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DMod3 Pt4 Urinary Tract Disease > DM3 Pt4-2 Chronic Kidney Disease (CKD) > Flashcards

DM3 Pt4-2 Chronic Kidney Disease (CKD) Flashcards

1
Q

What is Chronic Kidney Disease (CKD) previously known as?

A

Chronic renal failure

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2
Q

Why is CKD more commonly diagnosed in cats than in dogs?

A

Cats are 2 to 3 times more likely to suffer from CKD than dogs.

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3
Q

What causes CKD to progress to symptomatic renal failure?

A

CKD progresses to symptomatic renal failure when more than 2/3rds of functioning nephrons are lost.

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4
Q

What is the most common cause of CKD in cats?

A

Chronic interstitial nephritis (CIN)

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5
Q

What other diseases can lead to CKD besides Chronic Interstitial Nephritis?

A

Glomerulonephritis, bacterial pyelonephritis, FIP, nephrotoxins, bilateral hydronephrosis, chronic hypercalcaemia, neoplasia (renal lymphoma), polycystic kidney disease, amyloidosis, congenital abnormalities (renal dysplasia).

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6
Q

Which inherited disease is common in Persian cats and leads to CKD?

A

Polycystic kidney disease

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7
Q

What familial disease can cause CKD in Abyssinian cats?

A

Amyloidosis

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8
Q

How is Chronic Interstitial Nephritis (CIN) related to CKD?

A

CIN is the most common cause of CKD but is often the end stage of various kidney diseases.

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9
Q

Why is identifying the underlying cause of CKD important?

A

Recognizing less common causes may allow specific treatment for the underlying disease.

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10
Q

Which condition can result in bilateral hydronephrosis leading to CKD?

A

Nephroliths (kidney stones) and post-spay complications.

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11
Q

How is Chronic Kidney Disease (CKD) staged in cats?

A

By measuring plasma creatinine levels.

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12
Q

What is the creatinine level in Stage 1 of CKD in cats?

A

Creatinine <140 µmol/l

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13
Q

What is the creatinine level in Stage 2 of CKD in cats?

A

Creatinine 140-249 µmol/l (mild azotaemia)

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14
Q

What is the creatinine level in Stage 3 of CKD in cats?

A

Creatinine 250-439 µmol/l (moderate azotaemia)

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15
Q

What is the creatinine level in Stage 4 of CKD in cats?

A

Creatinine >440 µmol/l (severe azotaemia)

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16
Q

What is used to establish sub-stages of CKD?

A

Urine protein
ratio (UPC) and systolic blood pressure

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17
Q

Why is polyuria/polydipsia (PUPD) often not recognized in cats with CKD?

A

Cats may not be observed drinking and urinating, and retain their concentrating ability until later in the disease.

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18
Q

What causes uraemic gastropathy in cats with CKD?

A

Uraemic toxins directly affect the gastrointestinal tract, causing erosions, GI haemorrhage, vomiting, and anorexia.

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19
Q

What causes stomatitis and xerostomia in cats with CKD?

A

Conversion of urea to ammonia by bacterial urease in the mouth.

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20
Q

What are some complications caused by CKD in cats?

A

Dehydration, hypertension, hypokalaemia, anaemia, proteinuria, hyperphosphataemia, renal secondary hyperparathyroidism, and bacterial urinary tract infections.

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21
Q

What is the effect of hypokalaemia in CKD?

A

It causes muscle weakness and contributes to the progression of renal disease.

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22
Q

What percentage of cats with severe azotaemia experience metabolic acidosis?

A

50%

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23
Q

What is renal secondary hyperparathyroidism (R2HPT) in CKD?

A

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.

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24
Q

What is uraemic encephalopathy in CKD?

A

A condition involving altered consciousness and weakness, likely due to effects of PTH, altered ion pumps, neurotransmitter imbalances, and hypertension.

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25
Q

What is platelet dysfunction in CKD?

A

Uraemic toxins affect platelet function, leading to impaired platelet adhesion and increased bleeding tendencies.

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26
Q

Which age group is most commonly affected by CKD?

