Urinary therapeutics

Question 1

What factors can exacerbate CKD

Answer 1

hyperphosphataemia
hypertension
proteinuria
hypoperfusion
hypoxia
ischaemia

Question 2

How does hyperphosphataemia exacerbate CKD?

Answer 2

GFR reduction reduced phosphate excretion (system copes initially due to PTH)
Once overwhelmed Ca and P build up
Mineralisation of tissues including kidney
Mineralisation + PTH => worsens CKD

Question 3

How can we treat hyperphosphataemia?

Answer 3

restricted phosphate intake
Oral phosphate binders
calcitriol therapy

Question 4

How does systemic hypertension exacerbate CKD?

Answer 4

Renal disease predisposed hypertension:
- RAAS altered Na handling
- excessive SNS activation
Kidney is main target organ of hypertensive damage
Glomerular hypertension => glomerular sclerosis => proteinuria

Question 5

How can hypertension be treated?

Answer 5

Dietary sodium restriction
Anti-hypertensive drugs

Question 6

How does proteinuria exacerbate CKD?

Answer 6

protein processing by proximal tubular cells => pro-inflammatory mediators
Tubulointerstitial inflammation => structural disease

Question 7

How can we treat proteinuria?

Answer 7

reduced protein diet
polyunsaturated fatty acids (PUFA) - calms inflammation
Pharmacological reduction in GFR

Question 8

How do hypoperfusion, hypoxia and ischaemia exacerbate CKD?

Answer 8

=> inflammation, oxidative stress, increased damage

Question 9

How can hypokalaemia be treated?

Answer 9

supplementation in renal diets

Question 10

How can metabolic acidosis be treated?

Answer 10

prescription diets are alkalinizing

Question 11

How can inappetance/nausea be treated?

Answer 11

H2 blockers
Protein pump inhibitors
Maropitant citrate
Appetite stimulators (mirtazepine)

Question 12

what are the main attributes of prescription renal diets for CKD?

Answer 12

Low protein (high quality protein)
Reduced Na
Restricted phosphate
Alkalinising
PUFA (antioxidants)

Question 13

How can AKI and pre-renal azotaemia be differentiated?

Answer 13

Pre-renal azotaemia usually has hypersthenuria

Question 14

What is acute renal failure?

Answer 14

Result of AKI
Azotaemia with inability to concentrate urine

Question 15

What is the treatment for AKI?

Answer 15

replace fluids to improve renal perfusion and reduce ongoing hypoxia/ischaemia
Monitor and correct electrolytes and acid-base
Maybe instigate controlled diuresis once hydrated

Question 16

How do you treat struvites?

Answer 16

Antibiotics
Urinary acidifiers (struvites like alkaline environment)
NSAIDs if signs of inflammation/discomfort

Question 17

Describe the treatment of calcium oxalate crystals

Answer 17

promote hydration
alkalinise urine via diet

Question 18

Describe urate stones in dogs

Answer 18

due to Purine metabolism alteration => uric acid in urine
Treatment:
- xanthise oxidase inhibitors
- protein restriction
- promote hydration

Question 19

What are the treatment option for feline non-obstructive idiopathic/interstitial cystitis (FIC)?

Answer 19

Opiates or NSAIDs for pain and inflammation
Diet, hydration and antibiotics for urolithiasis
Behavioural support
Surgery, chemotherapy or NSAIDs for neoplasia

Question 20

What are causes of acute kidney injury in just dogs?

Answer 20

Leptospirosis
Grape/raisin toxicity
Acute pancreatitis
Lyme nephritis

Question 21

What are causes of AKI in dogs and cats?

Answer 21

kidney infection
Drugs (e.g., NSAIDs)
Ethylene glycol (anti-freeze)
Severe blood pressure alteration
Cyanuric/melamine acid

Question 22

What are causes of AKI in just cats?

Answer 22

ureteral obstruction
lily toxicity
renal lymphoma