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Advanced Clinical Nursing Theory > CKD > Flashcards

CKD Flashcards

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1
Q

what is the most common kidney disease in dogs and cats?

A

CKD

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2
Q

is CKD more prevalent in dogs or cats?

A

3 x more prevalent in cats

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3
Q

what is the definition of CKD?

A

functional and/or structural disease of the kidneys of >3 months duration

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4
Q

what is the result of CKD?

A

gradual, progressive and irreversible nephron loss leading to reduced ability to filter toxins from the body

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5
Q

what can therapeutic intervention do for CKD patients?

A

help slow disease progression
prolong good quality of life

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6
Q

what is the aim of CKD management?

A

reducing workload of remaining nephrons
prevention of further kidney damage

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7
Q

what level of nephron loss is there with normal kidney function?

A

none-50% loss

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8
Q

what disease signs are seen with 50% nephron loss?

A

none - disease still subclinical

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9
Q

what what level of nephron loss do kidneys loose urine concentrating ability?

A

67%

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10
Q

what happens to the kidneys at 67% nephron loss?

A

lose concentrating ability

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11
Q

what USG is seen in cats once they reach 67% nephron loss?

A

<1.035

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12
Q

what USG is seen in dogs once they reach 67% nephron loss?

A

<1.030

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13
Q

what happens to the kidneys at 75%% nephron loss?

A

become azotemic and clinical signs seen

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14
Q

at what level of nephron loss are clinical signs and azotemia seen?

A

75%

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15
Q

what happens between 75 and 100% nephron loss?

A

decreasing quality of life which then becomes incompatible with life

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16
Q

what are the majority of CKD cases caused by?

A

chronic interstitial nephritis

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17
Q

what is chronic interstitial nephritis?

A

inflammation of renal interstitium

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18
Q

what should be excluded when diagnosing CKD?

A

treatable or partially reversible causes

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19
Q

what are the main treatable/reversible causes of CKD?

A

pyelonephritis
ureterolithiosis

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20
Q

what may CKD be caused by other than chronic interstitial nephritis?

A

an asymptomatic or undiagnosed initial insult which leads to a reduction in glomerular filtration rate

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21
Q

what is pyelonephritis?

A

inflammation of kidney and renal pelvis with infectious cause (e.g. FIP/FIV)

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22
Q

how does ureterolithiasis cause kidney injury?

A

post renal obstruction but causes damage as waste products back up into kidney

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23
Q

what is caused by reduction in glomerular filtration rate?

A

compensatory hypertrophy of remaining nephrons which over time leads to progressive nephron loss as the process is damaging
overall reduction in GFR

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24
Q

is compensatory hypertrophy of nephrons effective?

A

initially yes - individual nephrons can increase GFR.
Over time this is damaging

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25
Q

what are the main consequences of CKD?

A

loss of water/electrolyte regulation
loss of acid/base regulation
failed excretion of uraemic solutes
impaired renal hormone synthesis
hypertension

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26
Q

what are the clinical manifestations of loss of water/electrolyte regulation due to CKD?

A

PUPD
dehydration
hypokalaemia

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27
Q

what are the clinical manifestations of loss of acid/base regulation due to CKD?

A

acidaemia leading to nausea, vomiting, dehydration and inappetance

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28
Q

what are the clinical manifestations of failed excretion of uraemic solutes due to CKD?

A

azotemia
hyperphosphataemia

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29
Q

what is caused by hyperphosphataemia?

A

nausea
vomiting
dehydration
inappetance
renal secondary hyperparathyroidism

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30
Q

what are the clinical manifestations of impaired renal hormone synthesis due to CKD?

A

lack of erythropoetin (EPO)
anaemia

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31
Q

what are the clinical manifestations of hypertension due to CKD?

A

end organ damage

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32
Q

what age of patient is affected by CKD?

A

increasing incidence with age
<1 year old may be affected

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33
Q

what patients are typically affected by CKD?

A

mature-geriatric cats

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34
Q

what is the usual cause of patients under 1 year being affected by CKD?

A

congenital disorders e.g. malformation or polycystic kidneys

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35
Q

how long will signs of CKD last for?

A

weeks to months

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36
Q

when may CKD be identified?

A

long term signs
incidental diagnosis in subclinical phase

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37
Q

how may CKD be diagnosed in the subclinical phase?

A

pre-op sceening profiles
geriatric wellness screening bloods and urinalysis

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38
Q

what should be discussed with an owner when taking patient history if CKD is suspected?

A

weight or condition changes
drinking and urination (PUPD)
appetite changes
change to demenour or activity levels
any GI signs
signs associated with hypertension
ease of medication administration

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39
Q

what GI signs may be seen with CKD?

