Diagnosis and Staging of CKD (Quimby) Flashcards
Dogs tend to get _________________
proteinuric kidney disease
Does a patient have to be azotemic to have CKD?
You can have renal disease without any azotemia at all
Clinical signs of kidney failure
Uremia
(T/F) Kidney disease is the presence of any structural or functional damage
True
CKD:
What are the structural damages that can occur?
- Nephroliths and/or Mineralization
- Polycystic Kidney Disease
- Renal dysplasia
- Infarcts
- Masses
CKD:
Common historical Findings are:
- PU/PD
- weight loss
- Inappetence
- Vomiting
- Lethargy
CKD:
Physical Exam Findings
- Poor BCS and Muscle mass
- Dehydration
- Small irregular kidneys, or big kidney & little kidney
- Uremic halitosis, uremic ulcers
- Poor hair coat
- Pale gums
- Heart murmur
- Blindness/ detached retinas
What does having poor muscle mass do to creatinine?
Lowers Creatinine
What can creatinine be affected by?
- Hydration status
- Muscle mass
Serial increase in creatinine should be noted and must be interpreted with ___________
USG
What is something that is going to tell us about GFR?
SDMA (Symmetric dimethylarginine)
- Byproduct of protein methylation
- Excreted primarily by renal clearance
What is the following describing?
- Correlated with creatinine and GFR
- INCREASES earlier than creatinine
- NOT affected by muscle mass like creatinine
SDMA test
(T/F) SDMA is always correct
False, It can sometimes be a little wonky
(T/F) Creatinine can be interpreted without USG
False
(T/F) Drop in USG may be the first sign of disease in cats
True
(T/F) Proteinuria may be first sign of disease in cats
False, first sign of disease in dogs
A USG < 1.035 in cats is consistent with _______________
CKD
A USG < 1.040 in cats merits ______________
monitoring
In cats a USG of _______________ is expected
> 1.040
(T/F) Dog’s USG varies more widely due to drinking habits
True
A USG of <1.025 in dogs could be consistent with ________________
CKD
When is UPC (Urine-protein creatinine ratio) appropriate?
- When sediment doesn’t have an indication of infection or inflammation
- < 250 RBC/hpf on sediment - Small amount of RBC/WBC expected with cystocentesis
- 50 RBC/ 1-2 WBC - No gross hematuria
- Urinary tract infection has been ruled out
What do you do if you have a first-time azotemic patient?
You have to get a UA (URINE CULTURE) to make sure that the reason they are azotemic, isn’t due to an infection
What percentage of cats with UTI have CKD?
66%
- Do bloodwork for these patients
What percentage of cats with stable CKD develop UTI?
30%
- patients with CKD have low USG which sometimes leads to UTI
Is the following describing Acute or Chronic?
- Sudden onset
- Previously healthy
- No weight loss
- Little or no PU/PD
- Maybe drugs or toxin
- Recent anesthesia
Acute
Is the following describing Acute or Chronic?
- Progressive illness
- Weight loss
- Anorexia
- PU/PD
- No obvious inciting cause
Chronic
Is the following describing Acute or Chronic: according to Lab Tests?
- Azotemia
- High phosphorus
- Acidosis
- K high or normal
- Normal PCV
- Active urine sediment
Acute
Is the following describing Acute or Chronic: according to Lab Tests?
- Azotemia
- High Phosphorus
- Acidosis
- K LOW or normal
- Non-reg anemia
- INACTIVE urine sediment
Chronic
What is the one big thing that is going to differentiate between Acute & Chronic?
The Non-reg anemia for CKD
Acute vs Chronic: Imaging
- Kidney may be large or swollen
- Could also be normal
Acute
Acute vs Chronic: Imaging
- Kidneys may be small or irregular
- Could also be normal
Chronic
What is IRIS Staging?
- A way to characterize the severity of the disease
- Based on serum creatinine in a stable patient
- Stage can also be amended based on SDMA - A way to characterize complications of disease that have been tied to prognosis
- Proteinuria (UPC)
- Hypertension (Blood pressure)
When do you IRIS Stage?
- AFTER diagnosis of CKD
- In a patient that is:
- Stable
- Decently hydrated
- At home
- No new medications, diet etc
- No new medical complications
What are some examples of information you can use to substantiate a decision about whether or not kidney disease is present and chronic?
- Weight loss
- Unkempt haircoat
- Muscle wasting
- Poorly concentrated urine
- Anemia
- Abnormal kidney structure
(T/F) CKD patients require more supportive care during a medical crisis than a patient that is otherwise normal and healthy. A few of the reasons for electing to hospitalize the CKD patient may include azotemia (over baseline), and electrolyte disturbances
True
(T/F) CKD patients who are severely azotemic should have their hydration corrected as quickly and aggressively as possible to prevent further damage to the kidney. A fluid monitoring plan may include daily PCV/TP, frequent physical assessment, and QID weight
False
- Can cause fluid overload
- The fluid monitoring plan statement is however, true
(T/F) Pyelonephritis is a common complication in CKD and factors that differentiate it from a lower urinary tract infection may include elevated creatinine from baseline, systemic signs of illness, kidney pain, and inflammatory leukogram. However, not all of these signs have to be present for it to be pyelonephritis, and it’s important to think about whether the patient might fit this clinical picture because it affects the intensity of care and monitoring
True
