DM3 Pt4-2 Chronic Kidney Disease (CKD) Flashcards
What is Chronic Kidney Disease (CKD) previously known as?
Chronic renal failure
Why is CKD more commonly diagnosed in cats than in dogs?
Cats are 2 to 3 times more likely to suffer from CKD than dogs.
What causes CKD to progress to symptomatic renal failure?
CKD progresses to symptomatic renal failure when more than 2/3rds of functioning nephrons are lost.
What is the most common cause of CKD in cats?
Chronic interstitial nephritis (CIN)
What other diseases can lead to CKD besides Chronic Interstitial Nephritis?
Glomerulonephritis, bacterial pyelonephritis, FIP, nephrotoxins, bilateral hydronephrosis, chronic hypercalcaemia, neoplasia (renal lymphoma), polycystic kidney disease, amyloidosis, congenital abnormalities (renal dysplasia).
Which inherited disease is common in Persian cats and leads to CKD?
Polycystic kidney disease
What familial disease can cause CKD in Abyssinian cats?
Amyloidosis
How is Chronic Interstitial Nephritis (CIN) related to CKD?
CIN is the most common cause of CKD but is often the end stage of various kidney diseases.
Why is identifying the underlying cause of CKD important?
Recognizing less common causes may allow specific treatment for the underlying disease.
Which condition can result in bilateral hydronephrosis leading to CKD?
Nephroliths (kidney stones) and post-spay complications.
How is Chronic Kidney Disease (CKD) staged in cats?
By measuring plasma creatinine levels.
What is the creatinine level in Stage 1 of CKD in cats?
Creatinine <140 µmol/l
What is the creatinine level in Stage 2 of CKD in cats?
Creatinine 140-249 µmol/l (mild azotaemia)
What is the creatinine level in Stage 3 of CKD in cats?
Creatinine 250-439 µmol/l (moderate azotaemia)
What is the creatinine level in Stage 4 of CKD in cats?
Creatinine >440 µmol/l (severe azotaemia)
What is used to establish sub-stages of CKD?
Urine protein
ratio (UPC) and systolic blood pressure
Why is polyuria/polydipsia (PUPD) often not recognized in cats with CKD?
Cats may not be observed drinking and urinating, and retain their concentrating ability until later in the disease.
What causes uraemic gastropathy in cats with CKD?
Uraemic toxins directly affect the gastrointestinal tract, causing erosions, GI haemorrhage, vomiting, and anorexia.
What causes stomatitis and xerostomia in cats with CKD?
Conversion of urea to ammonia by bacterial urease in the mouth.
What are some complications caused by CKD in cats?
Dehydration, hypertension, hypokalaemia, anaemia, proteinuria, hyperphosphataemia, renal secondary hyperparathyroidism, and bacterial urinary tract infections.
What is the effect of hypokalaemia in CKD?
It causes muscle weakness and contributes to the progression of renal disease.
What percentage of cats with severe azotaemia experience metabolic acidosis?
50%
What is renal secondary hyperparathyroidism (R2HPT) in CKD?
A condition where increased parathyroid hormone leads to signs of uraemia and calcium resorption from bone, affecting up to 100% of animals with end-stage renal disease.
What is uraemic encephalopathy in CKD?
A condition involving altered consciousness and weakness, likely due to effects of PTH, altered ion pumps, neurotransmitter imbalances, and hypertension.
What is platelet dysfunction in CKD?
Uraemic toxins affect platelet function, leading to impaired platelet adhesion and increased bleeding tendencies.
Which age group is most commonly affected by CKD?
CKD is most common in older animals but can occur in younger animals due to conditions like renal dysplasia, hereditary diseases, or glomerulonephropathy.
Is there any sex predisposition in CKD cases?
No, CKD does not have sex predispositions.
Which breed is more likely to develop familial CKD, especially PKD?
Persian cats are more likely to develop Polycystic Kidney Disease (PKD).
What are classic signs of dehydration in a physical exam?
Skin tenting, tacky mucous membranes, and sunken eyes indicate dehydration.
What is a classic sign of hypokalaemic myopathy in cats?
Ventroflexion of the neck is a classic sign of hypokalaemic myopathy in cats with CKD.
What is a typical finding when palpating kidneys in cats with CKD?
The kidneys are usually small and firm but can be normal-sized or enlarged depending on the cause (e.g., renal lymphoma, glomerulonephritis).
What is the hallmark in diagnosing CKD based on urinalysis?
The hallmark is azotaemia in the presence of poorly concentrated urine.
What urine specific gravity (SG) is consistent with chronic renal insufficiency in azotaemic cats?
A urine SG of less than 1.035 is consistent with chronic renal insufficiency.
Which dipstick tests are unreliable in urinalysis?
Tests for white blood cells (WBCs) on dipsticks are unreliable.
Why is bacterial culture and sensitivity (C&S) recommended for cats with CKD?
Urinary tract infections can complicate CKD and potentially worsen the condition.
What can biochemistry and haematology reveal in CKD?
They provide information on azotaemia, hyperphosphataemia, hypokalaemia, anaemia, and may help exclude other differential diagnoses.
What type of anaemia is commonly seen in CKD?
Mild to moderate non-regenerative normocytic, normochromic anaemia, or microcytic hypochromic anaemia if iron deficiency due to chronic GI blood loss.
Why is systolic blood pressure measurement important in CKD?
Hypertension is a common complication and can accelerate CKD progression if untreated.