A

CKD is most common in older animals but can occur in younger animals due to conditions like renal dysplasia, hereditary diseases, or glomerulonephropathy.

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27
Q

Is there any sex predisposition in CKD cases?

A

No, CKD does not have sex predispositions.

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28
Q

Which breed is more likely to develop familial CKD, especially PKD?

A

Persian cats are more likely to develop Polycystic Kidney Disease (PKD).

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29
Q

What are classic signs of dehydration in a physical exam?

A

Skin tenting, tacky mucous membranes, and sunken eyes indicate dehydration.

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30
Q

What is a classic sign of hypokalaemic myopathy in cats?

A

Ventroflexion of the neck is a classic sign of hypokalaemic myopathy in cats with CKD.

31
Q

What is a typical finding when palpating kidneys in cats with CKD?

A

The kidneys are usually small and firm but can be normal-sized or enlarged depending on the cause (e.g., renal lymphoma, glomerulonephritis).

32
Q

What is the hallmark in diagnosing CKD based on urinalysis?

A

The hallmark is azotaemia in the presence of poorly concentrated urine.

33
Q

What urine specific gravity (SG) is consistent with chronic renal insufficiency in azotaemic cats?

A

A urine SG of less than 1.035 is consistent with chronic renal insufficiency.

34
Q

Which dipstick tests are unreliable in urinalysis?

A

Tests for white blood cells (WBCs) on dipsticks are unreliable.

35
Q

Why is bacterial culture and sensitivity (C&S) recommended for cats with CKD?

A

Urinary tract infections can complicate CKD and potentially worsen the condition.

36
Q

What can biochemistry and haematology reveal in CKD?

A

They provide information on azotaemia, hyperphosphataemia, hypokalaemia, anaemia, and may help exclude other differential diagnoses.

37
Q

What type of anaemia is commonly seen in CKD?

A

Mild to moderate non-regenerative normocytic, normochromic anaemia, or microcytic hypochromic anaemia if iron deficiency due to chronic GI blood loss.

38
Q

Why is systolic blood pressure measurement important in CKD?

A

Hypertension is a common complication and can accelerate CKD progression if untreated.

39
Q

What can ultrasonography reveal in cases of CKD?

A

It may show small, shrunken kidneys with loss of corticomedullary definition, or other causes like pyelonephritis, neoplasia, or polycystic kidney disease (PKD).

40
Q

Why is intravenous urography contraindicated in azotaemic patients?

A

It can worsen renal function in azotaemic patients, despite being useful for diagnosing ureteral obstruction.

41
Q

What are the primary aims of CKD treatment?

A

The aims are to: identify and treat any underlying disease, correct and maintain fluid balance, manage complications, and delay CKD progression.

42
Q

Why is fluid balance critical in CKD management?

A

Inadequate water intake quickly leads to dehydration, reduced renal perfusion, and further renal function decline.

43
Q

What is a common presentation of animals with CKD after a stable period?

A

They may present with acute decompensation after being stable for some time.

44
Q

What is the initial treatment for acute decompensation in CKD?

A

Intravenous fluid therapy at 2-3 times maintenance (4-6 ml/hr), depending on dehydration severity.

45
Q

Why are urea and creatinine measurements repeated after rehydration in acute decompensation?

A

To assess the degree of renal azotaemia, as a large part of the azotaemia may be pre-renal.

46
Q

Which type of dehydration is more common in cats with CKD?

A

Chronic or recurrent dehydration is more common in cats due to the chronic nature of CKD.

47
Q

What are the options for managing chronic dehydration in cats with CKD at home?

A

Options include feeding moist foods, supplementing with additional water, and possibly administering subcutaneous fluids.

48
Q

Where can owners find resources for increasing a cat’s water intake?

A

Resources, including tips for increasing water intake, are available at www.catprofessional.com.

49
Q

What is the most beneficial treatment for cats with renal disease?

A

Dietary therapy is the most beneficial treatment for cats with renal disease, particularly renal prescription diets.

50
Q

How much longer do cats with CKD on renal prescription diets typically live compared to those on a standard diet?

A

Cats with CKD on renal prescription diets live around 16 months compared to 7 months for those on a standard diet.

