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3. Cat & Dog 2 > MAIKO CKD > Flashcards

MAIKO CKD Flashcards

1
Q

EXAM
Azotemia
- definition
- 3 origins

A
  • ↑ urea nitrogen, creatinine, other non proteinaceous
    nitrogenous waste
  • 3 origins:
  • Pre-renal (dehydration)
  • Renal azotemia (renal lesion)
  • Post-renal (obstruction)
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2
Q

Uremic syndrome
- what is it? clinical signs?

A
  • Increased urea and other protein metabolism products
  • Clinical signs (Gastro-intestinal, acidosis, pneumonitis, osteodystrophy, encephalopathy)
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3
Q

urinalysis and USG interpretation
- renal vs pre-renal azotemia

A

If Azotemia and USG low> renal azotemia
If high> pre-renal
<><><><>
Normal USG in cats: 1,035-1,060

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4
Q

uremic vs azotemic

A

uremic means there are clinical signs for sure

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5
Q

International Renal Interest Society- IRIS Stages CKD
what are the stages?

A

Stage 1: no azotemia

Stage 2: mild azotemia

Stage 3 moderate azotemia

Stage 4: severe

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6
Q

Prevalence of Kidney Disease

A

1 in 43 cats
1 in 285 dogs

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7
Q

Chronic kidney disease pathogenesis

A
  • injured kidney
    > decreased in number and function of nephrons
    > compensation by increasing size of remaining nephrons
    > if 2/3 of renal mass is lost due to damage > lower USG, kidney insufficiency
    > if 3/4 lost > azotemia, kidney failure
    > uremia
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8
Q

CKD etiology, chronic vs acute

A
  • Sustained functionnal +/- structural damage over >2-3 months or multiple AKI events
    <><>
    Decline in renal function
  • Ischemic or toxic insult
  • Leptospirosis
  • Cellular injury, swelling, death
    <><>
  • Reversible → Acute
  • Irreversible → Chronic
    > Loss of 3/4 renal mass
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9
Q

Causes of Chronic Kidney Failure

A

We wont know in most cases
<><>
* Sequel to acute renal failure
* Urinary outflow obstruction
* Neoplasia (“big kidney” CRF, mayoccur w/o CRF)
* Inflammatory or infectious causes (Pyelonephritis,leptospirosis)
* Immunologic disorders (Glomerular diseases, lupus erythematous, vasculitis-FIP)
* Nephrotoxicants
* Renalischemia
* Nephrolithiasis – cause and effect ?
* Inherited/congenitaljuvenilerenalfailure(polycystickidneys)
* Idiopathic

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10
Q

Most Common reasons for CKD

A
  • Sequel to acute renal failure
  • Urinary outflow obstruction
  • Nephrotoxicants
  • Nephrolithiasis – cause and effect?
  • Idiopathic
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11
Q

Physical Examination for CKD findings

A
  • Dehydration
  • Pallor
  • Poor body condition score
  • +/- Oral ulcers
  • +/- small irregular kidneys
  • Assess muscle condition score!
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11
Q

Risk Factors for CKD for Cats

A
  • Poor body condition
  • Periodontal disease
  • Cystitis
  • Being male neutered vs female spayed
  • Anesthesia
  • Documented dehydration in the preceding year
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12
Q

How do you diagnose Kidney Disease?

A
  • Essential: Creat/Urea and USG
    <><>
  • History (+/- clinical signs)
  • Persistent azotemia
  • Inadequate urine concentrating ability
  • +/- non regenerative anemia
  • +/- abnormal sediment
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13
Q

Biochemistry Profile
CKF lab results, and reasons

A
  • Azotemia (↑ urea and creatinine)
  • ↑ phosphorus > ↓ phophorus excretion
  • ↑ total calcium > Complexed calcium
  • Metabolic acidosis > ↓ ability to excrete hydrogen ions
    > Common complication of CRF in cats (60-80%)
    <><><>
    Low USG > Inappropriate
    > Lost ability of concentrating urine
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14
Q

creatinine for CKD - use of this measure, what influences it, when increased

A

Influenced by muscle mass
* Increased in heavily muscled dogs (Greyhound)
* Decreased in dogs and cats with muscle loss
* Underestimation of azotemia in lean animals
<><>
Impacted by food
* Create level can ↑ by 20% after eating cooked meat
<><>
* ↑ when ≥75% reduction of renal mass

