Chronic Kidney Disease

Question 1

At what point will we see azotemia with CKD?

Answer 1

Need 75% loss

Question 2

If a well-hydrated patient with a right ureteral obstruction has azotemia, what conclusions can you draw?

Answer 2

Left kidney is diseased as well

Question 3

What is the first sign of nephron loss?

Answer 3

Loss of concentrating ability

Question 4

Clinical signs of CKD

Answer 4

PUPD
Weight loss
Inappetence, nausea
V/D
Weakness
Constipation
Uremic ulcers

Question 5

What are the physiologic consequences of CKD?

Answer 5

Erythropoetin = anemia
Systemic BP = hypertension
Water conservation = dehydration
Protein conservation = proteinuria
P excretion = hyperphosphatemia
Ca retention = hypocalcemia
K retention = hypokalemia
Acid-base status = acidemia
Vit D converion = hypovitaminosis D

Question 6

What is the most common cause of CKD in cats?

Answer 6

Tubulointerstitial nephritis
Decreased USG first, then azotemia, proteinuria later

Question 7

What is the most common cause of CKD in dogs?

Answer 7

Glomerulonephropathies
Proteinuria fist, USG normal, azotemia and low USG later

Question 8

How is IRIS staging/substaging done?

Answer 8

Creatinine (or SMDA) for stage 1-4
Proteinuria and blood pressure (substages)

Question 9

When can you IRIS stage a patient?

Answer 9

Stable patient only!
Never stage a sick patient based on a single creatinine
You need two creatinine measurements in a stable patient

Question 10

What are the overarching goals of CKD?

Answer 10

Keep them eating
Keep them hydrated
Prevent ongoing damage
Avoid AKI on CKD
Monitor

Question 11

When should darbepoetin be used?

Answer 11

To treat anemia that is <20%

Question 12

How is hypertension treated in cats vs dogs with CKD?

Answer 12

Cats: calcium channel blockers (amlodipine)
Dogs: ACE-I (enalapril, benazepril), ARBs (losartan, telmisartan)

Question 13

How can proteinuria be reduced with CKD?

Answer 13

ACE-I
ARBs

Question 14

How can we prevent thrombi with CKD?

Answer 14

Clopidogrel

Question 15

Under what circumstances can you not differentiate CKD from AKI?

Answer 15

If PCV is normal
Based on magnitude of azotemia
Based on USG

Question 16

Differentiate history, PE, CBC, biochemistry, and UA for AKI vs CKD

Answer 16

Question 17

What type of drug is capromorelin?

Answer 17

Appetite stimulant for dogs

Question 18

Gastric acid reducing drugs

Answer 18

Omeprazole

Question 19

Phosphate binders

Answer 19

Aluminum hydroxide
Ianthanum carbohydrate
Sevelamer hydrochloride

Question 20

Potassium supplements

Answer 20

Potassium gluconate (Tumil-K)