CKD (Marin) Flashcards
what do we want for a minimum USG in cats?
1.035
what is the “new goal” of CKD
to be ahead of the curve! to catch it prior to clinical signs, be able to predict it early, to slow/prevent progression, early treatment intervention
chronic kidney disease means there is
permanent decrease in GFR–>increase in serum waste products that are supposed to be eliminated by the kidneys
true or false: BUN and creatinine are sensitive as markers
false! they are poorly sensitive and take forever to increase when there’s a problem. creatinine is slightly more reliable than BUN.
what are the causes of CKD?
active kidney injury!!!
lots of other things have been suggested put disproven, like vaccines, age, viruses, etc.
AGE IS NOT THE CAUSE OF CKD!!!!!!
please explain why active kidney injury causes CKD
active kidney injury, which can be anything involving INFLAMMATION, TOXINS, ISCHEMIA, cause the kidney to be unable to repair themselves fully, which then initiates CKD
if you detect renal azotemia and an inapproriate UCG, now much kidney damage has already happened?
75% decrease of nephron mass
what are the main issues with using creatinine as your marker of CKD?
creatinine only starts to increase when kidney disease is more advanced, AND creatinine also comes from muscle!!!
true or false: anesthesia procedures ex: dentals, can cause active kidney injury (inflammation) and increase risk of CKD
true!
please (you have to but hey I asked nicely) describe what SDMA is and why it is used as a marker of kidney disease
it is produced by all cells and released into circulation during protein degredation and is excreted almost exclusively by the kidneys. SDMA will increase at 40% loss of renal function which is better than creatinine! AND it can dientify CKD 10 months earlier in dogs and 17 months sooner in cats!
should you do an SDMA instead of running a chemistry (BUN and creatinine)?
NO! SMDA is an adjunct and does not replace your other tests
for diagnosis of CKD:
if there is renal azotemia and an inappropriate USG, you should…
if there is persistently elevated SDMA, you should…
for both scenarios, you should eliminate ureteral disease and check for possible active kidney injury
from the literature, what things have been shown to have an association with the development of CKD?
progressive weight loss, even if slight
chronic renal proteinuria
upper range creatinine
chronic inflammatory disease or ischemic events (like periodontal disease or recent anesthesia)
high phosphorus diet
frequent annual vaccination
what 3 things could help you predict if an animal will predict CKD?
- if they have chronic inflammatory disease or recent ichemic events, such as periodontal disease or a surgery
- if they have renal proteinuria/upper end creatinine
- if they have weight loss
who seems to have clinical signs of CKD sooner?
dogs! cats tend to hide azotemia better
most common clinical signs of CKD?
weight loss, PUPD, decreased appetite, poor haircoat, UTIs, lethargy
which stage of CKD has the most treatment/monitoring recommendations?
stage 1!!!! includes things like: using nephrotoxic drugs with caution, making sure fresh water is always available, monitor trends in SMDA, keep phosphorus low, renal diet if indicated, treat underlying diseases, etc.stae
stage 1 of CKD has long been forgotten because
cats rarely have clinical signs but this is now changing!!!!!!!
SDMA is useful for 2 main things which are:
early diagnosis: persistent SMDA above 14
late staging: helps differentiate muscle loss (creatinine can’t differentiate the two)
SDMA is more sensitive at detecting _______ and it is NOT impacted by _______
GFR changes
muscle loss
what do you do if the creatinine value fits into stage 3, but the SMDA value fits into stage 4?
it’s stage 4, you go with the higher stage
why is it important to correctly stage CKD?
it affects prognosis and treatments quite a bit
_____% of stage 1 cats will go into stage 2 within a year
30
true or false: you should diganose before you stage CKD
true
you can diagnose CKD if one of these 4 things is present
- renal azotemia and inappropriate USG
- inapprorpiate USG with no other causes
- structural damage
- SDMA over 14 mg/dl (persistently)
after doing IRIS staging, you can substage, which looks at what 2 things?
proteinuria and hypertension
why is it important to substage? why not stop at staging?
it is important for prognosis! if proteinuria and/or hypertension are present this is a negative prognostic indicator
you just diagnosed a cat with CKD and he is in stage 3. When substaging him, what numbers would make you “worry” and give the cat a worse prognosis?
proteinuria: if UPC>0.4, start to worry
hypertension: persistent elevation above 150mmHg, start to worry
who dies faster on average from CKD?
dogs, we dont know why tho
what 2 things can predict progression of CKD?
high phosphorus levels, and a higher UPC
true or false: renal diets with low protein in them carry some risk in that they can decrease lean body mass/muscle mass
false!
why do CKD diagnosed patients need to be treated as GI patients first?
because they will have nausea, decreased appetite, and will be dehydrated
what are the dos and donts when you FIRST diagnose CKD?
do: hydrate them, stimulate appetite, treat nausea, check hypertension, let them eat what they want and gradually introduce renal diet, screen for proteinuria
dont: treat for hyperphosphatemia, treat blindly for proteinuria, give them famotidine or sulfacrate
which appetite stimulant and antiemetic should you use in cats for initial diagnosis of CKD?
mirtazapine
maropitant (cerenia)
hyperphosphatemia in cats with CKD are treated via
phosphate binders: aluminum hydroxide, calcium carbonate, lanthanum carbonate
also renal diet (low in phosphorus)
why is secondary renal hyperparathyroidism a problem for the kidneys?
PTH causes calcium to go up and it also causes increased excretion of phosphorus, and the kidneys can struggle to keep up
which fluids are preferred for cats with CKD
LRS, you can add potassium to this if neccessary
what is the purina “hydra care” supplement do?
it’s organic osmolytes derived from whey to provide nutrient enriched water to improve hydration indices
why do cats with CKD get anemic?
erythropoietin deficiency, could also be things like: iron deficinecy, bone marrow fibrosis, GI bleeding,etc.
how can you treat anemia of renal disease?
erythrocyte stimulating agents such as Epogen (not used often due to aplastic anemia)
Darbepoetin: much safer and easier to give
**also dont forget iron supplementation
can you use melxoicam in an older cat with arthritis that also has CKD?
yes as long as you use the lowest dose possible and as long as the cat is stable
true or false: odds of getting a UTI increase with CKD
true, you need to screen for them at least once a year in CKD patients
