36. Chronic kidney diseases in dogs and cats. Nephrotic syndrome Flashcards
(9 cards)
Pathophysiology of chronic kidney disease?
Pathogenesis of Chronic kidney disease?
Pathomechanism of hyperphosphataemia and how this produces renal lesions ?
Clinical signs of CKD?
§ High P; PTH; FGF-23 → Shorter survival time
§ P retention + Ca → Mineralisation of soft tissues → Renal
secondary hyperparathyroidism & renal osteodystrophy
CLINICAL SIGNS
§ PU/PD § Thrombosis
§ Inappetence § Poor Coat
§ Weight loss § Anaemia
§ Dehydration § CNS Signs
§ Respiratory signs § GI signs
§ Immunosuppression § Inactivity
§ Hypertension consequences
Staging of chronic kidney disease?
Treatment of chronic kidney disease?
TREATMENT
Basis of management
§ Eliminating the cause
§ ↓ Signs
§ Prolong quality of life
§ Lifelong management
§ Application of drugs
§ Palatability of diets
Prolonging survival
§ Renal diet
§ ↓ Phosphorus: Phosphate binders (ca-carbonate)
§ Improve appetite
§ Maintain BCS
§ ↓ Proteinuria
§ Erythropoietin treatment
§ Correct BP: Measure every 3 months; Amlodipine;
Enalapril
Improving quality of life
§ Treat any hypokalaemia
§ Rehydration
§ Acidosis
§ Manage UTIs: Culture & sensitivity tests; ABx
Renal diet:
§ ↓ Protein but ↑ the quality
§ ↓ Phosphorus
§ ↑ Omega-3, potassium & Vit. B
Glomerular diseases?
Glomerular Diseases
Glomerulopathy → Proteinuria
§ Glomerular wall retains negative proteins (albumin)
§ Small amounts of smaller, positively charged proteins pass
through the glomerular wall → Reabsorption at the
proximal tubules
Causes of glomerulopathies
Immune complex GN (ICGN): 50%
Glomerular deposition of immune complexes
Chronic extrarenal disease;
§ Leishmania spp.
§ Anaplasma spp.
§ Ehrlichia spp.
§ Lyme’s disease
§ Neoplasia
§ Inflammation
In-situ immune complex formation
Usually against glomerular basement membrane
Non-immune complex GN (NIC-GN): 35%
Congenital – Familial glomerulopathies
Hypotension; Glucocorticoids; Toxins →
Glomerulosclerosis
Amyloidosis: 15%
Extracellular deposition of amyloid in the kidneys & other
organs
SAA (Serum Amyloid A) produced in the liver → Amyloid
a. Acquired form: Underlying
inflammatory/neoplastic
disease
b. Congenital form: Shar Pei
dogs & Abyssinian cats
Can be after subclinical period; Chronic/acute → Chronic
CSx: Signs of lower UTI (LUTI); Fever; Painful kidneys;
Depression; Anaemia; CKD signs
Diagnosis
Lab. D: Leukocytosis, cells (bacteria) in urine
sediment; Blood/urine findings associated with RF
Imaging: Dilated pelvis & ureter
Definitive dx: Bacteria in renal pelvis; bacteria in
inflammatory lesions in renal biopsy specimen.
Treatment
§ Long-term Abx treatment (based on culture &
sensitivity testing from cystocentesis or pelvic
puncture)
§ Eliminate any predisposing factors; Pus
aspiration (under US control); Nephrectomy in
unresponsive unilateral cases
Hydronephrosis
Dilation of the renal pelvis due to outflow obstruction
Clinical signs: Pain; Renal enlargement; Signs of CRF
Diagnosis: US; Excretory urography
Tx: Surgery; Relieve obstruction; Nephrectomy incomplicated, unilateral cases
Nephrotic syndrome?
Nephrotic Syndrome
Subacute/chronic progression; Severe glomerulopathy → Severe
proteinuria → Severe hypoalbuminaemia → Nephrosis syndrome
4 Criteria: Proteinuria; Hypoalbuminaemia; Hyperlipidaemia;
Extracellular fluid accumulation
DIAGNOSIS
Lab. D
Persistent, severe proteinuria with normal urine sediment
Severe kidney parameters can be normal; Hypoalbuminaemia;
Hypercholesteremia
Detection of proteins: UPC ratio
Urine electrophoresis: Glomerular/tubular/mixed proteinuria
Screening for infectious diseases
Renal biopsy: Histopathology
TREATMENT
Standard tx = ↓ Proteinuria
Specific tx: Immunosuppression; Amyloid prevention
Standard tx of proteinuria: Renal diet; Omega-3 supplement;
Inhibition of RAS; Antihypertensive treatment; Antiplatelet tx;
Anticoagulant tx.
- Diet (see renal diet earlier) →
Slower, non-immunologic
progression of the disease
- Inhibiting RAS (see Fig. 37.2), Ø
in dehydrated patients):
Benazepril; Enalapril;
Telmisartan; Spironolactones
- Tx of hypertension: Amlodipine
(Ca-channel blocker)
- Anticoagulant tx: If albumin
<20g/l → Clopidogrel or Aspirin
Different drugs affecting different stages of the RAAS?
Different drugs affecting different stages of the RAAS