A

vomiting
diarrhoea
haematemesis
melaena
constipation secondary to dehydration

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40
Q

what should you assess about a patient with suspected CKD?

A

hydration status
weakness
presence or uraemic ulcers/uraemic halitosis
hypertensive retinopathy
palpation of kidneys
presence of rubber jaw

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41
Q

what signs may suggest weakness in CKD patients?

A

neck ventroflexion

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42
Q

what is neck ventroflexion in CKD patients caused by?

A

hypokalaemic myopathy

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43
Q

how may kidneys appear on palpation if the patient has CKD?

A

small and irregular

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44
Q

what is rubber jaw caused by?

A

renal secondary hyperparathyroidism

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45
Q

how is CKD diagnosed?

A

combination of diagnostic tools and functional tests

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46
Q

what tests are used to diagnose CKD?

A

USG
urine protein:creatinine ratio
serum creatinine and urea
GFR
symmetric dimethylarginine (SDMA)
imaging (xray or US)

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47
Q

what is the earliest indication of CKD?

A

weight loss
reduction in urine concentration

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48
Q

what is the most sensitive test for CKD?

A

GFR

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49
Q

at what level of nephron loss is azotemia seen?

A

75%

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50
Q

what is azotemia?

A

increased blood urea and creatinine

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51
Q

at what level of nephron loss is inappropriately concentrated urine seen?

A

67%

52
Q

what clinical signs are seen at 67% GFR loss?

A

inappropriately concentrated urine

53
Q

what clinical signs are seen at 75% GFR loss?

A

azotemia

54
Q

what clinical signs confirm CKD diagnosis?

A

azotemia and submaximally concentrated urine

55
Q

what USG is submaximally concentrated urine in cats?

A

<1.035

56
Q

what USG is submaximally concentrated urine in dogs?

A

<1.030

57
Q

what is urinalysis also used to assess?

A

urine infection
urine protein

58
Q

what is the benefit of SDMA testing for CKD?

A

may identify kidney disease earlier than elevated urea or creatinine

59
Q

how can kidneys be elevated for structural disease?

A

US
xray

60
Q

what can be shown about kidneys on US?

A

renal size and architecture

61
Q

what can be shown about kidneys on xray?

A

ureteroliths

62
Q

what may be found on imaging of kidneys?

A

reversible causes

63
Q

what are some reversible causes of CKD that may be seen on imaging?

A

ureteric obstruction
pyelonephritis
lymphoma

64
Q

what are the main complications associated with CKD?

A

hypertension
renal secondary hyperparathyroidism
hypokalaemia
proteinuria
anaemia

65
Q

what percentage of cats with CKD have hypertension?

A

20-60%

66
Q

what is the most common cause of hypertension in cats and dogs?

A

CKD

67
Q

what is the target systolic BP for cats and dogs?

A

120-140 mmHg

68
Q

what is seen with persistent hypertension?

A

occular damage
target organ damage
neuro issues

69
Q

how many BP measurements should be taken for an average?

A

minimum 3
ideally 5-7

70
Q

how can stress be reduced for patients under going BP measurement?

A

quiet room
minimal/gentle handling
feliway
headphones for doppler
patience

71
Q

what size BP cuff should be used?

A

40% of limb circumference

72
Q

what effect does CKD have on phosphate?

A

increased levels of serum phosphate

73
Q

what hormone responds to increased serum phosphate?

A

parathyroid hormone

74
Q

what effect does parathyroid hormone have on phosphate?

A

under normal circumstances it should reduce phosphate levels

75
Q

what is the effect of parathyroid hormone on calcium?

A

increase release of calcium from bones to increase serum Ca2+

76
Q

why is parathyroid hormone ineffective in reducing phosphate levels during CKD?

A

inadequate renal function to excrete the increased phosphate

77
Q

how does CKD cause secondary hyperparathyroidism?

A

CKD leads to increased serum phosphate
parathyroid hormone released in response
actions of paratyroid hormone ineffective as renal function is inadequate and phosphate cannot be released
PTH continues to be released due to high phospate levels
leads to bone reabsorption due to calcium releasing effects of PTH

78
Q

why is bone reabsorption seen with hyperphosphataemia?

A

PTH releases calcium from bone
PTH released in response to hyperphosphataemia leads to demineralisation of bone and bone reabsorption

79
Q

what is the commonly seen sign of renal secondary hyperparathyroidism?

A

rubberjaw

80
Q

when is rubber jaw most commonly seen?

