urinary therapeutics WS

Question 1

what exacerbates CKD

Answer 1

• hyperphosphatemia
• hypertension
• proteinuria
• hypoperfusion
• hypoxia
• ischemia

Question 2

how does hyperphosphatemia exacerbate CKD and how can we treat it

Answer 2

• GFR reductiuon reduces ability to excrete phosphate; early on PTH increases phosphate excretion so copes
• over overwhelmed calcium and phosphate build up
• mineralisation of tissues including kidneys
• mineral bone dzz
• mineralisation plus PTH is considered uraemic toxin making CKD worse
• osteodystrohpy can result as well

Tx
- restric phosphate intake
- oral phosphate binders (almuninum hydroxide, chitosan, calcium carbonate, calcium acetate
- calcitriol therapy

Question 3

how does systemic hypertension exacerabte CKD and how do we treat

Answer 3

• renal disease predisposes hypertension (RAAS, altered Na handling, excessing SNS activation)
• the kidney is also one of the main target organs for hypertensive damage
• in extremes of pressure, autoregulation cannot control glomerular blood flow
• glomerular hypertension = glomerular sclerosis = proteinuria

tx:
- dietary sodium restriction
- anti hypertensive drugs (constrict afferent arteriole and dilate efferent)

Question 4

how does proteinuria exacerbate CKD and how do we treat

Answer 4

Question 5

how does hypoperfusion, hypoxia and ischaemia exacerbate CKD and how do we trreat

Answer 5

Question 6

what are the main attributes of prescription renal diets for CKD

Answer 6

• lower protein but good quality
• reduced sodium
• phosphate restriction
• alkalinising
• PUFA (polyunsaturated fatty acids)

Question 7

lsit the main therapeutic aims and associated drug groups that might be used to treat a case of CKD

Answer 7

• maintain hydration and perfusion
• limit MBD w/ phosphate binders and calcitriol therapy
• reduce systemic hypertension
• reduce proteinuria (PUFAs)
• GI signs

Question 8

list causes of AKI

Answer 8

Question 9

how do you treat AKI

Answer 9

• replace fluids rapidly and substantially to improve renal perfusion and reduce ongoing hypoxia/ischaemia
• monitor and correct electrolytes and acid/base
• once hydrated maybe instigate controlled diuresis to support excretion

Question 10

how do you treat uroliths

Answer 10

Question 11

how do you diagnose and treat feline non-obstructive cystitis

Answer 11