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12- SA- Urinary and endocrine disease > Chronic kidney disease > Flashcards

Chronic kidney disease Flashcards

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1
Q

what is chronic kidney disease

A

Long-standing, irreversible damage to the kidneys that impairs their function

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2
Q

List 8 common presenting signs of CKD

A

PU/PD
Anorexia
Weight loss
Vomiting and diarrhoea
Dehydration
Pallor
Mucosal ulcers
Uraemic breath

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3
Q

describe how nephron damage gets worse and therefore irreversible

A

Nephron loss > other nephrons GFRs increased to compensate> more damage

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4
Q

how can reduced renal function lead to non-regenerative anaemais

A

reduced EPO production

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5
Q

what is a uraemic crisis

A

Build-up of urea and other toxins usually excreted in kidneys to intolerable levels.

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6
Q

list 3 conditions that can lead to uraemic crisis

A

End stage Chronic Kidney Disease
Acute Kidney Injury
Acute on Chronic Kidney disease

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7
Q

List 11 clinical signs of a uraemic crisis

A

VERY SICK
* Vomiting/nausea
* Anorexia
* Lethargy
* Depression
* Oral ulcers
* Melena (GI ulcers)
* Anaemia
* Weakness
* Hypothermia
* Muscle tremors
* Seizures

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8
Q

why should you not introdue a renal diet to a cat in hospital for renal disease

A

food aversion
offer when at home

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9
Q

describe the difference in duration of signs between CKD and AKI

A

CKD > 3 months
AKI <48 hours

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10
Q

what do we tend to find on clinical exam with CKD

A

BCS and coat quality reduced. Kidneys small and hard (enlarged possible dependant on cause e.g. PKD)

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11
Q

Describe stage 1 and 2 of IRIS STAGING

A

rarely picked up this soon
Abnormal renal imaging/ known insult OR
Persistent elevation/ increasing Creatine/ SDMA OR
Persistent renal proteinuria

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12
Q

Describe late 2 -4 stages of IRIS staging

A

consitent clinical signs
Azotaemia / persistently elevated creatinine/ SDMA
AND
USG <1.035 (cats) or <1.030 (dogs)

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13
Q

what is stage 1-4 of Iris staging based on

A

cratinine OR SDMA

consistent elevation in hydrated patient

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14
Q

what is substage of iris staging based on

A

proteinuria
systolic blood pressure

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15
Q

when does serum creatinine increase

A

when 75% of nephrons have been lost

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16
Q

when does SDMA increase

A

at 40% nephron loss

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17
Q

Describe how to treat CKD

A

treat underlying cause
mange risk factors to slow progression
renal diet

changes as it progresses

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18
Q

what is the problem with hyperphosphataemia with CKD

A

causes quicker progression of renal disease
can also lead to hyperparathyroidism –> Metabolic Bone Disease

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19
Q

Why do we get hyperphosphataemia in CKD

A

Phosphate –> filtered by kidneys so builds up in CKD

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20
Q

why is hypertension a concern

A

can cause end organ damage if susteined

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21
Q

describe how to diagnose hypertension

A

Based on repeated measurements of systolic blood pressure (SBP) - consistent technique and equipment

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22
Q

at what point do we treat hypertension

A

Treat if Systolic BP reliably and consistently >160 mm Hg

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23
Q

List 3 ways to treat renal hypertension

A

ACE inhibitor - e.g. Benazepril, Enalapril
Angiotensin receptor blockers (ARB) - e.g. Telmisartan, Spironolactone
Calcium Channel Blocker (CCB) - e.g. Amlodipine

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24
Q

how quick do you aim to reduce hypertension

A

Aim to reduce to <150mmhg over a few weeks – quicker (hours) if severe ocular / CNS signs

