36. Chronic kidney diseases in dogs and cats. Nephrotic syndrome Flashcards
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
