Hypertension/renal failure CR Flashcards
What is this cases history and signalment?
Jess Hill is a 14 year old female domestic shorthair
She is a completely indoor cat and lives with one other cat (her brother)
She has been in the cattery for 2 weeks and the owners of the cattery suggested a visit to the vet as Jess seems to be drinking a lot.
Mrs Hill had noticed this at home too and also thinks Jess has lost some weight, so she has come to the surgery straight away.
What did Jess’s clinical exam show?
CLINCIAL EXAM
Jess weighs 2.58kg. According to the records she weighed 3.25kg last time she was weighed 6 months ago
Jess has a body condition score of 2/5
Clinical examination is otherwise unremarkable
Mrs Hill does not want to leave Jess at the surgery as she has only just come out of the cattery.
Do a SOAP analysis of this case?
SUBJECTIVE
- Drinking a lot
OBJECTIVE
- Weight loss (initially 3.25kg now 2.58kg)
- BCS = 2/5
ASSESSMENT
Degenerative – CKD,
Anomaly – polycystic kidney disease (PKD), liver disease
Metabolic – hyperthyroidism, psychogenic polydipsia, Diabetes mellitus, hypercalcaemia
Nutritional/neoplastic – lymphoma, transitional cell carcinoma of the bladder, malnourished, hypervitaminosis D. urolithiosis
Inflammatory/ idiopathic/ iatrogenic – UTI, cystitis, FeLV and FIV
Toxic/ trauma – ethylene glycol toxicity,
Vasculature – kidney infarction, glomerular disease
PLAN –
Investigation
Urinalysis – dipstick, sediment, USG. Ideally collect the sample by cystocentesis
Check for kidney function by USG, infection and crystals by sediment, glucose and protein using a dipstick.
Blood sample – CBC (look at WBC levels for infection/inflammatory) and PCV for anaemia and hydration) and
Biochemistry
check total protein, creatinine and electrolytes – kidney function
glucose – diabetes
azotaemia
liver enzymes
What were the next steps with Jess?
THE NEXT STEP
Jess has not eaten so you collect a blood sample and carry out cystocentesis for a urine sample. Creatinine could be high due to not eating.
Mrs Hill takes Jess home and awaits a phone call from you
What did the in house haematology show?
MCHC – slightly raised. Could be an artefact
What did the in house biochemistry show?
Creatinine – high
Phosphate – high
BUN – high
Potassium is low
What did the in house urinalysis show?
Isosthenuric and protein present. Also some blood in the urine – due to use performing cystocentesis.
What further tests would you like?
Before evening surgery you call Mrs Hill to discuss Jess’ results.
She gives you permission to send the urine off for a urine protein:creatinine ratio and urine culture
She doesn’t want Jess to have anymore blood tests
You arrange for Jess to come back after morning surgery tomorrow to have her blood pressure measured and an ocular examination
What were the results of the Urine protein:creatinine ratio?
RESULTS
Urine protein:creatinine ratio = 0.1 – this is fine. Reference <0.5 is normal
Urine culture negative
Systolic blood pressure is 230mmHg after repeated measurements – this high.
No abnormalities were detected on ocular examination
Outline an immediate treatment (including dosages/quantities required) and management plan for Jess?
Plan
Phosphate restricted diet and phosphate binders
Kaminox – potassium supplement
Anti-hypertensive agents = Benazepril (this is licensed for cats but risk of hyperkalaemia) or amlodipine (Ca channel blocker and causes vasodilation and reduces afterload). Also Telmisartan is licensed for cats with CKD and has proteinuria – doesn’t lead to hyperkalaemia. This tends to be well tolerated by cats. We discussed this and decided we would start with amlodipine as IRIS guidelines.
What are the IRIS guidelines on this case?
Guidelines on Iris =
- Phosphate restriction diets
- Start amlodipine
- Increase the dose of amlodipine
- Then add other drugs in
Dosage -
Amlodipine dose – initially 0.125-0.25mg/kg/day – given once daily.
Telmisartan – 0.25ml/kg/day.
What is the prognosis for Jess?
Prognosis – if well managed can live for years. Cat has hypertension which we will manage. Needs regular monitoring for blood pressure and electrolyte monitoring.
What was the CASE OUTCOME for Jess?
Jess was prescribed:
Amlodopine
Royal canin renal diet (sachets)
Kaminox
