Urinary therapeutics Flashcards
What factors can exacerbate CKD
hyperphosphataemia
hypertension
proteinuria
hypoperfusion
hypoxia
ischaemia
How does hyperphosphataemia exacerbate CKD?
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
How can we treat hyperphosphataemia?
restricted phosphate intake
Oral phosphate binders
calcitriol therapy
How does systemic hypertension exacerbate CKD?
Renal disease predisposed hypertension:
- RAAS altered Na handling
- excessive SNS activation
Kidney is main target organ of hypertensive damage
Glomerular hypertension => glomerular sclerosis => proteinuria
How can hypertension be treated?
Dietary sodium restriction
Anti-hypertensive drugs
How does proteinuria exacerbate CKD?
protein processing by proximal tubular cells => pro-inflammatory mediators
Tubulointerstitial inflammation => structural disease
How can we treat proteinuria?
reduced protein diet
polyunsaturated fatty acids (PUFA) - calms inflammation
Pharmacological reduction in GFR
How do hypoperfusion, hypoxia and ischaemia exacerbate CKD?
=> inflammation, oxidative stress, increased damage
How can hypokalaemia be treated?
supplementation in renal diets
How can metabolic acidosis be treated?
prescription diets are alkalinizing
How can inappetance/nausea be treated?
H2 blockers
Protein pump inhibitors
Maropitant citrate
Appetite stimulators (mirtazepine)
what are the main attributes of prescription renal diets for CKD?
Low protein (high quality protein)
Reduced Na
Restricted phosphate
Alkalinising
PUFA (antioxidants)
How can AKI and pre-renal azotaemia be differentiated?
Pre-renal azotaemia usually has hypersthenuria
What is acute renal failure?
Result of AKI
Azotaemia with inability to concentrate urine
What is the treatment for AKI?
replace fluids to improve renal perfusion and reduce ongoing hypoxia/ischaemia
Monitor and correct electrolytes and acid-base
Maybe instigate controlled diuresis once hydrated
How do you treat struvites?
Antibiotics
Urinary acidifiers (struvites like alkaline environment)
NSAIDs if signs of inflammation/discomfort
Describe the treatment of calcium oxalate crystals
promote hydration
alkalinise urine via diet
Describe urate stones in dogs
due to Purine metabolism alteration => uric acid in urine
Treatment:
- xanthise oxidase inhibitors
- protein restriction
- promote hydration
What are the treatment option for feline non-obstructive idiopathic/interstitial cystitis (FIC)?
Opiates or NSAIDs for pain and inflammation
Diet, hydration and antibiotics for urolithiasis
Behavioural support
Surgery, chemotherapy or NSAIDs for neoplasia
What are causes of acute kidney injury in just dogs?
Leptospirosis
Grape/raisin toxicity
Acute pancreatitis
Lyme nephritis
What are causes of AKI in dogs and cats?
kidney infection
Drugs (e.g., NSAIDs)
Ethylene glycol (anti-freeze)
Severe blood pressure alteration
Cyanuric/melamine acid
What are causes of AKI in just cats?
ureteral obstruction
lily toxicity
renal lymphoma
