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Applied Clinical Veterinary Nursing > Nursing the CKD cat > Flashcards

Nursing the CKD cat Flashcards

1
Q

which species is more affected by chronic kidney disease?

A

cats (3x more prevalent than in dogs)

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2
Q

what type of disease is chronic kidney disease?

A

functional and/or structural disease of >3 months duration

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3
Q

what is the pathogenesis of chronic kidney disease?

A

gradual, progressive, irreversible nephron loss

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4
Q

what is the aim of chronic kidney disease management?

A

reducing workload of the remaining nephrons and preventing further damage

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5
Q

what is no nephron loss classed as?

A

normal kidney function

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6
Q

what is the loss of 50% of nephrons classed as?

A

subclinical kidney disease

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7
Q

what happens as a result of 67% kidney loss?

A

lose their concentrating ability

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8
Q

what USG indicates the kidneys have lost concentrating ability?

A

<1.030 in dogs
<1.035 in cats

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9
Q

at what percentage nephron loss do the kidney lose their concentrating ability?

A

67%

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10
Q

what occurs when there is 75% nephron loss?

A

become azotemic

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11
Q

at what nephron loss does the body become azotemic?

A

75%

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12
Q

at what stage of nephron loss do clinical signs of kidney disease appear?

A

75%

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13
Q

what occurs at 100% nephron loss?

A

incompatibility with life

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14
Q

what are the 2 main causes chronic kidney disease?

A

chronic interstitial nephritis

asymptomatic/undiagnosed initial kidney insult

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15
Q

what is chronic interstitial nephritis?

A

inflammation of the renal interstitium

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16
Q

what are the treatable and/or (partially) reversible causes of chronic kidney disease?

A

pyelonephritis

ureterolithiasis

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17
Q

what is pyelonephritis?

A

inflammation of the kidney and renal pelvis

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18
Q

what might cause pyelonephritis?

A

FIP, FIV, leishmaniosis

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19
Q

how can ureterolithiasis cause chronic kidney disease?

A

it is post-renal but causes renal damage

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20
Q

how might an asymptomatic insult lead to chronic kidney disease?

A

upregulate GFR rate –> compensatory hypertrophy of remaining nephrons

over time –> progressive nephron loss, progressive decrease in GFR

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21
Q

what are the main consequences of chronic kidney disease?

A

loss of water/electrolyte regulation

loss of acid/base regulation

failed excretion of uraemic solutes

impaired renal hormone synthesis

hypertension (cause vs consequence?)

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22
Q

what is the clinical manifestation of loss of water/electrolyte regulation?

A

PUPD, dehydration

hypokalaemia

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23
Q

what is the clinical manifestation of loss of acid/base regulation?

A

acidaemia - contributes to nausea, vomiting, inappetence

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24
Q

what is the clinical manifestation of failed excretion of uraemic solutes?

A

azotemia, hyperphosphataemia - contributes to nausea, vomiting, inappetence

contributes to renal secondary hyperparathyroidism

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25
Q

what is the clinical manifestation of impaired renal hormone synthesis?

A

lack of erythropoietin - anaemia

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26
Q

what is the clinical manifestation of hypertension?

A

end organ damage

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27
Q

which cats typically get chronic kidney disease?

A

mature-geriatric cats

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28
Q

when are young cats affected by chronic kidney disease?

A

due to congenital disorders (polycystic kidneys, malformation of kidneys)

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29
Q

when might we diagnose kidney disease in the sub-clinical phase

A

incidental finding - at time of pre-op profiles or geriatric wellness screening (bloods and urinalysis)

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30
Q

what should we discuss with the owner if kidney disease is suspected/diagnosed?

A

weight/condition changes - catabolic state

drinking/urination, appetite

demeanour, activity levels

vomiting +/- diarrhoea +/- haematemesis/melaena

signs associated with hypertension

medication admin - ease/problems

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31
Q

why might cats with chronic kidney disease have constipation?

A

secondary to dehydration

32
Q

what signs are associated with hypertension?

A

neurological signs
blindness

33
Q

why might we ask about drinking/urination?

A

to check for PUPD

34
Q

what things should we be mindful of on assessment of a CKD cat?

A

hydration status

weakness (neck ventroflexion)

uraemic ulcers +/- halitosis

hypertensive retinopathy

small irregular kidneys on palpation

‘rubber jaw’

35
Q

why might a cat with CKD show neck ventroflexion?

A

hypokalaemic myopathy

36
Q

why do cats with CKD get ‘rubber jaw’?

A

due to renal secondary hyperparathyroidism

37
Q

when might we have a clinical suspicion of CKD?

A

declining urinary concentration plus decline in weight

38
Q

how do we diagnose CKD?

A

often combines diagnostic tools and functional tests

39
Q

which tests may be undertaken for diagnosis of CKD?