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25
How do we treat CKD in dogs
aim to interfere with RAAS activation . 1st choice= Angiotensin receptor blockers (ARB) OR ACE inhibitors (ACEi) If needed can add in calcium channel blocker
26
How do we treat CKD in cats
start with Calcium Channel Blocker as more effective at reducing BP unless also proteinuria can add angiotensin receptor blockers or ACEi to increase effect if needed
27
what should you do if urine dipstick +ve for protein
Urine Protein Creatinine Ratio
28
How do we treat proteinuria
RAAS inhibitor (ACEI or Angiotensin Receptor Blocker ) and feed a clinical renal diet
29
define pyelonephritis
bacterial infection of the renal pelvis and parenchyma
30
describe how to diagnose pyelonephritis
Very sick haem- neutrophilia with left shift U ltrasound - renal pelvis dilatation with hyperechoic mucosa, altered cortex/ medulla echogenicity. NOT pyelocentesis as high risk- culture urine sample
31
Describe how to treat UTIs/ pyelonephritis
choose renally excreted drugs e.g. amoxycillin / amoxyclav
32
why should we avoid aminoglycosides in patients with CKD
can cause acute tubular necrosis e.g. gentamycin
33
why should we avoid Enrofloxacin in patients with CKD
can cause renal damage in cats with reduced renal function at high
34
why do renal neoplasia generally not show signs of CKD
usually unilateral so other kidney compensates
35
Describe Polycystic Kidney Disease (PKD)
congenital disease seen more in cats Fluid filled cysts present from birth in the kidney--> Size and number gradually increase with age ---> CKD
36
what do you find on clinical exam with Polycystic Kidney Disease (PKD)
as CKD but large irregular kidneys
37
describe how to diagnose Polycystic Kidney Disease (PKD)
-ultrasound -hypo/anechoic spherical cavities there is genetic testing- PCR for mutated gene (helps find animals we should not be breeding from)
38
describe Fanconi’s syndrome
Disease of proximal tubule > reduced resorption of solutes Dogs
39
List the clinical signs of Fanconis syndrome
PU/PD weight loss signs or uraemia
40
describe how to diagnose Fanconi's syndrome
Increased urinary fractional excretion of glucose, , Na+, K+, phosphorus & bicarbonate in urine despite normal plasma concs.
41
describe how to treat Fanconis syndrome
remove cause if possible supplement electrolytes lost
42
List the indications of renal biopsy
Only if will alter patient management (generally not CKD) e.g. - Protein Losing Nephropathy – unexpected/doesn’t respond to treatment - AKI- cause and prognosis - Mass lesions
43
List 6 contraindications of renal biopsy
Late stage CKD Severe anaemia/ azotaemia Uncontrolled hypertension/ coagulopathy Severe hydronephrosis/ many large cysts Pyelonephritis/ perirenal abscesses NSAIDs in last 5 days
44
what is nephrotic syndrome
Lost so much protein from blood--> no longer keep water in the blood so oedema formed
45
what is seen with nephrotic syndrome
Pitting oedema /ascites/ pleural effusion Hypoalbuminaemia Hyperlipidaemia (TGs and cholesterol)
46
Describe how to treat nephrotic syndrome
Antiproteinurics- ACE inhibitors Anticoagulants - Aspirin or Clopidogrel- minimize spontaneous platelet aggregation Fluid removal - if QOL decreasing as result
47
describe how to treat glomerular disease
If a cause of immune complex disease present – treat Manage Nephrotic syndrome if present Limit proteinuria - with ACE inhibitors Monitor and manage CKD as per IRIS staging
48
List 5 things that decrease prognosis of CKD
Uncontrolled hypertension Persistent ↑ Serum Phosphorus Persistent Proteinuria Unable to medicate/ switch to renal diet. Can’t control underlying issue.
49
Describe how to treat CKD in cats
Treat underlying causes if possible Discontinue nephrotoxic drugs- NSAIDS Treatment as dogs/cats BUT dietary management different 2ndary hypertension common- diagnose as dogs/cats and treat with ACEi
50
List 7 potential underlying causes of CKD
Polycystic kidney disease pyelonephritis toxins glomerulonephritis neoplasia amyloidosis FIP
51
List 5 examples of nephrotoxic drugs that can cause CKD
NSAIDs aminoglycosides sulphonamides polymyxins chemotherapeutics
52
Why do we get renal hyperparathyroidism secondary to CKD
reduced metabolism and excretion of parathyroid hormone
53
How do we treat a uraemic crisis
IVFT- Hartmanns Assess acidosis (blood gas analysis) Treat nausea and GI ulceration (Maropitant, pain relief, omeprazole ) Nutritional support
54
Describe how we reduce phosphate levels
renal diet- low in phosphate phosphate binders e.g. Aluminium hydroxide
55
What is a biomarker for cats at risk of hyperphosphataemia
FGF23
56
How can hypertension effect the kidneys
Faster decline of renal function Increased proteinuria More frequent uremic crisis Higher mortality
57
How does CKD lead to proteinuria
Nephron loss => other nephrons GFRs increased to compensate => glomerular capillary wall damage and more plasma protein filtration => further glomerular and tubulointerstitial damage.
58
How do we monitor patients being treated for hypertension
Evidence of worsening EOD on exam Marked increase in azotaemia Evidence syncope/hypotension (SBP <120mmHg)
59
Describe how we treat pyelonephritis
Only if clinical signs Choose renally excreted drugs e.g. amoxycillin/ amoxyclav - higher conc in urine TMPS Fluoroquinolones (not enroflocacin) - protected
60
List some nephrotoxin antibiotics
Aminoglycosides - can cause acute tubular necrosis Enrofloxacin- can cause renal damage in cats with reduced renal function at high doses
61
what type of cancer can result in CKD
Lymphoma- multi centric
62
What testing can we do for polycystic KD before disease develops
Genetic testing - PCR for mutated PKD1 gene
63
List the clinical signs of glomerular disease
Signs consistent with CKD/ uraemia or can be non-specific weigh loss/ lethargy.
64
Describe how to diagnose glomerular disease
Haematology/ Biochem - Likely as for CRF but may not be azotaemia - Likely hypoproteinaemia Urinalysis - Proteinuria => always - May still be able to concentrate urine - Hyaline casts common as protein lines tubules Renal biopsy - definitive diagnosis
65
Which part of the kidney would you biopsy for glomerular disease diagnosis
cortex only
66
which diuretic is potassium sparing
spironolactone
67
How do we diagnose CKD in rabbits
urinalysis biochemistry
68
How do we get a urine sample in rabbits
Don't cysto if possible Free catch/express best option
69
Describe how to treat CKD in rabbits
Treat underlying causes if possible Discontinue nephrotoxic drugs Treatment as dogs/cats BUT dietary management different (see endocrine) 2ndary hypertension common- diagnose as dogs/cats and treat with ACEi

12- SA- Urinary and endocrine disease (20 decks)

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