Renal Flashcards
What diagnostic tests should be used to analyse the kidneys?
Haematology
Anaemia, increased urea and creatinine increased phosphorus hypokalaemia
Urinalysis
USG, glucose, crystals, protein, ketones, culture and sensitivity
Imaging
U/s
Biopsy: FNA tru cut
What is pre-renal azoteamia?
Not enough blood flow to the kidneys
Hypovolameia
concentrate urine usually reversible
What is post renal azoteamia?
Blockage of urine leaving the system Blocked cat Uroltihs Bladder distension Increased pressure decreased glomerular filtration can get perms any damage and bladder rupture
What is acute kidney injury?
Acute damage to the kidney can be caused by anti freeze ischeamia infections
What are the clinical signs of acute kidney injury?
Lethargy inappetance Vomiting D + Dehydration Ureamic breath Oral ulceration Decreased urine production Azoteamia Hyperkalaemia Hyperphospateamia
What can treat acute kidney injury
Stop nephrotoxic drugs Ivft Treat pre/post abnormality Anti-emetics(metrocolpramide, maropitant) Ab Nutrition Acid base abnormalities Phosphate binders
What is chronic kidney disease?
Gradual deterioration of kidney function usually seen in older cats and dogs
What are the clinical signs of chronic kidney disease?
Un concentrated urine Azoteamia PUPD Weight loss Halitosis Inappetance Vomiting Non-regenerative anaemia Small irregular kidneys Dehydration Hypertension Hypokalemia Hyperphophotemia Bacterial urinary infection
What can cause chronic kidney disease?
Glomerulonephropathies Infectious Nephrotoxins Hydronephrosis Neoplasia Inherited or congenital diseases
Investigations of CKD
Urinalysis
Haemotlogy and biochem
Severe azoteamia, anaemia hypokalema hyperphospotemia
Blood pressure
Below 120mmhg in a dog below 150mmhg in a cat
Diagnostic imaging
What is kidney staging based on?
Creatinine levels
Proteinuria
Blood pressure
Recognise CKD is progressive
What are the main aims of COD treatment?
Treat and underlying cause
Correct and maintain fluid balance
Manage clinical signs and complications
Delay progression
What should fluid therapy include for CKD?
2-3xmaintanence Electrolyte imbalance Hartmann Correct dehydration over 24hours Reassess urea and creatinine in 24 hours Home fluid therapy sc blouses Encourage fluid intake broths
What dietary management should be tried for CKD
Good quality proteins (restricted) Wet diet Energy dense High in potassium vitamins B and E Decrease sodium High fermentable fibre Restricted phosphorus Phosphorus binders Careful food aversion
How should vomiting and nausea be treated in CKD?
Gastroprotectants Sulcrulfate Zantac
Anti-emetics metoclopromide martipotant
How should inappetance and anorexia be managed in CKD?
Tasty food Slow diet change Control nausea Assisted enteral feeding Appetite stimulate (mitazipine)
How should constipation be treated in CKD?
Lactulose enemas
Lactulose orally
Manage dehydration and electrolyte imbalance
How should hypokalemia be corrected in CKD?
Supplement ivft of oral k gluconate
What are the clinical conditions that should be treated to maintain CKD?
Fluid imbalance Hypokalemia Constipation Inappetance/nausea Anorexia Diet Hyoerphospahtemia Hypertension Urinary tract infections Anaemia
How should hypophosphotaemia Ben corrected in CKD?
Phosphate binders in the food
Calcium carbonate
Constipation is a side effect
How should hypertension be managed in CKD
Regular check ups Amlodopine cats ACE inhibitor dogs (benezipril) Telmisartan angiotensin 1 receptor blocker Decrease sodium in the diet
How should urinary tract infections be prevented in CKD
Encourage urination multiple walks
Multiple litter trays
Antibiotics based on culture and sensitivity
How should anaemia be managed in a CKD patient?
Blood transfusion
Gastroprotectants (minimise blood loss)
Anaboli steriods (little evidence)
EPO deficiency correct human erythropoietin
How should proteinuria be managed in a CKD patient?
Benazepril
Omega 3 fatty acids
Telmisartan
What is the prognosis for dogs and cats with CKD?
Dogs average survival 6-12months
Cats 1-3 years
Best guide is clinical condition rather than lab parameters
What conditions can present in lower urinary tract disease?
Cystitis Blocked cat Uroliths Urinary incontinence Idiopathic feline lower urinalysis tract disease
What are the clinical signs of cystitis and how should it be treated?
Pain urination Increased frequency urination Blood in urine Bacterial infection Uroliths Incontient dribbling Treatment Antibiotic culture and sensitivity Encourage urination and fluid intake
What may be the causes of urinary incontinence?
Neurogenic Spinal cord disease Brain disease Peripheral nerve damage Anatomical defects Sphincter mechanism
What Nursing care is required for urinary incontinence
Barrier creams Keep dry and clean Frequent trips outside Antibiotics Hormones Bladder expression
What are the three types of caliculi and what ph urine do they form in?
Calcium oxalate acidic coffin
Struvite alkaline Maltese cross
Urate -acidic thorn aplle
Clinical signs of caliculi
Hameatouria pollkiuria dysuria
Uti
Emergency treatment of a blocked cat
Empty the bladder
Cystocentesis
Catheterise and flush bladder with saline until clear
Ivft to treat Hyperkalaemia
Care post obstruction diuresis polyuric and hypokalemic
Monitor urine output and electrolytes
Anti spasmodic treatment
Idiopathic lower feline urinary tract disease risk factors and clinical signs
Young over weight restricted exercise indoor cat ablib feeding Multicat dry diets Cystitis stranguria Episodic signs self limiting Urethral obstruction Painful bladder
Treatment FLUTD
Minimise stress encourage grooming increase water intake antispasmodic reduce stress minimise weight improve toileting
GAGs ABs diet