51
Q

What is the risk of over-restricting protein in the diet of cats with CKD?

A

Over-restricting protein can lead to protein-calorie malnutrition if the cat refuses to eat, causing body protein catabolism.

52
Q

What are the benefits of a restricted phosphate diet for CKD patients?

A

Restricted phosphate reduces the development of renal secondary hyperparathyroidism, which is associated with uraemic syndrome and may slow CKD progression.

53
Q

Why is protein restriction used in CKD, even though it does not delay progression?

A

Protein restriction helps reduce clinical signs of uraemic syndrome like inappetence, lethargy, and vomiting.

54
Q

What ingredients are typically included in renal prescription diets for CKD?

A

They typically include increased potassium, B vitamins, reduced sodium, energy-dense content, and Omega 3 PUFAs.

55
Q

What are common treatments for vomiting and nausea in CKD?

A

Gastroprotectants (H2 antagonists, sucralfate), and anti-emetics like maropitant (Cerenia) or metoclopramide are used.

56
Q

What treatments are available for managing inappetence in CKD?

A

Appetite stimulants such as cyproheptadine (Periactin) or mirtazapine, and assisted feeding via naso-oesophageal or gastrostomy tubes in severe cases.

57
Q

How is constipation managed in CKD patients?

A

Manage dehydration, correct electrolyte imbalances, and use oral lactulose.

58
Q

What are the common causes of hypokalaemia in CKD patients?

A

Hypokalaemia is caused by reduced potassium intake and increased urinary loss due to PU/PD.

59
Q

How is severe hypokalaemia treated in CKD?

A

Potassium chloride is added to intravenous fluids at a concentration of 20-30 mmol/l, not exceeding 0.5 mmol/kg/hr.

60
Q

What are the treatments for hyperphosphataemia if dietary management is insufficient?

A

Oral phosphate binders like aluminium hydroxide, calcium carbonate/chitosan, or lanthanum carbonate are used.

61
Q

What is the first-line treatment for systemic hypertension in CKD?

A

Amlodipine is the first-line treatment, while benazepril is usually ineffective alone.

62
Q

How are urinary tract infections treated in CKD?

A

Antibiotic treatment is based on urine culture and sensitivity.

63
Q

When is recombinant human erythropoietin used in CKD-related anaemia?

A

It is used for severe anaemia but has risks such as antibody development and higher costs.

64
Q

How is metabolic acidosis managed in CKD?

A

Oral bicarbonate may be used if levels are <15 mmol/l, but acid-base status must be closely monitored.

65
Q

How is proteinuria managed in CKD?

A

Proteinuria is treated with benazepril (an ACE inhibitor) or Semintra (an angiotensin receptor blocker), which helps slow disease progression.

66
Q

What are key management strategies to delay the progression of CKD?

A

Managing hypokalaemia, controlling systemic hypertension, and reducing hyperphosphataemia.

67
Q

Which drugs are licensed for the treatment of CKD in cats?

A

Benazepril (an ACE inhibitor) and telmisartan (an angiotensin receptor blocker).

68
Q

When should ACE inhibitors or ARBs like benazepril or telmisartan be used in CKD?

A

These drugs should be used when the urine protein
(UPC) ratio is greater than 0.4, indicating proteinuria.

69
Q

What are the potential benefits of benazepril in non-proteinuric cats?

A

Some cats experience improved quality of life and possibly extended survival time, though the benefits remain controversial.

70
Q

Which factors are associated with shorter survival in CKD?

A

Increased creatinine (higher IRIS stage), increased UPC, increased leukocytes, elevated plasma phosphate, low haemoglobin, low haematocrit, and elevated plasma urea concentration.

71
Q

What is the median survival time for a cat with IRIS Stage II CKD?

A

1151 days.

72
Q

What is the median survival time for a cat with IRIS Stage III CKD?

A

778 days.

73
Q

What is the median survival time for a cat with IRIS Stage IV CKD?

A

103 days.

74
Q

Why is IRIS stage predictive of survival in CKD cats?

A

The IRIS stage correlates with disease severity and is strongly predictive of survival time.

DMod3 Pt4 Urinary Tract Disease (7 decks)

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