CKD (Yr 4) Flashcards
what is the definition of chronic kidney disease?
structural or functional abnormalities of one or both kidneys that have been present for 3 months or longer
is CKD reversible?
no (irreversible, slowly progressing)
what are some congenital causes of CKD?
renal dysplasia
polycystic kidney disease
amyloidosis
falconi-like syndrome
what breed is predisposed to polycystic kidney disease?
persian cats
what is the top cause of CKD in cats?
idiopathic tubulointerstial nephritis
what is the top cause of CKD in dogs?
glomerular disease
what are some causes of CKD progression (even if active disease is not present)?
other tubules try to compensate for lost tubules meaning intraglomerular hypertension which causes damage
systemic hypertension
proteinuria
phosphate precipitation in tubules
what are the clinical signs of CKD?
weight loss, poor appetite
PUPD
dehydration
vomiting, constipation
poor hair growth
neurological and hypertensive signs
what are the three criteria for staging CKD?
creatinine (GFR estimate)
proteinuria
blood pressure
what is the initial marker for staging CKD?
creatinine (GFR estimate)
how can albumin be affected by CKD?
decrease (due to protein losing nephropathy)
how can potassium be affected by CKD?
usually low (increases with end-stage CKD)
how can phosphorus be affected by CKD?
increased
how can calcium be affected by CKD?
increased or deacreased
what affect does increased phosphorous caused by CKD have?
initiates secondary hyperparathydroidism and metastatic calcification
how will CKD affect the USG?
will be poorly concentrated (<1.030 in dogs and <1.035 in cats)
can CKD be cured?
no - irreversible, can only be managed symptomatically to minimise progression and severity
what is a uraemic crisis?
acute presentation of CKD
how is a uraemia crisis treated?
same as AKI with fluids and treating underlying cause
how is stage 1 CKD treated?
reduce proteinuria - inhibit RAAS plus dietary protein reduction (antiplatelet drugs as they are at risk of clots)
control hypertension - ACE inhibitors, telmisartan, amlodipine
combat dehydration - wet food, water
when should you not use ACE inhibitors in CKD patients to treat stage 1 with proteinuria?
if the animal is dehydrated or hypovolaemic (causes a catastrophic drop in GFR) - so stabilise them first
what new therapy is started for stage 2 CKD on top of the stage 1 treatments?
start renal diet
control serum phosphate (add binder)
avoid hypokalaemia (supplement)
why are renal diets beneficial?
protein restriction
phosphate restriction
low sodium
increased fibre
when are renal diets indicated in CKD?
dogs in stage 3 or 4, if they have proteinuria or stage 2 when phosphate is >1.5mmol/L
cats in stage 2, 3 and 4
what does phosphate need to be controlled to in CKD cases?
<1.5 in stage 2
<1.6 in stage 3
<1.9 in stage 4
what treatments need to be added in stage three CKD?
treat nausea and vomiting
consider erythropoietin
control metabolic acidosis
consider SC fluids
what might be used in stage 3 CKD for vomiting and nausea?
anti-emetic
appetite stimulants (mirtazpine)
reduction of gastric acid production
sucralfate (for gastric ulcers)
what therapy is added when an animal enters stage 4 CKD?
same as others (nutrition and fluids)
what can be used to give a prognosis for CKD?
stage
proteinuria
do congenital or acquired CKD cases progress faster?
acquired
