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VET433: Renal, Endocrine, Urinary > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

(52 cards)

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1
Q

what are the functions of the kidneys

A
  1. excretory
  2. endocrine
  3. regulatory
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2
Q

how do changes in cardiac output affect the kidneys

A

kidneys receive 25% of CO - reduction in CO severely affects the kidneys

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3
Q

what is a nephron

A

functional unit of the kidney

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4
Q

glomerular filtration rate

A

filtration rate of all functioning glomeruli
- depends on the proportion of perfused and filtering glomeruli

single nephron GFR x total # of nephrons

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5
Q

what are reserve glomeruli

A

“backup” nephrons that are non-perfused in health

become perfused when normal ones get damaged

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6
Q

how does chronic kidney disease develop

A

damage and loss of functional nephrons –> recruitment of reserve nephrons –> loss of critical mass (all reserve nephrons are used up) –> hyperperfusion and hyperfiltration of surviving nephrons –> overwhelms remaining nephrons –> glomerular hypertension –> inflammation and progressive damage –> CKD

interstitium gets replaced with fibrosis

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7
Q

what is renal failure

A

failure of the kidneys to carry out their normal functions –> accumulation of uremic toxins and dysregulation of fluid, electrolyte, and acid-base balance

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8
Q

when can a diagnosis of chronic kidney disease be made

A

irreversible + progressive structural/functional abnormalities in the kidneys that persist for > or = 3 months

can only SLOW progression - can NOT reverse it

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9
Q

can a patient have CKD without being azotemic

A

YES - must lose 70-75% of renal functional mass in order for creatinine to exceed the reference interval

have to monitor increasing trends in creatinine in order to detect CKD before azotemia develops

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10
Q

how can a diagnosis of CKD be made

A

increasing creatinine with inappropriate urine concentration

usually isosthenuria with dehydration

ALWAYS evaluate alongside comorbidities, fluid administration, and medication

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11
Q

what must always be done before a diagnosis of CKD can be made

A

rule out all causes of acute kidney injury
- pyelonephritis, ureteral obstruction, leptospirosis, nephrotoxins

confirm the damage is IRREVERSIBLE before diagnosing

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12
Q

chronic kidney disease general disease presentation

A

long history of illness
thin BCS + history of weight loss
anemia
normal to small/irregular kidneys

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13
Q

at what % nephron loss does creatinine exceed reference interval

A

70-75%

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14
Q

what is the best way to interpret creatinine

A

monitor trends

do NOT just look at reference interval

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15
Q

creatinine in small vs large breeds

A

small: lower creatinine (0.5-0.9)
large: higher creatinine (0.7-1.8)

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16
Q

at what % nephron loss does SDMA exceed reference interval

A

40%

always evaluate alongside creatinine, BUN, and USG

best used in patients with normal creatinine + isosthenuria

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17
Q

what steps should be taken if a patient has an elevated SDMA + normal creatinine

A

can start taking renal precautions in terms of diet, drug use/disuse, and monitoring

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18
Q

stage 1 CKD

A

“non-azotemic” CKD

creatinine within reference interval BUT patient is showing signs of renal dysfunction (inability to concentrate urine, renal abnormalities on US, increasing creatinine trends, renal proteinuria)

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19
Q

CKD substaging

A

move up 1 stage if proteinuria or hypertension

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20
Q

clinical signs of CKD

A

appear around stage 2

  1. PU/PD
  2. weight loss
  3. GI signs
  4. lethargy, inappetance
  5. oral ulcers (uremic toxins)
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21
Q

clinical consequences of CKD

Study These Flashcards
A
  1. uremic stomatitis
  2. uremic gastropathy
  3. anemia
  4. dehydration
  5. hypertension
  6. hypokalemia
  7. metabolic acidosis
  8. hyperphosphatemia
    9.low calcitriol
22
Q

when should a patient be treated for uremic gastropathy

Study These Flashcards
A

only if showing signs of GI bleeds - hematemesis, melena, etc

23
Q

what causes anemia with CKD

Study These Flashcards
A
  1. GI hemorrhage
  2. iron deficiency
  3. decreased EPO
24
Q

