Kidney, diabetes Flashcards

1
Q

kidney disease nutritional goals

A
  • Slow the progression of disease
  • Maintain appropriate body weight & body condition
  • Reduce incidents of uremic crises
  • Support immune function
  • Increase quality of life
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2
Q

what is IRIS staging, and what are the ‘stages?’

A

guidelines to help better diagnose, understand, and treat renal disease in cats and dogs

  1. Staging based off blood creatinine and SDMA
  2. Sub-staging by Proteinuria
  3. Sub-staging by Blood Pressure
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3
Q

when do we use IRIS staging

A
  • Important to stage AFTER fluid therapy and stabilization!
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4
Q

how many iris results do we need

A

at least 2

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5
Q

KNFs for renal diet: water

A

need lots

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6
Q

KNFs for renal diet: phosphorus

A
  • Accumulation due to imbalance between intake and excretion
    (P retention)
  • Increased PTH
  • Secondary renal hyperparathyroidism
  • more P corresponds to more renal lesions
  • Intestinal Phosphorus Binders
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7
Q

KNFs for renal diet: protein

A
  • Restriction?
  • Approach:
  • Early Stage: goal - altering disease course
  • Late Stage: goal - controlling clinical signs/uremic symptoms
  • Early stages (I/II)
  • Proteinuria (elevated UPC)
  • Minimize proteinuria
  • High protein intake led to increased UPC in laboratory induced disease
  • Moderate protein may limit diet-related hyperfiltration
  • Late stages (III/IV)
  • Azotemia and uremia
  • Accumulation of protein metabolites
  • Excess protein: azotemia and morbidity
  • Protein malnutrition
  • Provide high quality protein
  • Minimal protein requirements?

Best approach:
1. Treat each patient as an individual
2. Monitor BW, BCS, MCS, albumin, total protein, UPC, BUN, creatinine etc.
3. Adjust based on patient response

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8
Q

kidney disease KNF: energy

A

Fat
* Energy density

  • EPA+DHA
  • ↓ Glomerular hypertension (↓ TXA2, ↓ PGE2) - Anti-inflammatory (↓ LTB4, ↓ PGE2)
  • ↓ Systemic hypertension
  • EPA+DHA
  • Precautions: high doses (n-6:n-3 ±1:1)
  • Immunosuppression
  • Oxidative stress
  • ↓ platelet function
  • ↓ wound healing
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9
Q

kidney disease KNF: sodium

A
  • Sodium retention leads to hypertension
  • Hypertenstion contributes to progression of disease
  • Risk of target organ damage (e.g. kidneys, eyes, brain, heart)
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10
Q

kidney disease KNF: potassium

A
  • 2—30% of cats with CKD have hypokalemia
  • Reduced dietary intake: anorexia, vomiting
  • Excessive renal loss
  • Hyperkalemia in dogs
  • ACE inhibitors?
  • Not possible to control with renal diet?→Homemade diet
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11
Q

buffering capacity / pH for urine in kidney disease

A
  • Buffering capacity
  • Urine pH of 6.5 to 7 recommended
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12
Q

TIPS FOR INTRODUCING RENAL DIETS

A
  • Better success when cat/dog is feeling “healthy”
  • Slow gradual transition
  • Weigh on gram scale
  • Try different flavours/textures
  • Homemade diets?
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13
Q

NUTRITIONAL GOALS FOR DIABETES

A
  • Improve blood glucose
  • Maintain ideal BCS/MCS
  • Eliminate clinical signs
  • Minimize complications

How?
* Medical treatment: insulin
* Diet
* Treat causes of insulin resistance (obesity!)

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14
Q

difference in diabetes type in dogs vs cats

A
  • Dog: Type 1 (B-cell destruction – absolute insulin deficiency)
  • Cat: Type 2 (insulin resistance)
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15
Q

feeding frequency for diabetes

A
  • CONSISTENCY! in type, amount, timing
  • Multiple small meals
  • Regular intervals
  • Timed with insulin
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16
Q

KNF diabetes: water

A
  • Fresh and clean water should be available at all times
17
Q

KNF diabetes: protein

A
  • Varies in diabetic diets
  • Important to provide all essential amino acids
  • Prevent loss of lean muscle
  • Cats: 28-55% DM
    > High protein, low carb approach (‘Catkins’ diet)
  • Dogs: 15-35% DM
18
Q

KNF diabetes: fat

A
  • Hyperlipidemia
  • Excess fat can contribute extra calories
  • Important for overweight and obese diabetics
  • Dogs and Cats: <25% DM
    > Moderate fat (12-15% DM)
    > Low fat (<10% DM) if obese
19
Q

KNF diabetes: carbs

A
  • Simple vs complex carbs

simple absorb fast and give postprandial hyperglycemia, glucosuria, should be avoided
>found in semi-moist/canned foods with sauce

  • NOT nutritionally essential for cats and other mammals
    >cats have different digestion, Glucose absorption, Hepatic glucose metabolism
20
Q
  • Do carbohydrates cause obesity and/or diabetes in cats?
A

unclear?

  • Macronutrient content→NO major cause of obesity & diabetes
  • More attention to:
  • Normalising public’s view of a normal body condition for cats
  • Feeding behaviour & amount fed
  • Lifestyle and activity level
21
Q

KEY NUTRITIONAL FACTORS: DIABETES carbohydrate macro % for dogs and cats

A
  • Dogs: <55% DM
  • Cats:
  • Option 1: <40% DM (high fibre/carb approach)
  • Option 2: <20% DM (high protein, low carb approach)
22
Q

KEY NUTRITIONAL FACTORS: DIABETES: fibre

A
  • Dogs: 7 to 18% DM
  • Cats: 7 to 18% DM (high fibre/high carb option)
23
Q

KEY NUTRITIONAL FACTORS: DIABETES: energy

A

Depends on BCS
* BCS 5/9: weight maintenance
* BCS 6 to 9/9: weight loss
* BCS 1 to 3(4)/9: weight gain

Controlled vs uncontrolled
* Energy requirement can be much higher in uncontrolled diabetics
* Weight maintenance until controlled

24
Q
A