the geri cat check up part 2 ws

Question 1

what is SDMA and why is it useful

Answer 1

SDMA (symmetric dimethylarginine) is the amino acid, arginine, that contains two methyl groups (dimethyl) in a symmetrical orientation. SDMA is considered a sensitive and early marker (more sensitive than serum creatinine) of declining GFR in dogs and cats

Physiology: SDMA is produced by all nucleated cells at a constant rate, with highest concentrations in the brain, and is excreted primarily by the kidneys, with some evidence of liver uptake in humans. It does not appear to be reabsorbed in renal tubules or influenced by many non-renal factors, other than diet

Question 2

what is FGF23 and how is it useful

Answer 2

As CKD develops and a decline in glomerular filtration rate (GFR) occurs, phosphorus concentration increases, which causes an imbalance in phosphate-calcium homeostasis.
This is labeled chronic kidney disease–metabolic bone disease (CKD-MBD; also referred to as mineral bone disorder) and in totality describes a complex syndrome that involves fibroblast growth factor 23 (FGF-23), parathyroid hormone (PTH), 1,25-dihydroxy D3
(1,25 vitamin D3, calcitriol), calcium, and phosphorus CKD-MBD leads to chronically elevated FGF-23 concentrations in most patients. There is strong clinical evidence from both human and veterinary literature that FGF-23 identifies mineral disruption and phosphorus overload (CKD-MBD) earlier than total serum phosphorus and is a valuable tool in the management of cats with CKD.

Question 3

how is CKD staged and diagnosed and what should be considered when interpreting results

Answer 3

• animal should be hydrated
• IRIS uses creatinine and SDMA blood levels to stage
• sub staged depending on proteinuria and hypertension

Question 4

CKD is involved in which type of azotaemia

Answer 4

renal

Question 5

why do we see calcium imbalance in CKD

Answer 5

CKD can cause real disruption to calcium and phosphate metabolism. We often see hypercalcaemia (total and/or ionised Ca)

Question 6

what clinical signs would you expect to see in a cat with hypertension

Answer 6

Depression, lethargy, reduced appetite; neurological abnormalities.
Ocular abnormalities – tortuous retinal vessels; retinal haemorrhage; blindness
Cardiac disease – tachycardia, heart murmur, signs of poor perfusion

Question 7

why is hypertension a clinical concern

Answer 7

target organ damage. organs with fragile small vessels can be easily damaged in hypertension. we’d classically think of the brain, kidney and retina

Question 8

outline some treatment options of CKD

Answer 8