IRIS Staging CKD Flashcards
Generellt
IRIS CKD staging gäller endast för hundar och katter med stabil CKD. Stabil CKD definieras som patient med serum creatinin som fluktuerar <25 umol/l under en period på 2-4 veckor. Andra sjudomstillstånd kan ge stora fluktationer i creatin, och då mer rätt att stage efter AKI.
Om azotemi är persisterande över veckor till månader -> CKD och non-reversibel!
Om plötsligt upptäckt azotemi, eller progression enligt ovan, viktigt att:
- 1) Identifiera AKI
- 2) Avgöra om azotemi är: Prerenal, renal eller postrenal.
- 3) Om orsakten till AKI är renal -> avgöra om AKI er ren akut, eller acute on cronic (Dekompenserat CKD)
Den akut dåliga partient med ustabil njursjukdom bör få sina njurar graded -> den kan övergå till att ha en stabil CKD efter 2-4 veckor (Som resultat av AKI, eller stabilserat acute on chronic).
CKD bör stages om var 6e månad i den stabile patient.
CKD indelas från grad 1-4, med underkategorierna proteinuri och blodtryck.
Baserat ffa. på mätning av kreatinin, då ingen bättre markör för GFR finns i nuläget. IRIS tagit med SDMA i CKD staging, men SDMA undersökt fortfarande i hund och katt. IRIS medvetande om stor njurskada innan stegring i plasma kreatinin, därmed har steg 1 och 2 fortfarnde normal kreatinin enligt referensvärden.
http: //www.iris-kidney.com/pdf/IRIS_Staging_of_CKD_modified_2019.pdf
http: //www.iris-kidney.com/pdf/IRIS_Pocket_Guide_to_CKD.pdf
CKD Stage 1 - Hund
Kreatinin <125 umol/L
SDMA <18 ug/dL
Normal blood creatinine or normal or mild increase blood SDMA. Some other renal abnormality present, such a
abnormal renal palpation or renal imaging findings, proteinuria of renal origin, abnormal renal biopsy results, increasing blood creatinine or SDMA concentrations in samples collected serially, inadequate urinary concentrating ability in the absence on an extra-renal cause. En eller fler av dessa starker misstanken om CKD.
SDMA kan hjälpa med att stage CKD rätt i dom patienterna som har falsk lågt creatinin, pga nedsatt muskelmassa.
Persistently elevated blood SDMA concentration (>14 µg/dl) may be used to diagnose early CKD
OM kreatinin <125 umol/l, men SDMA >18 ug/dL, klassificeras den som Stage 2, trots Stage 1 på Kreatinin
CKD Stage 1 - Katt
Kreatinin <140umol/L
SDMA <18 ug/dL
Normal blood creatinine or normal or mild increase blood SDMA. Some other renal abnormality present (such as, inadequate urinary concentrating ability without identifiable non-renal cause, abnormal renal palpation or renal imaging findings, proteinuria of renal origin, abnormal renal biopsy results, increasing blood creatinine or SDMA concentrations in samples collected serially).
Persistently elevated blood SDMA concentration (>14 µg/dl) may be used to diagnose early CKD.
OM kreatinin <140 umol/l, men SDMA >18 ug/dL, klassificeras den som Stage 2, trots Stage 1 på Kreatinin
CKD Stage 2 - Hund
Kreatinin 125-250umol/L
SDMA 18-35 ug/dL
Normal or mildly increased creatinine, mild renal azotemia
(lower end of the range lies within reference ranges for
creatinine for many laboratories, but the insensitivity of
creatinine concentration as a screening test means that
patients with creatinine values close to the upper
reference limit often have excretory failure). Mildly
increased SDMA.Clinical signs usually mild or absent
OM kreatinin 125-250 umol/l, men SDMA >35 ug/dL, klassificeras den som Stage 3, trots Stage 2 på Kreatinin
CKD Stage 2 - Katt
Kreatinin 140-250 umol/L
SDMA 18-35 ug/dL
Normal or mildly increased creatinine, mild renal azotemia
(lower end of the range lies within reference ranges for
creatinine for many laboratories, but the insensitivity of
creatinine concentration as a screening test means that
patients with creatinine values close to the upper
reference limit often have excretory failure). Mildly
increased SDMA.Clinical signs usually mild or absent.
