Renal disease: chronic kidney disease Flashcards
Chronic kidney disease refers to
● Structural and/or functional abnormalities of one or both kidneys that have been continuously present for ≥3 months.
● Is irreversible and progressive
● Concurrent prerenal/postrenal azotemia, “acute-on-chronic” kidney disease.
● More common in older animals
Causes of chronic kidney disease.
● Initial inciting cause of CKD is not usually determined, likely a series of renal
insults.
Causes of chronic kidney disease in dogs. (4-5)
● Familial, congenital, acquired conditions
● Juvenile nephropathy (renal dysplasia) - young dogs
● Tubulointerstitial nephritis - older dogs
● Glomerular disease - majority
- Immune-complex mediated glomerular nephritis, amyloidosis, non-immune complex glomerulonephritis conditions, infectious diseases (borreliosis, ehrlichiosis, anaplasmosis, babesiosis, leishmaniasis)
Causes of chronic kidney disease in cats. (2)
● Tubulointerstitial nephritis
- Age, viral infection, extrarenal diseases, environmental factors,
ischemia, hypoxemia
● Polycystic kidney disease (PKD)
In the context of kidney disease, what important question should not be forgotten during anamnesis?
potential toxin exposure (lilies, pest bait and poisons etc.)
Clinical signs in potential chronic kidney disease patients.
● Can be subclinical in early stage
● PU/PD, weight loss, decreased appetite, lethargy, dehydration, vomiting, halitosis
Physical exam findings in potential chronic kidney disease patients.
● Normal in early stage
● Later: palpable kidney abnormalities (e.g. unilateral compensatory hypertrophy), evidence of weight loss, dehydration,
pale mucous membranes, uremic ulcers, evidence of hypertension (retinal hemorrhages/detachment).
CKD - findings persistent, no pre/postrenal causes
For the diagnosis of chronic kidney disease, hematological changes.
anemia
CKD - findings persistent, no pre/postrenal causes
For the diagnosis of chronic kidney disease, blood biochemical changes. (7)
Azotemia,
SDMA,
hyperP,
hypo/hyperK,
hypo/hyperCa,
hypoalb,
metabolic acidosis
CKD - findings persistent, no pre/postrenal causes
For the diagnosis of chronic kidney disease, urine-analytical changes. (9)
Impaired urine concentration/dilution,
proteinuria,
cylindruria,
hematuria,
pyuria,
inappropriate urine pH,
inappropriate urine glucose,
cystinuria,
bacteriuria
CKD - findings persistent, no pre/postrenal causes
For the diagnosis of chronic kidney disease, imagine diagnostics may show what types of changes?
Abnormal renal size, shape,
echotexture, mineralization,
uroliths, absence of a kidney,
neoplasia
CKD - findings persistent, no pre/postrenal causes
Diagnosis of chronic kidney disease stage 1 and early stage 2
One or more of these findings should be present:
● Creatinine/SDMA increasing within the reference interval where no prerenal
cause is apparent.
● Persistent increased SDMA >14 µg/dL
● Abnormal kidney imaging
● Persistent renal proteinuria
● UPC >0.5 in dogs,
>0.4 in cats
Diagnosis of chronic kidney disease late stage 2-4.
Both of these diagnostic findings must be present:
● Increased creatinine and SDMA concentrations
AND
● USG <1.030 in dogs, <1.035 in cats
Describe staging of chronic kidney disease.
● Only once the diagnosis has been confirmed and the patient is stable.
● For developing treatment plan and establishing prognosis.
● IRIS Guidelines
Based on renal function:
● Creatinine
● SDMA
Substages based on:
● Proteinuria
● Arterial blood pressure
(as seen in attached table)
Treatment of chronic kidney disease.
● Medical management is to minimize metabolic complications, slow progression.
● Treatment is individualized based on stage of disease and
- Clinical and laboratory status of the patient
- Owner
● Is a progressive and dynamic disease and therapy modifications are based on serial
clinical and laboratory assessment.
CKD-MBD, RSHP stand for:
CKD-MBD = Chronic kidney disease–mineral bone disorder
CKD-RSHP = Chronic kidney disease-refractory secondary hyperparathyroidism