how to treat iron deficiency

Study These Flashcards
A

ensure adequate nutrition
iron dextran injection

25
how to treat anemia due to decreased EPO
erythropoiesis stimulating agents (ESAs) - darbepoetin (aranesp) molidustat - promotes erythropoiesis by increasing endogenous EPO + increases iron availability always ensure adequate iron load prior to administration
26
when should IV/SQ fluids be used in CKD patients
ONLY in order to prevent or treat hydration ex. if patient is dehydrated OR if patient is hydrated but has ongoing losses (vomiting, diarrhea)
27
what causes hypertension with CKD
renal dysfunction leading to decreased BP regulation by kidneys
28
outcomes of hypertension
- progressive renal damage - retinal detachment - CV effects (LV hypertrophy) - hypertensive encephalopathy
29
hypertension treatment
amlodipine ACE inhibitors angiotensin receptor blockers (ARBs)
30
how does hypokalemia occur with CKD
malnutrition/decreased intake exacerbated by renal losses and malabsorption
31
treatment for hypokalemia
1. ensure adequate nutrition 2. potassium gluconate (tumil K)
32
how does CKD cause a metabolic acidosis
accumulation of uremic acids AND inability to produce bicarbonate
33
treating metabolic acidosis
before treating, ALWAYS correct: 1. dehydration (need to correct underlying lactic acidosis) 2. hypokalemia (sodium bicarb will exacerbate hypokalemia) treatment: sodium bicarbonate
34
what is the ideal sodium bicarbonate levels
20 mmol/L
35
how to calculate bicarbonate deficit
bicarb deficit = BW (kg) x base deficit x 0.3 base deficit = 20 - current bicarbonate
36
how does CKD cause hyperphosphatemia
phosphorus retention in the kidneys leads to secondary renal hyperparathyroidism + tissue mineralization
37
pathogenesis of renal secondary hyperparathyroidism
high P --> complexes with Ca in tissues --> decreases iCa in serum --> low Ca stimulates PTH --> PTH causes increased Ca and stimulates P excretion --> P unable to be excreted due to CKD --> hypercalcemia + hyperphosphatemia
38
treatment for hyperphosphatemia
low phosphate diet phosphate binders
39
what causes low calcitriol in CKD
renal secondary hyperparathyroidism elevated PTH should stimulate calcitriol activation in the kidneys BUT kidneys are dysfunctional --> decreased active vitamin D --> exacerbates renal secondary hyperparathyroidism NO standard treatment
40
general CKD management
1. hydration - IV or SQ fluids only if indicated 2. nutrition - renal diets, appetite stimulants if severely ill, enteral feeding tube
41
what is the overall goal of nutritional CKD management
1. adequate calories (meet energy requirements) 2. alleviate clinical signs 3. minimize electrolyte, acid-base, and fluid abnormalities 4. slow disease progression
42
how to ensure adequate calories
monitor appetite due to waxing/waning appetites of CKD patients want to ensure patient is eating diet, if not may need to consider switching diet or enteral feeding tubes
43
CKD diet parameters to improve clinical signs
LOW protein MAINTAIN sodium HIGH potassium, bicarbonate, B vitamins
44
CKD diet parameters to slow progression
LOW phosphorus, protein HIGH omega 3 FAs, antioxidants
45
what stages of CKD is it most important to reduce dietary protein
stages III-IV lowering protein reduces uremia
46
what renal disease is it most important to reduce dietary protein
PLNs (protein losing nephropathies) protein will worsen renal tubular damage low protein will decrease glomerular hypertension
47
dietary sodium goals for CKD
0.4-1.5 g per 1000kcal do not want too low - will stimulate RAAS do not want too high - will increase risk of hypertension
48
why is it important to supplement potassium in CKD diets
high risk of hypokalemia in CKD
49
why is it important to supplement HCO3 in CKD diets
want to alkalinize the urine to combat metabolic acidosis
50
how does reducing phosphorus help in CKD
controls PTH levels + reduces risk of soft tissue mineralization increased P can cause kidney injury
51
important dietary considerations
- do not switch during stress, illness, or hospitalization - switch diet gradually - ensure adequate water intake - may need to rotate or add variability for palatability
52
what parameters should be monitored in CKD patients
- appetite - weight trends - muscle mass trends - azotemia - phosphorus - electrolyte imbalances - serum albumin/UPC

VET433: Renal, Endocrine, Urinary (20 decks)

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