OM kreatinin 140-250 umol/l, men SDMA >35 ug/dL, klassificeras den som Stage 3, trots Stage 2 på Kreatinin
CKD stage 3 - Hund/Katt
Kreatinin: 251-440 umol/L
SDMA: 36-54 ug/dL
Moderate renal azotemia. Many extra renal signs may be
present, but their extent and severity may vary. If signs
are absent, the case could be considered as early Stage
3, while presence of many or marked systemic signs
might justify classification as late Stage 3.
OM kreatinin 251-440 umol/l, men SDMA >54 ug/dL, klassificeras den som Stage 4, trots Stage 3 på Kreatinin
CKD Stage 4 - Hund/katt
Kreatinin: >440 umol/L
SDMA: >54 ug/dL
Increasing risk of systemic clinical signs and uremic
crises.
Substaging - Proteinuri - Hund
UPC - Urin Protein:kreatinin kvot
Non-proteinuric: < 0.2
Borderline proteinuric: 0.2 - 0.5
Proteinuric: >0.5
Canine and feline patients that are persistently borderline proteinuric should be reevaluated within 2 months and re-classified as appropriate.
Proteinuria may decline as renal dysfunction worsens and so may be less frequent
in dogs and cats in Stages 3 and 4.
Substaging - Proteinuri - Katt
UPC - Urin Protein:kreatinin kvot
Non-proteinuric: < 0.2
Borderline proteinuric: 0.2 - 0.4
Proteinuric: >0.4
Canine and feline patients that are persistently borderline proteinuric should be reevaluated within 2 months and re-classified as appropriate.
Proteinuria may decline as renal dysfunction worsens and so may be less frequent
in dogs and cats in Stages 3 and 4.
Substaging - Blodtryck - Hund/katt
Systolic Blood Pressure in mmHg
<140 Normotensive: Risk of Future Target Organ Damage = Minimal
140 – 159 Prehypertensive: Risk of Future Target Organ Damage = Low
160 – 179 Hypertensive: Risk of Future Target Organ Damage = Moderate
> 180 Severely hypertensive: Risk of Future Target Organ Damage = High
However, some breeds of dog, particularly sight hounds, tend to have higher blood
pressure than other breeds. It is preferable to use breed-specific reference ranges if
available.
Staging - exempel
Euvolemic cat with stable renal function Creatinine 200 µmol/l(2.3 mg/dl) SDMA 22 µg/dl UP/C 0.32 Systolic blood pressure 200 mm Hg
Classification – IRIS CKD Stage 2, borderline proteinuric, severely hypertensive.
Same cat after antihypertensive treatment Creatinine 220 µmol/l(2.5 mg/dl) SDMA 24 µg/dl UP/C 0.12 Systolic blood pressure 155 mm Hg
New classification – IRIS CKD Stage 2, non-proteinuric, prehypertensive (treating).
Staging - exempel
Euvolemic dog with stable renal function Creatinine 230 µmol/l(2.6 mg/dl) SDMA 39 µg/dl UP/C 0.8 Systolic blood pressure 155 mm Hg
Classification – IRIS CKD Stage 3,, proteinuric, prehypertensive
Note: As described above in the Discrepancies between creatinine and SDMA section,
if blood SDMA is persistently >35 µg/dl in a canine patient whose blood creatinine is between
1.4 and 2.8 mg/dl (IRIS CKD stage 2 based on creatinine), this dog should be staged and
treated as an IRIS CKD Stage 3 patient
Same dog after antiproteinuric treatment Creatinine 240 µmol/l(2.7 mg/dl) SDMA 42 µg/dl UP/C 0.4 Systolic blood pressure 155 mm Hg
New classification – IRIS CKD Stage 3, borderline proteinuric (treating),
prehypertensive
