidney

Improve appetite in proteinuric cats

46
Q

Telmisartan MOA?

A

Angiotensin receptor blocker

47
Q

What are the side effects of telmisartan?

A

Mild and transient GI signs
Elevated liver enzymes
Reduced BP
Decrease in RBC counts

48
Q

How can you treat proteinuria?

A

ACEi
Angiotensin receptor blockers
Correct BP

49
Q

Methods of long-term monitoring for CRF?

A 
Kidney palpation 
PCV 
Electrolytes 
BUN/CREA/PO4 
UA and possible culture and sensitivity 
Urine protein: creatinine (UPC) ratio
Systolic BP 
Ophthalmic examination
50
Q

Increased creatinine and phosphate indicates what about the prognosis for CRF?

A

Poor

51
Q

What is the prognosis for CKD in dogs?

A

Stage 1/2- 18months
Stage 3- 6 months
Stage 4- 30days

52
Q

What is the prognosis for CKD in cats?

A

Stage II - 3 -8 years

Stage IV - 35days

RUSVM SAM 2 (44 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions