CKD (Yr 4)

Question 1

what is the definition of chronic kidney disease?

Answer 1

structural or functional abnormalities of one or both kidneys that have been present for 3 months or longer

Question 2

is CKD reversible?

Answer 2

no (irreversible, slowly progressing)

Question 3

what are some congenital causes of CKD?

Answer 3

renal dysplasia
polycystic kidney disease
amyloidosis
falconi-like syndrome

Question 4

what breed is predisposed to polycystic kidney disease?

Answer 4

persian cats

Question 5

what is the top cause of CKD in cats?

Answer 5

idiopathic tubulointerstial nephritis

Question 6

what is the top cause of CKD in dogs?

Answer 6

glomerular disease

Question 7

what are some causes of CKD progression (even if active disease is not present)?

Answer 7

other tubules try to compensate for lost tubules meaning intraglomerular hypertension which causes damage
systemic hypertension
proteinuria
phosphate precipitation in tubules

Question 8

what are the clinical signs of CKD?

Answer 8

weight loss, poor appetite
PUPD
dehydration
vomiting, constipation
poor hair growth
neurological and hypertensive signs

Question 9

what are the three criteria for staging CKD?

Answer 9

creatinine (GFR estimate)
proteinuria
blood pressure

Question 10

what is the initial marker for staging CKD?

Answer 10

creatinine (GFR estimate)

Question 11

how can albumin be affected by CKD?

Answer 11

decrease (due to protein losing nephropathy)

Question 12

how can potassium be affected by CKD?

Answer 12

usually low (increases with end-stage CKD)

Question 13

how can phosphorus be affected by CKD?

Answer 13

increased

Question 14

how can calcium be affected by CKD?

Answer 14

increased or deacreased

Question 15

what affect does increased phosphorous caused by CKD have?

Answer 15

initiates secondary hyperparathydroidism and metastatic calcification

Question 16

how will CKD affect the USG?

Answer 16

will be poorly concentrated (<1.030 in dogs and <1.035 in cats)

Question 17

can CKD be cured?

Answer 17

no - irreversible, can only be managed symptomatically to minimise progression and severity

Question 18

what is a uraemic crisis?

Answer 18

acute presentation of CKD

Question 19

how is a uraemia crisis treated?

Answer 19

same as AKI with fluids and treating underlying cause

Question 20

how is stage 1 CKD treated?

Answer 20

reduce proteinuria - inhibit RAAS plus dietary protein reduction (antiplatelet drugs as they are at risk of clots)
control hypertension - ACE inhibitors, telmisartan, amlodipine
combat dehydration - wet food, water

Question 21

when should you not use ACE inhibitors in CKD patients to treat stage 1 with proteinuria?

Answer 21

if the animal is dehydrated or hypovolaemic (causes a catastrophic drop in GFR) - so stabilise them first

Question 22

what new therapy is started for stage 2 CKD on top of the stage 1 treatments?

Answer 22

start renal diet
control serum phosphate (add binder)
avoid hypokalaemia (supplement)

Question 23

why are renal diets beneficial?

Answer 23

protein restriction
phosphate restriction
low sodium
increased fibre

Question 24

when are renal diets indicated in CKD?

Answer 24

dogs in stage 3 or 4, if they have proteinuria or stage 2 when phosphate is >1.5mmol/L
cats in stage 2, 3 and 4

Question 25

what does phosphate need to be controlled to in CKD cases?

Answer 25

<1.5 in stage 2
<1.6 in stage 3
<1.9 in stage 4

Question 26

what treatments need to be added in stage three CKD?

Answer 26

treat nausea and vomiting
consider erythropoietin
control metabolic acidosis
consider SC fluids

Question 27

what might be used in stage 3 CKD for vomiting and nausea?

Answer 27

anti-emetic
appetite stimulants (mirtazpine)
reduction of gastric acid production
sucralfate (for gastric ulcers)

Question 28

what therapy is added when an animal enters stage 4 CKD?

Answer 28

same as others (nutrition and fluids)

Question 29

what can be used to give a prognosis for CKD?

Answer 29

stage
proteinuria

Question 30

do congenital or acquired CKD cases progress faster?

Answer 30

acquired