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3. Cat & Dog 2 > MAIKO CKD pt 2 > Flashcards

MAIKO CKD pt 2 Flashcards

1
Q

goal of CKD treatment

A

Address the inciting cause of CKF
* Ideal
* But primary cause????
<><><><>
Detect and eliminate risk factors
* Stones
* Infection
<><><><>
* ↓ renal workload
* Gain weight
<><><><>
Slow progression of the renal dysfunction
* Fix anemia
* Control proteinuria
* Control BP

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2
Q

Hypokalemia with CKD
- common for who?
- Tx?
- goal?

A
  • More common in cats
    <><>
    Treatment
  • Diet higher in K
  • Oral supplements
    > Pill, powder, gel
    > Potassium citrate or gluconate
  • Supplement in fluids
    <><>
    Goal
  • Serum K>4mEq/L
  • Don’t wait until K below normal (If acidotic, K cell depleted)
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3
Q

CKD-Mineral Bone Disorder
- pathogenesis
- control

A

“Renal secondary hyperparathyroidism” = CKD-MBD
* Decreased activation of Vitamin D3 (calcitriol)
* Normally inhibits parathyroid gland
<><><>
Control of phosphorus is key
* Decreases calcitriol activation
* Renal diets
* Phosphate binders
* Goal: low normal range

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4
Q

When to worry about phosphorus for CKD?

A
  • Before it is even increased!!
  • When P>1.45mmol/L
  • Phosphorus > upper end when 75% ↓ in GFR
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5
Q

Management of Hyperphosphatemia in CKD

A
  • Low phosphorus diet (kidney diet)
    <><>
    Oral phosphate binders
  • Aluminiumhydroxide
  • Lanthanum carbonate (Renalzin)
  • Sevelamer (Renagel)
  • Chitosan (Epakitin)
  • Calcium carbonate (Viyo Renal)
  • Calcium carbonate plus magnesium carbonate (Pronefra)
    <><>
    Calcitriol
  • Evidence is weak in cats in particular
  • Expensive, requires close monitoring
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6
Q

Phosphate Binders in CKD
- what do they do? how do they work?
- how to administer?

A
  • Binds phosphate in GI tract
  • Efficient only if animal eats
  • Ideally with meals
  • For grazer prefer powder or switch to 3 meals / day
  • Calcium-based phosphate binders contraindicated if hypercalcemia
    > Prefer calcimimetic drugs (Cinacalcet)
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7
Q

Radiographs for CKF - what might we see? limitations?

A
  • Small and irregular kidneys
  • Or 1 small and 1 enlarged kidney
    <><>
    Limitations
  • Stones?
  • Obstructions?
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8
Q

Urinary Tract Ultrasound for CKD - what might we see?

A
  • Irregular shape and small size
  • Hyperechoic renal cortices
  • Loss of normal corticomedullar boundary
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9
Q

renal biopsy for CKD - should we do it?

A

NO - though we could do it and get information, we dont want to remove what little functional kidney the animal has left

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10
Q

Urine Culture - purpose for CKD

A
  • To rule out urinary tract infection
  • To treat adequately the patient
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11
Q

Hypertension and CKD
- how common?
- related to what in cats?
- consequences

A
  • Check blood pressure!!!
  • Hypertension in 20-65% cats, 31-54% dogs
  • 65-100% cats with retinal detachment have CKD
  • Etiology and relationship unclear (multifactorial)
    <><><><>
    Consequences
  • Retinal damage, blindness
  • Worsening of renal damage
  • Exacerbating proteinuria
  • Seizures, ischemic encephalopathy
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12
Q

When to treat ↑ blood pressure (related to CKD)?
goal?

A
  • Hypertension ↑ risk of uremic crisis and death
  • If blood pressure >150 mmHg, recheck BP 2-3 times
    <><>
    TREAT If
  • BP»200mmHg
  • Retinopathy/encephalopathy
    <><>
  • GOAL: reduce BP to <150mmHg
    <><>
    Otherwise
  • Follow the trend
  • Fundic exam
  • Recheck on 2-3 occasions
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13
Q

How to treat ↑ blood pressure with CKD patient?

A
  • Calcium channel blockers (Amlodipine)
  • Angiotensin-converting-enzyme inhibitors
    (enalapril, benazepril)
  • +/- Angiotensin receptor blockers (telmisartan)
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14
Q

Angiotensine-converting enzyme inhibitor (ACE inhibitors)
- when do we use this?
- what does it do?
- important for what species?
- drugs?

A
  • Treatment for high blood pressure
    <><>
    Reduces:
  • angiotensine II production
  • vascular resistance and volume retention
    <><>
  • 1st line in dogs
    <><>
  • Benazepril, Enalapril
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15
Q

Calcium Channel Blocker - use of this type of drug? important in what animal?

