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Flashcards in AKI and CKD Deck (100)
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Compare CKD and AKI prognosis

- AKI is reversible if treated early, sudden onset, can be rapidly fatal
- CKD irreversible, manageable not curable, may live for some time


Describe the typical clinical pathology findings with AKI

- PCV often normal or increased
- HyperK
- Azotaemia
- HyperPhos
- Metabolic acidosis (can be marked)


Describe the typical clinical pathology findings with CKD

- Often non-regenerative mild anaemia
- Often hypoK, sometimes hyperK
- Hyperphos
- Normal/mild acidosis
- High creatinine (may be normal in early CKD or if poor muscle mass)
- +/-Elevated SDMA


Which CKD dogs may be more at risk of becoming hyperkalaemic in late stage renal disease ?

Dogs fed renal diet and on ACE-I


Describe the signalment for CKD

- Older animals, can be juveniles
- Some breed susceptibilities to: juvenile nephropathy (boxers), polycystic kidney disease, amyloidosisi


Give the normal water intake for dogs and cats

- Dogs: 60-90ml/kg/day
- Cats: generally up to 45mls/kg/day


Describe the clinical signs that would be highly indicative of CKD

- Weight loss
- V+
- Lethargy
- Dehydration
- Halitosis
- Low BCS
- Small renal size, irregular
- Oral ulceration


What USG would be indicative of CKD in dogs and cats?

- Dog: 1.008-1.030
- Cat: 1.008-1.035


When might pre-renal azotaemia be challenging in the diagnosis of CKD?

- Patient who is dehydrated (azotaemia will seem worse)
- Azotaemic cat with relatively concentrate urine (SG 1.030) and vague clinical signs
- Dog on furosemide with restricted access to water


What must be done in order to be able to accurately diagnose and stage an animal with CKD?

IVFT - resolve any pre-renal azotaemia and give better reflection of renal azotaemia


Outline the use of diagnostic imaging in the diagnosis of CKD in small animals

- Cats: should nearly always be able to palpate the kidneys
- Can palpate in some dogs, not all
- If palpate small kidneys: radiography confirms size, margination, presence, secondary problems e.g. dystrophic calcification, loss of bone density. Ultrasonography may demonstrate changes in echogenictiy
- Enlarged kidneys: imaging more useful than with small kidneys, radiography confirms size, ultrasonography shows changes in echogenicity that may be suggestive of specific conditions


Give the differentials for causes of an enlarged kidney in a cat

- Polycystic kidney disease
- Lymphoma
- Perinephric pseudocyst


Discuss the prognosis for CKD in cats

- Can have stable CKD for months - years
- May have CKD and die of another disease


Discuss the prognosis for CKD in dogs

- Progressive, linear condition
- More rapid deterioration in dogs vs. cats
- More likely to die of CKD


List the markers of worsening CKD

- Worsening azotaemia
- Anaemia
- High BP
- Proteinuria
- Soft tissue mineralisation


Outline the initial therapeutic plan for stabilisation of CKD

- Fluid therapy e.g. Hartmann's
- Correct hypokalaemia if necessary (fluids likely enough)
- Antiemetics e.g. maropitant, metoclopramide CRI
- Gastroprotectants e.g. sucralfate, ranitidine, famotidine
- Identify and resolve complicating factors e.g. UTI, hypertension


What group of drugs do ranitidine, cimetidine and famotidine belong to?

H2 receptor antagonists


What is the mechanism of action fo maropitant?

NK1 receptor antagonist


Give the initial treatment of hypertension in CKD in dogs and cats

- Cats: amlodipine (Ca Channel blocker)
- Dogs: ACE - I


What are the main aims of managing CKD?

- Determine underlying cause
- Control factors contributing to disease progression
- Maintain quality of life


Discuss the determination of an underlying cause with CKD

- Often not possible
- Treat specific disease where possible e.g. ureteral obstruction, pyelonephritis, renal lymphoma, PLN


Discuss the control of factors contributing to the progression of CKD

- Renal hyperPTH (aka CKD -MBD): control occurs due to elevated phosphate, phosphate and PTH detrimental to nephrons, use phosphate, protein and sodium restricted diets
- Consider adding phosphate binders only if using the renal diet
- Bone demineralisation: care in high risk situations e.g. geriatric dental extractions
- Glomerular hypertension and proteinuria: use ACE-Is (benazepril) in dogs
- Benazepril or telmisartan (angiotensin II receptor antagonist) in cats for proteinuria (but no evidence for effect on survival)


List the aspects involved in the maintenance of quality of life in a CKD patient

- Avoid dehydration
- Use appetite stimulants e.g. mirtazepine (low dose q48hrs), maropitant (decrease vomiting, may improve appetite)
- Manage hypokalaemia (consider supplementation with Kaminox, Tumil K)
- Manage anaemia if causing clinical signs (darbepoietin + iron)
- Manage/prevent constipation
- NSAIDs if in pain


What signs may be seen with hypokalaemia?

Muscle weakness -> ileus -> reduced appetite


Describe the management of constipation in CKD

- Encourage water intake
- Laxatives e.g. lactulose, polyethylene glycol (Miralax)
- Appropriate treatment for joint disease


Describe the steps involved in the IRIS CKD staging

- Step 1: diagnose CKD
- Step 2: Use fasting blood glucose checked at >2 time points and allocate stage I-IV
- Step 3: allocate substage based on degree of proteinuria (UPCR), presence/absence of hypertension


What stage of CKD would the following creatinine results (umol/l) be indicative of?
Dogs: <125
Cats: <140

I, early CKD


What stage of CKD would the following creatinine results (umol/l) be indicative of?
Dogs: 125-180
Cats: 140-250

II, mild or absent clinical signs


What stage of CKD would the following creatinine results (umol/l) be indicative of?
Dogs: 181-440
Cats: 251-440

III, moderate renal azotaemia, onset of significant clinical signs


What stage of CKD would the following creatinine results (umol/l) be indicative of?
Dogs and cats: >440

IV, increased risk of uraemic crisis, significant clinical signs