A

USG
urine protein:creatinine ratio
serum creatinine and urea
GFR
SDMA
diagnostic imaging - U/S and radiography

40
Q

what is the most indicative test of chronic kidney disease?

41
Q

which parameters confirm reduced kidney function?

A

azotemia - increased urea and creatinine

WITH inappropriately concentrated urine

42
Q

which other test may be used to diagnose chronic kidney disease?

A

symmetric dimethylarginine (SDMA)

43
Q

what is the advantage of testing SDMA?

A

may identify kidney disease earlier than elevated urea/creatinine when used appropriately

44
Q

how can we looks for structural disease of the kidney?

A

u/s - renal size and architecture

radiography - ureteroliths

45
Q

what reversible causes of chronic kidney disease might we be able to see with imaging?

A

ureteric obstruction

pyelonephritis

lymphoma?

46
Q

what is the most common cause of hypertension in cats and dogs?

A

chronic kidney disease

47
Q

what is the target measurement for SBP?

48
Q

how many BP measurements should ideally be taken?

A

minimum 3, preferably 5-7 consecutive measurements

49
Q

what can results from prolonged high BP?

A

ocular, target organ damage and neuro issues

50
Q

how can we reduce the stress of taking blood pressure measurements in cats?

A

feline friendly room
long appointment
use headphones with doppler
tail measurement
feliway
consider medication e.g. gabapentin

51
Q

how does ‘rubber jaw’ occur in CKD patients?

A

due to renal secondary hyperparathyroidism

52
Q

how does renal secondary hyperparathyroidism result in bone resorption?

A

kidneys failing to excrete phosphorous –> raised serum phosphate

triggers increased PTH secretion to lower phosphate (ineffective as inadequate renal function to excrete phosphate efficiently anyway)

persistent PTH release –> bone resorption resulting from increased PTH activity

53
Q

when is rubber jaw clinically most recognised?

A

in renal dysplasia

54
Q

what is the overall effect of excess PTH?

A

demineralisation of calcium to correct balance in blood

(PTH increases calcium and decreases phosphate)

55
Q

how does CKD result in hypokalaemia?

A

multiple factors - inappetence, GI losses, urinary losses

56
Q

what does hypokalaemia cause?

A

weakness - neck ventroflexion

inappetence

57
Q

how do we treat hypokalaemia in CKD cats?

A

potassium supplementation

58
Q

which species commonly gets proteinuria as a result of CKD?

59
Q

how do we identify proteinuria?

A

need urine protein:creatinine ratio (dipstick not sufficient)

60
Q

what value is classed as proteinuria?

61
Q

why do cats with CKD get anaemia?

A

multifactorial - lack of erythropoietin production, reduced RBC lifespan, GI losses (?)

62
Q

what does anaemia contribute towards in CKD cats?

A

weakness
lethargy
inappetence
proportional to disease stage

63
Q

what should be involved in the consultation for suspected CKD?

A

clinical history

weight, BCS

blood pressure, retinal exam

PCV, urea, phosphate, calcium, electrolytes

urinalysis

64
Q

how often should CKD cats be re-seen?

A

every 3-6 months if stable

more frequently (as needed) if unstable

65
Q

when is staging of CKD undertaken?

A

after diagnosis, once reversible problems have been addressed

66
Q

why do we stage CKD?

A

in order to facilitate appropriate treatment and monitoring of the patient

67
Q

what is IRIS staging?

A

an internationally recognised set of guidelines to CKD staging and treatment

68
Q

what are the factors which contribute to IRIS staging of CKD?

A

creatinine
substage by proteinuria
substage by blood pressure

69
Q

what are the most important therapies for CKD?

A

maintenance of hydration
feeding a renal diet

70
Q

what is in a renal diet?

A

restricted protein content
low phosphate content
antioxidants
essential fatty acids
added potassium
bicarbonate to help acidosis

71
Q

how can we encourage water intake in CKD cats?

A

water fountains
add water to food/feed wet food
trying different shaped/material bowls
multiple water bowls
keep water away from food

72
Q

how can we help transition a cat onto a prescription renal diet?

A

don’t introduce in hospital
heat up food
mixing with existing diet, transition gradually

stabilise first - more important they eat non-renal than not eat at all

73
Q

how can we manage hypertension in CKD patients?

A

amlodipine in cats
ACE inhibitors in dogs

74
Q

how can we manage hyperphosphataemia in CKD patients?

A

renal diet
phosphate binders

75
Q

how can we manage hypokalaemia in CKD patients?

A

renal diet
potassium supplementation

76
Q

how can we manage proteinuria in CKD patients?

A

renal diet
ACE inhibitors
omega 3 PUFAs
anti-platelets (for cardiac issues)

Applied Clinical Veterinary Nursing (31 decks)

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