A
  • 1st line in hypertensive cats
    <><>
  • Amlodipine besylate
  • Long acting Calcium blocker
  • Causes vasodilation without cardiac effect
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16
Q

Telmisartan - what does this do?

A
  • RAAS inhibitor
  • Shown to efficiently lower BP
  • Not assessed in cats BP>200
17
Q

Tips for Hypertension Treatment for CKD patients?
- what is good for acute injury?

A
  • Don’t use telmisartan and benazepril when the patient is in acute kidney injury (or acute on chronic)
  • Use Amlodipine
  • If using Telmisartan monitor more frequently as dosage decrease frequently needed over time
18
Q

Hypertension Monitoring for CKD patient

A

Stage I-II moderate hypertension
* Recheck in 7-14 days
* Gradual adjustment of dose
<><>
Stage III-IV disease
* Recheck in 3-5 days
* Particularly if on other drugs
<><>
Telmisartan
* Longer onset of effect
* Potential need for dose decrease

19
Q

Proteinuria in CKD
- effect on prognosis?
- how we detect?
- thresholds for dogs and cats?
- should we do anything?

A
  • Associated with poorer prognosis, progression
    > Most often develops with later stage CKD
  • Urine Protein/ Creatinine Ratio (UPCS)
  • Dogs UPCR≥ 0.5 increased risk of uremic crises and death
  • Cats UPCR≥ 0.4 predicts shorter survival
    > Should be treated
    > Close monitoring required
    > CAUTION using ACEI/ARB in late stage disease
20
Q

Proteinuria Approach in Non Azotemic Dogs or cats

A
  • 0.5-1: Monitor
  • 1.1-2: Investigate
  • ≥2: Treat
21
Q

Proteinuria Approach in Azotemic Dogs or cats

A
  • ≥0.5 (Dogs): Treat
  • ≥0.4 (Cats): Treat
22
Q

Telmisartan (SEMINTRA)
- what does this drug do?

A

demonstrated to decrease proteinuria in CKD cats

23
Q

GI signs associated with CKD

A
  • Anorexia
  • Picky appetite
  • Nausea
  • Vomiting
24
Q

Maropitant use for CKD cats

A

Palliates Uremic Vomiting
* Significant decrease in vomiting
<><>
* (No difference in weight, appetite scores after 2 weeks)

25
Q

Mirtazapine use for CKD cats

A
  • Significant increase in appetite
  • Significant decrease in vomiting
    > weight gain, vs weight loss without
    > generally improvement of BCS
26
Q

Clinical Effect of Dehydration

A
  • Inappetence, lethargy, weakness = QOL * Constipation
  • Increased susceptibility to uremic crisis * Exacerbate stone formation
  • Increase occurrence of UTI
27
Q

renal diet - what is different? 4 goals?

A
  • Modified in protein, phosphorus, sodium and lipid composition
  • Supplemented in Omega-3 fatty acids and antioxydants
    <><><><>
    4 goals
  • Ameliorate or prevent clinical consequences of CKD and uremia
  • Slow progression of CKD and/or prolong survival
  • Minimize derangements of electrolyte, mineral and acid base balance
  • Maintain adequate nutrition
    <><><><><><><><>
  • Modified in protein, ↓ phosphorus
    > If high phosphorus: diet low in P
    > If protein losing nephropathy : focus on the proteins
  • Others: sodium and lipid composition
  • +++ omega 3 fatty acids
28
Q

effects of renal diets?

A
  • ↓ uremic episodes (clinical signs)
  • ↓ mortality rate
  • ↓ renal causes of death by 69%
  • ↓ risk for uremic crisis by 72%
  • In cats and dogs with spontaneous renal failure
  • Better than adult maintenance diet
29
Q

Feeding a CKD patient - how to focus on weight? what is the priority?

A
  • If BCS ≤ 4/9- try to put on weight
  • Of if obese- try to weight loss until BCS of 7/9
  • Priority: maintain muscle mass
  • APPETITE STIMULANT!!!!
30
Q

what stage of kidney disease is it best to start a renal diet at?

A

Stage 2
* More chance of being accepted
* If needed to achieve Phosphorus goals * If UPCR >0.4
<><><><>
* Stage 4 – introduction new diet may be difficult- calories intake paramount

31
Q

CKD prognosis

A
  • Cats stage II and III: 1-3 years??
  • Dogs stage III: 6-12 months
32
Q

if a cat has an acute on chronic renal failure episode, and gradually improves from stage 4 renal failure, when can the cat go home?

A
  • send the cat home when good appetite and energy back to normal
    > will still show kidney failure, eg. stage 2, but the cat will plateau here and never go back to normal…
    <><><><>
  • Eating well + creat plateau
  • SC fluids 50-70ml every 2 days
  • Recheck in 1 week (renal profile, PCV)
  • Meds: cerenia, mirtazapine

3. Cat & Dog 2 (50 decks)

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