What can ultrasonography reveal in cases of CKD?
It may show small, shrunken kidneys with loss of corticomedullary definition, or other causes like pyelonephritis, neoplasia, or polycystic kidney disease (PKD).
Why is intravenous urography contraindicated in azotaemic patients?
It can worsen renal function in azotaemic patients, despite being useful for diagnosing ureteral obstruction.
What are the primary aims of CKD treatment?
The aims are to: identify and treat any underlying disease, correct and maintain fluid balance, manage complications, and delay CKD progression.
Why is fluid balance critical in CKD management?
Inadequate water intake quickly leads to dehydration, reduced renal perfusion, and further renal function decline.
What is a common presentation of animals with CKD after a stable period?
They may present with acute decompensation after being stable for some time.
What is the initial treatment for acute decompensation in CKD?
Intravenous fluid therapy at 2-3 times maintenance (4-6 ml/hr), depending on dehydration severity.
Why are urea and creatinine measurements repeated after rehydration in acute decompensation?
To assess the degree of renal azotaemia, as a large part of the azotaemia may be pre-renal.
Which type of dehydration is more common in cats with CKD?
Chronic or recurrent dehydration is more common in cats due to the chronic nature of CKD.
What are the options for managing chronic dehydration in cats with CKD at home?
Options include feeding moist foods, supplementing with additional water, and possibly administering subcutaneous fluids.
Where can owners find resources for increasing a cat’s water intake?
Resources, including tips for increasing water intake, are available at www.catprofessional.com.
What is the most beneficial treatment for cats with renal disease?
Dietary therapy is the most beneficial treatment for cats with renal disease, particularly renal prescription diets.
How much longer do cats with CKD on renal prescription diets typically live compared to those on a standard diet?
Cats with CKD on renal prescription diets live around 16 months compared to 7 months for those on a standard diet.
What is the risk of over-restricting protein in the diet of cats with CKD?
Over-restricting protein can lead to protein-calorie malnutrition if the cat refuses to eat, causing body protein catabolism.
What are the benefits of a restricted phosphate diet for CKD patients?
Restricted phosphate reduces the development of renal secondary hyperparathyroidism, which is associated with uraemic syndrome and may slow CKD progression.
Why is protein restriction used in CKD, even though it does not delay progression?
Protein restriction helps reduce clinical signs of uraemic syndrome like inappetence, lethargy, and vomiting.
What ingredients are typically included in renal prescription diets for CKD?
They typically include increased potassium, B vitamins, reduced sodium, energy-dense content, and Omega 3 PUFAs.
What are common treatments for vomiting and nausea in CKD?
Gastroprotectants (H2 antagonists, sucralfate), and anti-emetics like maropitant (Cerenia) or metoclopramide are used.
What treatments are available for managing inappetence in CKD?
Appetite stimulants such as cyproheptadine (Periactin) or mirtazapine, and assisted feeding via naso-oesophageal or gastrostomy tubes in severe cases.
How is constipation managed in CKD patients?
Manage dehydration, correct electrolyte imbalances, and use oral lactulose.
What are the common causes of hypokalaemia in CKD patients?
Hypokalaemia is caused by reduced potassium intake and increased urinary loss due to PU/PD.
How is severe hypokalaemia treated in CKD?
Potassium chloride is added to intravenous fluids at a concentration of 20-30 mmol/l, not exceeding 0.5 mmol/kg/hr.
What are the treatments for hyperphosphataemia if dietary management is insufficient?
Oral phosphate binders like aluminium hydroxide, calcium carbonate/chitosan, or lanthanum carbonate are used.
What is the first-line treatment for systemic hypertension in CKD?
Amlodipine is the first-line treatment, while benazepril is usually ineffective alone.
How are urinary tract infections treated in CKD?
Antibiotic treatment is based on urine culture and sensitivity.
When is recombinant human erythropoietin used in CKD-related anaemia?
It is used for severe anaemia but has risks such as antibody development and higher costs.
How is metabolic acidosis managed in CKD?
Oral bicarbonate may be used if levels are <15 mmol/l, but acid-base status must be closely monitored.
How is proteinuria managed in CKD?
Proteinuria is treated with benazepril (an ACE inhibitor) or Semintra (an angiotensin receptor blocker), which helps slow disease progression.
What are key management strategies to delay the progression of CKD?
Managing hypokalaemia, controlling systemic hypertension, and reducing hyperphosphataemia.
Which drugs are licensed for the treatment of CKD in cats?
Benazepril (an ACE inhibitor) and telmisartan (an angiotensin receptor blocker).
When should ACE inhibitors or ARBs like benazepril or telmisartan be used in CKD?
These drugs should be used when the urine protein
(UPC) ratio is greater than 0.4, indicating proteinuria.
What are the potential benefits of benazepril in non-proteinuric cats?
Some cats experience improved quality of life and possibly extended survival time, though the benefits remain controversial.
Which factors are associated with shorter survival in CKD?
Increased creatinine (higher IRIS stage), increased UPC, increased leukocytes, elevated plasma phosphate, low haemoglobin, low haematocrit, and elevated plasma urea concentration.
What is the median survival time for a cat with IRIS Stage II CKD?
1151 days.
What is the median survival time for a cat with IRIS Stage III CKD?
778 days.
What is the median survival time for a cat with IRIS Stage IV CKD?
103 days.
Why is IRIS stage predictive of survival in CKD cats?
The IRIS stage correlates with disease severity and is strongly predictive of survival time.
