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year 4 small animal studies > Internal Medicine: Chronic Kidney Disease > Flashcards

Internal Medicine: Chronic Kidney Disease Flashcards

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1
Q

What is the definition of chronic kidney disease?

A

Structural or functional abnormalities of one or both kidneys that have been there for 3 months of longer

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2
Q

Is CKD more prevalent in cats or dogs?

A

Cats

increases with age but can affect young

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3
Q

What are congenital causes of CKD in dogs/cats?

A
  • Renal dysplasia
  • Polycystic kidney disease
  • Amyloidosis
  • Fanconi-like syndrome
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4
Q

What are acquired causes of CKD in dogs and cats?

A
  • Idiopathic tubulointerstitial nephritis
  • Glomerular disease
  • Amyloidosis
  • Sequel to AKI
  • Lower urinary tract obstruction
  • Pyelonephritis
  • Hypercalcaemia
  • Renal neoplasia
  • Nephrotoxic drugs
  • Hypokalaemia in cats
  • Hypertension
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5
Q

How does CKD progress even in the absence of active kidney disease?

A
  • Intraglomerular hypertension- increased single nephron glomerular filtration rate
  • Systemic hypertension
  • Proteinuria- glomerular diseases tend to progress more quickly than those affected
  • Precipitation of calcium phosphate in renal tubules
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6
Q

What happens at each IRIS stage of CKD?

A
  • Stage 1- primary renal injury
  • Stage 2- mild azotaemia, maladaptions
  • Stage 3- Uraemua, systemic complications
  • Stage 4- End-stage renal failure

International renal intrest society

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7
Q

What are the clinical signs of CKD?

A
  • Weight loss
  • Poor appetite
  • Dullness, lethargy, sleeping
  • PUPD
  • Dehydration
  • Consitpation
  • Poor hair coat
  • Neurological signs
  • Signs related to hypertension
  • Oedema/ascites
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8
Q

What is used to stage CKD?

A
  • Creatinine- stage
  • Proteinuria- substage
  • Blood pressure- substage
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9
Q

What is the upper boundary of stage 1, 2 and 3?

A
  • Stage 1- 140 umol/l
  • Stage 2- 250 umol/l
  • Stage 3- 440 umol/l

Stable- creatinine not relevant if dehydrated etc

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10
Q

What is the optimal minimum databse in CKD?

A
  • History- exposure to toxins/nephrotoxic drugs
  • Physical examination- including eyes, thyroid in cat
  • Haematology, biochem, urinalysis
  • Blood pressure
  • Abdominal radiographs
  • Abdominal ultrasound
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11
Q

After diagnosis (bloods) of CKD what is the diagnostic approach?

A
  • Determine diagnosis and stage
  • Identify ongoing active renal diseases
  • Identify any complications
  • Identify concurrent conditions
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12
Q

What is important to check in haematology?

A

Haematocrit
Haemoglobin
RBC- most important

Anaemia may occur needs to be managed

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13
Q

What does urea and creatinine correlate with?

A

Urea
* correlated with clinical signs

Creatinine
* Correlates with GFR
* Muscle mass

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14
Q

What aboutthe following biochem should be checked?
1. Albumin
2. Potassium
3. Phosphorus
4. Calcium

A
  1. Decrease in PLN- protein losing nephropathy
  2. Frequently low- increase at end stage
  3. Initiated secondary hyperparathyroidism/metastatic calcification
  4. Increase, normal or decrease-
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15
Q

What may urinalysis show with CKD?

A

Isothenuric, moderately concentrated

  • May be normal if patient hydrated
  • Definetly abnormal in dehydration
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16
Q

When should UPCR be done for CKD?

A

If sediment is inactive

Urea protein creatinine ratio

17
Q

How is a uraemic crisis treated?

A
  • IVFT
  • Hartmanns or Saline
  • Supply ongoing maintenance
  • Monitor electrolytes and azotaemia
  • Reduce IVFT if animal starts drinking
18
Q

How is stage 1 CKD treated?

A
  • Stop all potentially nephrotoxic drugs
  • Identify and eliminate any on-going specific diseases
  • Measure blood pressure and UPCR
  • Reduce proteinuria- RAAS inhibition and dietary reduction and antiplatelet drugs
  • Control hypertension- < 160
    ACEi
    Telmisartan
    Amlodipine
  • Combat dehydration- wet diet, supply fountains/taps, large bowl, chicken flavoured water
19
Q

When should ACE inhibitors not be used?

A

If dehydrated or hypovalaemic patient

20
Q

When should a renal diet be started?

A

Stage 2 onwards

All dogs with proteinuric

21
Q

How do renal diets differ?

A
  • Protein restriction- reduces clin signs, stops uraemic crisis, reduces proteinuria, reduced PUPD, reduced acid load
  • Phosphate restriction
  • Omege 3 fatty acids
  • Fibre
  • Decreased sodium
  • Water soluble vitamins
22
Q

Other then renal diet what can help control phosphate?

What level are you aiming for?

A

Add phosphate binder it diet alone

Stage 2 < 1.5mmol/l
Stage 3 < 1.6mmol/l
Stage 4 < 1.9 mmol/l

23
Q

How is hypokalaemia avoided?

A
  • Supplement IVFT with KCL
  • Oral supplements- potassium gluconate, potassium citrate
  • Aim for > 4 mmol/l
24
Q

Overall how is stage 2 treated?

A
  • Control dehydration
  • Control hypertension
  • If proteinuric, start ACEi
  • Start renal diet
  • Control phosphate
  • Supplement potassium
25
Q

What additional treatments are recomended for CKD?

A
  • Treat nausea and vomiting
  • Consider EPO- erythropoetin (anaemia)
  • Control metabolic acidosis
  • Consider subcutaneous fluids
26
Q

What can be used at stage 3 to control vomiting, nausea and poor appetite?

A
  • Antiemetics
  • Appetite stimulants- mitrazapine, capromorelin
  • Reduce gastric acid secretion
  • Sucalfate
  • Consider feeding tube
27
Q

How can anaemia be managed for stage 3?

A
  • Avoid excessive blood sampling
  • Minimise GI blood loss- ulcers
  • Treat iron defiency
  • Transfusions
  • EPO replacement
28
Q

What additional treatment can be added for stage 4 CKD?

A
  • Control phosphate < 1.9 mmol/l
  • Intensify efforts to provide nutrition
  • More likely to require extra fluids
  • Consider euthanasia
29
Q

What can be used for a prognosis?

A
  • IRIS stage at baseline
  • Proteinuria- risk factor for uraemia and death

year 4 small animal studies (97 decks)

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