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522 (dog & cat class) > CKD (Marin) > Flashcards

CKD (Marin) Flashcards

1
Q

what do we want for a minimum USG in cats?

A

1.035

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2
Q

what is the “new goal” of CKD

A

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

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3
Q

chronic kidney disease means there is

A

permanent decrease in GFR–>increase in serum waste products that are supposed to be eliminated by the kidneys

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4
Q

true or false: BUN and creatinine are sensitive as markers

A

false! they are poorly sensitive and take forever to increase when there’s a problem. creatinine is slightly more reliable than BUN.

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5
Q

what are the causes of CKD?

A

active kidney injury!!!

lots of other things have been suggested put disproven, like vaccines, age, viruses, etc.

AGE IS NOT THE CAUSE OF CKD!!!!!!

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6
Q

please explain why active kidney injury causes CKD

A

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

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7
Q

if you detect renal azotemia and an inapproriate UCG, now much kidney damage has already happened?

A

75% decrease of nephron mass

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8
Q

what are the main issues with using creatinine as your marker of CKD?

A

creatinine only starts to increase when kidney disease is more advanced, AND creatinine also comes from muscle!!!

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9
Q

true or false: anesthesia procedures ex: dentals, can cause active kidney injury (inflammation) and increase risk of CKD

A

true!

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10
Q

please (you have to but hey I asked nicely) describe what SDMA is and why it is used as a marker of kidney disease

A

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!

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11
Q

should you do an SDMA instead of running a chemistry (BUN and creatinine)?

A

NO! SMDA is an adjunct and does not replace your other tests

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12
Q

for diagnosis of CKD:

if there is renal azotemia and an inappropriate USG, you should…

if there is persistently elevated SDMA, you should…

A

for both scenarios, you should eliminate ureteral disease and check for possible active kidney injury

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13
Q

from the literature, what things have been shown to have an association with the development of CKD?

A

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

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14
Q

what 3 things could help you predict if an animal will predict CKD?

A
  • 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
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15
Q

who seems to have clinical signs of CKD sooner?

A

dogs! cats tend to hide azotemia better

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16
Q

most common clinical signs of CKD?

A

weight loss, PUPD, decreased appetite, poor haircoat, UTIs, lethargy

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17
Q

which stage of CKD has the most treatment/monitoring recommendations?

A

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

18
Q

stage 1 of CKD has long been forgotten because

A

cats rarely have clinical signs but this is now changing!!!!!!!

19
Q

SDMA is useful for 2 main things which are:

A

early diagnosis: persistent SMDA above 14

late staging: helps differentiate muscle loss (creatinine can’t differentiate the two)

20
Q

SDMA is more sensitive at detecting _______ and it is NOT impacted by _______

A

GFR changes

muscle loss

21
Q

what do you do if the creatinine value fits into stage 3, but the SMDA value fits into stage 4?

A

it’s stage 4, you go with the higher stage

22
Q

why is it important to correctly stage CKD?

A

it affects prognosis and treatments quite a bit

23
Q

_____% of stage 1 cats will go into stage 2 within a year

A

30

24
Q

true or false: you should diganose before you stage CKD

A

true

25
Q

you can diagnose CKD if one of these 4 things is present

A
  • renal azotemia and inappropriate USG
  • inapprorpiate USG with no other causes
  • structural damage
  • SDMA over 14 mg/dl (persistently)
26
Q

after doing IRIS staging, you can substage, which looks at what 2 things?

A

proteinuria and hypertension

27
Q

why is it important to substage? why not stop at staging?

A

it is important for prognosis! if proteinuria and/or hypertension are present this is a negative prognostic indicator

28
Q

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?

A

proteinuria: if UPC>0.4, start to worry

hypertension: persistent elevation above 150mmHg, start to worry

29
Q

who dies faster on average from CKD?

A

dogs, we dont know why tho

30
Q

what 2 things can predict progression of CKD?

A

high phosphorus levels, and a higher UPC

31
Q

true or false: renal diets with low protein in them carry some risk in that they can decrease lean body mass/muscle mass

A

false!

32
Q

why do CKD diagnosed patients need to be treated as GI patients first?

A

because they will have nausea, decreased appetite, and will be dehydrated

33
Q

what are the dos and donts when you FIRST diagnose CKD?

A

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

34
Q

which appetite stimulant and antiemetic should you use in cats for initial diagnosis of CKD?

A

mirtazapine

maropitant (cerenia)

35
Q

hyperphosphatemia in cats with CKD are treated via

A

phosphate binders: aluminum hydroxide, calcium carbonate, lanthanum carbonate

also renal diet (low in phosphorus)

36
Q

why is secondary renal hyperparathyroidism a problem for the kidneys?

A

PTH causes calcium to go up and it also causes increased excretion of phosphorus, and the kidneys can struggle to keep up

37
Q

which fluids are preferred for cats with CKD

A

LRS, you can add potassium to this if neccessary

38
Q

what is the purina “hydra care” supplement do?

A

it’s organic osmolytes derived from whey to provide nutrient enriched water to improve hydration indices

39
Q

why do cats with CKD get anemic?

A

erythropoietin deficiency, could also be things like: iron deficinecy, bone marrow fibrosis, GI bleeding,etc.

40
Q

how can you treat anemia of renal disease?

A

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

41
Q

can you use melxoicam in an older cat with arthritis that also has CKD?

A

yes as long as you use the lowest dose possible and as long as the cat is stable

42
Q

true or false: odds of getting a UTI increase with CKD

A

true, you need to screen for them at least once a year in CKD patients

522 (dog & cat class) (31 decks)

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