A

renal dysplasia

81
Q

what is renal dysplasia?

A

kidney not fully developed in utero

82
Q

what is hypokalaemia in CKD due to?

A

inappetance
GI losses
urinary losses

83
Q

what is caused by hypokalaemia in CKD?

A

weakness
neck ventroflexion
inappetance

84
Q

in how many cats with CKD is hypokalaemia seen?

A

20-30%

85
Q

how is hypokalaemia treated?

A

K+ supplementation

86
Q

in what animals is proteinuria more commonly seen with CKD?

A

dogs

87
Q

what urine:protein creatinine ratio indicates CKD?

A

> 0.4

88
Q

what causes proteinuria in CKD?

A

glomerulus is damaged leading to protein loss into urine

89
Q

what is needed to diagnose proteinuria?

A

urine:protein creatinine ratio (UPC)

90
Q

in how many CKD patients is anaemia seen?

A

30-60%

91
Q

how does CKD lead to anaemia?

A

multifactorial:
lack of erythropoetin production
reduced RBC lifespan
GI losses

92
Q

what are the signs of anaemia in CKD patients?

A

weakness
lethargy
inappetance
proportional to disease sateg

93
Q

what parameters should be recorded on CKD patient review?

A

hydration
BP
K+
Ca+
USG
weight

94
Q

what is involved in a CKD clinic?

A

history
weight and BCS
BP
retinal exam
testing

95
Q

what history questions are crucial in CKD consults?

A

appetite
drinking (PUPD)
GI signs

96
Q

what tests may be done regularly in patients with CKD?

A

BP
PCV
urea
creatinine
phosphate
calcium
electrolytes
urinalysis

97
Q

how often should CKD patients be seen?

A

if stable: 3-6 months depending on stage
if unstable: as needed

98
Q

what are the IRIS guidelines?

A

international guidelines for diagnosis, management and treatment of CKD

99
Q

when is IRIS staging performed?

A

following CKD diagnosis

100
Q

what is the aim of IRIS staging?

A

facilitate appropriate treatment and monitoring

101
Q

what is involved in IRIS staging?

A

creatinine level
substage by proteinuria
substage by BP

102
Q

what must be done before testing for IRIS stage of CKD?

A

address reversible problems

103
Q

describe IRIS stage 1

A

non-azotemic
inability to concentrate urine
elevated SMDA

104
Q

describe IRIS stage 2

A

mild azotemia
may not have any clinical signs

105
Q

describe IRIS stage 3

A

moderate azotemia
some extrarenal signs

106
Q

describe IRIS stage 4

A

increasing risk of systemic signs and uraemic crisis

107
Q

what is an emphasis of IRIS management of CKD patients?

A

hydration

108
Q

what are the main areas of therapy for CKD patients?

A

maintain hydration
feed renal diet

109
Q

what is the most effective CKD management strategy?

A

feeding a renal diet

110
Q

what effect can dehydration have on CKD?

A

advance disease

111
Q

what are the key components of a renal diet?

A

low phosphate
low protein
antioxidants
essential fatty acids
K+ supplementation
bicarbonate

112
Q

why should CKD diets be low phosophate?

A

reduction of hyperphosphataemia
kidneys cannot remove as well

113
Q

why should CKD diets be low protein?

A

kidneys not handling protein as well
leak from glomerulus into urine

114
Q

why should CKD diets have antioxidants?

A

protection against organ damage

115
Q

why should CKD diets have essential fatty acids?

A

support bloodflow and GFR

116
Q

why should CKD diets have bicarbonate?

A

prevention of acidosis

117
Q

what are the main options for improving hydration of CKD patients?

A

fountain
shallow bowl
multiple bowls
fresh water
wet food or adding water to food
try different bowls / materials / sizes
keep water away from food

118
Q

what is the aim of CKD therapy?

A

supportive and symptomatic treatment of disease consequences

119
Q

what factors may need treatment in CKD?

A

hypertension
hyperphosphataemia
hypokalaemia
proteinuria

120
Q

how can hypertension be managed?

A

amlodipine (cats)
ACE inhibitors (dogs)

121
Q

how can hyperphosphataemia be managed?

A

renal diet
phosphate binders

122
Q

what is the role of phosphate binders?

A

prevent absorption

123
Q

how can hypokalaemia be managed?

A

renal diet
potassium supplementation

124
Q

how can proteinuria be managed?

A

renal diet
ACE inhibitors
omega 3 PUFAs
antiplatelets

125
Q

what is the role of antiplatelets?

A

prevention of cardiac issues

126
Q
A

Advanced Clinical Nursing Theory (36 decks)

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