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15
Q

how to interpret creatinine
- muscle mass considerations
- when to measure
- when can use as a sign of CKD

A
  • Not reliable in very thin animals (overestimate
    kidney dysfunction)
  • Ideally measurement in fasted animals
  • Late marker of kidney dysfunction
16
Q

CREATININE
conventional markers of kidney function based on
Size of Dog- Reference Range (RR)

A

larger: 1/3 upper end of RR
mid size: 1/3 middle of RR
small: 1/3 lower end of RR

17
Q

creatinine - how do levels change based on GFR in early vs advanced renal failure?

A

X - blood creatinine
Y - GFR
> graph starts with steep negative slope, becomes shallower over time
<><><><>
- early renal disease - large changes in GFR have very little impact on blood creatinine
- advanced renal disease - small changes in GFR correspond to large changes in blood creatinine
> ie. we will see large changes in blood creatinine even when GFR changes a little bit in advanced renal disease

18
Q

creatine reference ranges - are they the same for everyone?

A

Not really
- Each Dog has its own “normal” Creat

19
Q

SDMA - what is it? what does it correlate with? values?

A

New Renal Biomaker
* Product of intranuclear protein metabolism
* Correlated with GFR strongly
* Correlated with creatinine and inulin clearance
* Cut off <14ug/dL IN ADULTS!
> higher for puppies

20
Q

SDMA
- effect of body mass
- sensitivity vs sCr
- correlation to renal function
- possible issues? when its ok to use

A
  • Not affected by lean body mass
  • More sensitive marker for kidney disease than sCr in dogs and cats
  • Persistent increases in SDMA >14ug/dL suggestive of reduced kidney function
  • But specificity??
  • Use it on lean animals
21
Q

IRIS Classification staging - when should we stage an animal?

A
  • Stage IRIS when animal stable (not in AKI)
  • Wait for creatinine plateau before staging
22
Q

Urinalysis for CKD - what might we see?

A
  • Impaired urine dilution and concentration
  • +/- proteinuria and hematuria
  • Sediment
    > Casts (tubular lesions)
    > Bacteria
    > Cylindruria
23
Q

Anemia of CKD
- characterize
- how common
- reasons

A
  • Nornomocytic, normochromic, non regenerative
  • 30-65% of cats with CKF
    <><><><>
    Reasons
  • ↓ erythropoietin production
  • ↓ RBC survival
  • GI tract blood loss
  • Uremic toxins ↓ erythropoiesis
  • Poor nutrition
  • Acidosis
  • Iatrogenic
  • Infection
  • Medication (ACEI and aluminium hydroxide)
24
Q

Options to Treat Anemia of CKD?

A
  • Address GI hemorrhage
  • Blood transfusion (if tachycardia, weakness)
  • AVOID Anabolic steroid (stanozolol)
    > Benefits questionable
    > Risk for hepatotoxicity in cats
  • Administration of erythrocyte-stimulating agents (ESAs)
25
Q

Darbepoetin for anemia in CKD - when should we consider it? outcomes?
adverse effects?

A
  • Consider once PCV < 20% (historic)
  • Consider once PCV < 25% (IRIS group)
  • Estimated success 60-65%
    > anecdotally higher
  • Target PCV 28-30%
    <><><><>
    Adverse Effects
  • Polycythemia
  • Hypertension
    <><>
  • Fever
  • Seizure
  • Arthralgia
  • Iron deficiency
  • Pure red cell aplasia
26
Q

darbapoietin
- monitoring
- expected response time

A
  • Recheck weekly until target reached
    > PCV
    > Blood pressure (most common side effect hypertension)
  • Median response is 3 weeks
    > then can decrease injections (from weekly to every 2 weeks)
    > Recheck every 2 weeks until stable

3. Cat & Dog 2 (50 decks)

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