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Small Animal Medicine > Renal - Chronic Kidney Disease > Flashcards

Renal - Chronic Kidney Disease Flashcards

1
Q

What is chronic kidney disease?

A

Structural/functional abnormalities of the kidney that have been present long-term

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2
Q

CKD is typically reversible/irreversible and progressive/nonprogressive despite therapy.

A

Irreversible and progressive

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3
Q

What is the pathophysiology of CKD?

A

Initial insult/disease process occurs and results in the loss of the majority of the nephrons

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4
Q

What are the adaptive mechanisms to compensate for loss nephrons in CKD?

A

Increase single-nephron GFR (nephron hypertrophy)

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5
Q

How do adaptive mechanisms effect CKD?

A

They result in damage of the remaining nephrons thus causing spontaneous, continued decline in renal function

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6
Q

True or False: Anything that can cause AKI can cause CKD.

A

True

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7
Q

What is often found on histopathology in CKD patients?

A

Tubulointerstitial nephritis and fibrosis

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8
Q

What is the signalment for CKD?

A

Increasing prevalence with age, all ages can be affected, and all breeds can be affected

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9
Q

What history/presenting complaints are associated with CKD?

A

PU/PD, gastrointestinal signs (decreased appetite, vomiting, diarrhea) and weight loss

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10
Q

What will you find on PE in patients with CKD?

A

Weight loss; muscle atrophy
small, irregular kidneys
dehydration

Less commonly - uremic breath/oral ulceration and pale mucous membranes

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11
Q

What will you find on CBC in CKD patients?

A

Normocytic, normochromic nonregenerative anemia

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12
Q

What will you find on chemistry in CKD patients?

A

Azotemia, hyperphosphatemia, metabolic acidosis, and variable potassium (often normal to low)

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13
Q

What USG is associated with CKD?

A

Isosthenuria is often present (1.008-1.012)

There is inadequate concentrating ability in the face of azotemia

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14
Q

If no azotemia, persistent isosthenuria is suggestive of _____.

A

CKD

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15
Q

What will the SDMA value be in patients with CKD (not a specific number)?

A

elevated

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16
Q

When may be SDMA measurements be useful?

A

In cases of persistent isosthenuria/inappropriately concentrated urine when there is no azotemia

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17
Q

What clinical characteristics are associated with IRIS stage I?

A

Non-azotemic; clinical signs absent other than possible PU/PD

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18
Q

What clinical characteristics are associated with IRIS stage II?

A

Mildly azotemic; clinical signs absent other than PU/PD +/- mild appetite changes, weight loss

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19
Q

What clinical characteristics are associated with IRIS stage III?

A

Moderately azotemic; clinical signs typically present, disease progressive

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20
Q

What clinical characteristics are associated with IRIS stage IV?

A

Severely azotemic; clinical signs of uremia, disease progressive

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21
Q

What is IRIS substaging based on?

A

The presence of proteinuria and/or hypertension

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22
Q

What are the goals to managing patients with CKD?

A

Deal with any active or exacerbating sources of kidney injury
Slow progression of renal function loss
Minimize clinical signs of uremia
Manage complications and comorbid conditions

23
Q

What is a therapeutic renal diet made up of?

A

Reduced phosphorus, added omega-3 polyunsaturated fatty acids, limited high-quality protein, and calorie dense

24
Q

What do you need to make sure to manage about the nutrition in CKD patients?

A

Maintain adequate calorie consumption because low BCS is associated with reduced survival

25
Q

Why does hyperphosphatemia occur in CKD patients?

A

There is decreased GFR which results in phosphorus retention

26
Q

What should you do first to manage hyperphosphatemia in CKD patients?

A

Dietary phosphorus restriction first

Note: the IRIS scale for phosphorus supplementation recommends values below the normal RI for phosphorus

27
Q

What should you do second to manage hyperphosphatemia in CKD patients?

A

Add dietary phosphate binders - give with food to be effective

28
Q

Why are cats and dogs with CKD prone to dehydration?

A

because of polyuria

29
Q

What do you want to do to mitigate dehydration in CKD patients?

A

Promote compensatory polydipsia - free access to several water sources, water in food/canned food, carefully manage exacerbating factors

30
Q

In chronically dehydrated pets, what is the recommended fluid therapy?

A

SQ fluids or enteral hydration

31
Q

How do you manage vomiting in CKD patients?

A

antiemetics

32
Q

How do you manage uremic gastritis in CKD patients?

A

Acid suppression (proton-pump inhibitor) +/- sucralfate may be indicated in dogs

33
Q

If a patient with CKD has poor appetite, what should you give?

A

Mirtazapine or a feeding tube

34
Q

Is hypokalemia seen in CKD cats or dogs more commonly?

A

cats

35
Q

What is the most recognized clinical sign with hypokalemia?

A

muscle weakness

36
Q

How is potassium supplemented in CKD patients?

A

Parenteral (IV) supplementation if severe and/or symptomatic

Oral supplementation long-term

37
Q

When may hyperkalemia be seen in CKD patients?

A

in end-stage disease

38
Q

Why is hypertension problematic in CKD patients?

A

Because it contributes to further renal damage as well as damage to other organ systems

39
Q

What is the recommended treatment for hypertensive CKD cats?

A

amlodipine

40
Q

What is the recommended treatment for hypertensive CKD dogs?

A

Ace-inhibitors (benazepril or enalapril)

41
Q

Why is CKD sometimes accompanied by proteinuria?

A

Protein leakage into the urine is suspected to be damaging to the renal tubules

42
Q

How is it recommended to treat proteinuria in CKD?

A

with medication

43
Q

Why is anemia associated with CKD?

A

EPO deficiency develops as functional renal mass declines

44
Q

How is anemia managed in CKD patients?

A

Erythrocyte-stimulating agents - Darbepoetin alpha

Note: anti-EPO antibodies can develop

45
Q

What mineral and bone disorders can develop as a result of CKD?

A

Renal secondary HPTH, renal osteodystrophy, and soft tissue mineralization

46
Q

What should you do to manage mineral and bone disorders in CKD patients?

A

Reduce phosphorus

Maybe calcitriol therapy

47
Q

What diagnostic steps should be taken after CKD is diagnosed?

A

Measure BP
Obtain urine culture
Quantify urine protein
Consider renal imaging

48
Q

What are the therapeutic steps to treating stage 1 CKD?

A

Avoid or discontinue any medications that may be nephrotoxic
discuss hydration/lifestyle with owner
identify and treat any complicating factors

49
Q

What are the therapeutic steps to treating stage 2 1CKD?

A

Same as stage 1 - introduction of a renal diet

50
Q

What are the therapeutic steps to treating stage 3 CKD?

A

Same as stage 1 + renal diet

+/- phosphate binder, GI symptomatic support as needed, and hydration support as needed

51
Q

What are the therapeutic steps to treating stage 4 CKD?

A

Same as stage 1 + renal diet
+/- phosphate binder, GI symptomatic support as needed, and hydration support as needed
+/- anemia management if indicated

52
Q

What is the prognosis for CKD?

A

variable - it depends on underlying etiology, complicating factors, stage and quality of management

53
Q

Do dogs or cats tend to live longer with CKD?

A

cats

54
Q

What are the poor prognostic indicators associated with CKD?

A

Degree of azotemia, phosphorus, anemia, proteinuria, and weight loss/body condition

Small Animal Medicine (100 decks)

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