CKD - Dowers

Question 1

What is SDMA?

Answer 1

Symmetric dimethylarginine

Its a renal biomarker that detects renal damage when only 25% of total nephrons are compromised

• more sensitive than creatinine
• *but still don’t know if animals that have detectable SDMA will go into renal failure

Question 2

If you are given a single creatinine value, can you determine the stage of CKD (IRIS)?

Answer 2

NO!

You need at least TWO creatinine measurements over time in a STABLE patient

Question 3

How can we substage a patient?

Answer 3

1. Proteinuria (called 2a)
2. Blood pressure ( called 2b)
   * both exacerbate progression of dz

Question 4

Cats more often get _____ _____. They have decreased ____ first, and _____ second. ______ usually comes later

Answer 4

Tubulointerstitial nephritis

USG

Azotemia

Proteinuria

Question 5

Dogs usually get ________. They have _____ first. ____ is often normal (tubules normal). _____ and low ____ come later

Answer 5

Glomerulonephropathies

Proteinuria

USG

Azotemia and low USG

Question 6

What are some clinical consequences of CKD? Specifically from Uremia as CKD advances

Answer 6

• PU/PD (early sign)
• inappetence/nausea
• V/D
• Wt loss
• Weakness
• Constipation

Question 7

Normal kidney functions and what their dysfunction leads to…

1. EPO
2. Systemic BP
3. Water conservation
4. Protein conservation
5. Phosphorus excretion
6. Ca retention
7. K retention
8. Acid-base status
9. Vit D conversion

Answer 7

1. Anemia
2. Hypertension
3. Dehydration
4. Proteinuria - PLE more common in dogs
5. Hyperphosphatemia
6. Hypocalcemia (ionized)
7. Hypokalemia - mostly in cats
8. Acidemia
9. Dec Vit D

Question 8

When you have a patient with kidney dz you should always do a _____ exam and measure ___ ____

Answer 8

fundic

Blood pressure

Question 9

What are the overarching goals of CKD treatment?

Answer 9

1. Keep them eating!
2. Keep them hydrated!
3. Prevent on-going damage
4. Avoid AKI and CKD
5. Monitor!

Question 10

Treating hypertension…

Ca Channel blockers (_______) - cats

ACEI (______, ______) - dogs

Answer 10

Amlodipine

Enalapril, benazepril

Question 11

If proteinuric, reduce proteinuria…. _____ or ____

Answer 11

ACEI or ARBs

Question 12

If proteinuric –> most likely losing _____ –> risk of thrombi…
_____ or _____

Answer 12

AT3

Aspirin
Clopidogrel

Question 13

Prevent hypoxemia with ____

Answer 13

Darbepoetin

Question 14

When treating CKD, you want to avoid AKI (3 main categories)

Answer 14

1. Infectious
2. Dehydration
3. Hypo/hypertension

Question 15

What is the typical therapy regimen for dogs?

Answer 15

Renal diet 
Anti-hypertensives
- ACEI, ARBs, amlodipine 
Anti-proteinurics 
- ACEI, ARBs 
Anti-thrombotics 
- Aspirin, clopidogrel

Question 16

Typical therapy regimen for cats

Answer 16

Renal diet 
Antihypertensives 
- amlodipine 
K supplements 
Appetite stimulants 
- maropitant, mirtazapine 
Phosphate binders 
Darbepoetin 
SQ fluids

Question 17

You want to monitor CKD patients typically every _____ months (more or less depending on patient). Check: BUN, creatinine, phosphorus, electrolytes, BP, fundic exam, PCV/total solids, UA and culture, BCS, and hydration status

Answer 17

1-3

Question 18

Renal secondary Hyperparathyroidism

Complicated pathophysiology. Decreased _____ production (kidneys), and _______ retention (kidney dysfunction). This leads to increased ___ released, as well as dec Ca and P absorbed from GI tract

Answer 18

Vit D

Phosphorus

PTH