Kidney Disease

Question 0

How would you differentiate between chronic kidney disease and acute kidney injury?

Answer 0

AKI= hyperkalaemia, oliguria, Anuria 
CKD = patients usually have weight loss, hypokalaemia, polydipsia and polyuria

Question 1

What is the normal range for USG for cats and dogs?

Answer 1

Cats: 1.030 - 1.060
Dogs: 1.015-1.050

Question 2

How would you use dietry management to treat uroliths? Including struvite, calcium oxalate and urate.

Answer 2

Struvite = dissolved by dietry management. Decrease protein, less substrate for bacteria to produce ammonium ion, decrease magnesium and phosphate, diuresis ( increase salt). 
Oxalate= canned food! increase water content  decrease calcium and oxalate in diet, increase salt, will increase thirst. Increase in dietry fibre to reduce intestinal absorption of calcium. (Potassium citrate) 
Urate= maximise water intake, alkalinising diet (potassium citrate)

Question 3

Give 4 risk factors that predispose cats to FIC (feline idiopathic cystitis)

Answer 3

• sedentary lifestyle
• litter tray
• limited outdoor access
• overweight
• between the ages of 2-7 years old.
• ad lib feeding, dry food
• multicat household

Question 4

Give some examples of long term management advice you’d give an owner, who’s cat had been diagnosed with FIC (feline idiopathic cystitis)

Answer 4

Educate them about need for increased water intake for cat. Decrease stressors, eg increase number of litter trays ( n+1), change location of litter trays so cat has more privacy, weight loss - encourage outside, lead? Try covered litter trays, dietry management, de-stress diets prior to known stressor event eg going on holiday. These diets contain L-tryptophan or alpha-casozepine.

Question 5

How would you treat an emergency obstructed cat?

Answer 5

Start with IVFT, empty bladder with cystocentesis or during catheter placement, GA needed for catheter placement, relieve obstruction by flushing bladder until fluid comes out clear, fluid must be warm. Leave in place for 24 hours and monitor urine output. Increase fluid administration (oral as much as possible), as will be pollakiuric. Watch urine chemistry (eg potassium, as usually hypokalaemic)

Question 6

What are the clinical signs associated with cystitis?

Answer 6

Haematuria, pollakiuria, recurrent UTI, dysuria/stranguria, incontinence witnessed by owners, small thickened bladder

Question 7

Why does chronic kidney disease cause secondary hyperparathyroidism?

Answer 7

PTH induces osteoclasts to read down bone to release Ca2+ into the blood! promotes it’s reabsorption in the kidneys. Inhibits phosphorus reabsorption at the kidneys. Renal insufficiency means phosphorus is always high and calcium always low, leading to constant production of PTH and hyperparathyroidism.