Chronic Renal Disease Flashcards
(41 cards)
What hormones are produced by the kidney and what do they do?
EPO: produces RBC
Renin: controls BP
Calcitriol: active Vitamin D which increases calcium absorption
What hormones act on the kidney?
Aldosterone: Na/K pump
ADH: vasopressin or anti diuretic hormone: increases water absorption
PTH: parathyroid hormone; maintains your calcium and phosphorous
Where does the problem lie in ARF?
problem is in proximal tubule
Where does the problem lie in CRF?
problem is in the whole nephron
If SDMA is >45 what stage of IRIS are we in?
Stage IV
What is chronic kidney dz?
Loss of fxn’al renal tissue d/t a prolonged process (generally > 2 months)
Usually progressive and irreversible
CKD often smolders for many months or yrs before it becomes clinically apparent (>stage 2)
Why is CKD important?
Affects animals of all ages
Incurable dz :(
Prolonged survival is common (especially in cats)
T/F CKD leads to nephron disease and loss
True
If the animal is no longer able to concentrate their urine, how many of their nephrons have failed?
66% (renal insufficiency)
If the animal is azotemic, how many of their nephrons have failed?
75%
What are the 5 major failures of CKD and what does their failure result in?
- failure of excretion of nitrogenous wastes = uremia
- failure of {urine} = PU/PD
- failure to synthesize calcitriol (Vit D3) = hypocalcemia and renal secondary hyperparathyroidism
- failure to synthesize erythropoetin = anemia
- failure to catabolize peptide hormones (e.g. gastrin) = uremic gastritis
These things can initiate systemic hypertension
Can result in defective hemostasis
What is the classical presenting signs?
PU/PD: NOCTURIA! most common presenting sign= peeing their bed at night
What are other clinical signs?
Anorexia, diarrhea, hypersalivation, weight loss . . . think about it, this has been going on for a while. It’s chronic so they’re gonna have depression, pale mucous membranes, small kidneys, hypertensive retinopathies, loose teeth/deformed jaw, poor body condition
What will our urinalysis show us for dog and cat?
Unable to concentrate urine/ inappropriately concentrates urine.
Dog SG: 1008- 1022
Cat SG: 1008-1030
What will CKD definitely have on diagnostic findings?
Often will have azotemia and will DEFINITELY have an inappropriately concentrated urine
What will our Biochem results show us?
- Hyperphosphatemia
- Hypo/hyperkalemia
- Hypo/hypercalcemia
- Metabolic acidosis
Why do we see hyperphosphatemia with CKD?
kidneys are primary route of phosphate excretion
reduced renal fxn –> phosphate retention
Stage I and II CKD: compensatory mechanisms keep P in line
Stage III and IV: compensatory mechanisms fail: phosphate increases
What effects will we see with hyperphosphatemia?
Unlikely to directly cause CS
Drives renal secondary hyperparathyroidism
Causes progression of dz
Leads to reduced survival :(
Why do we see hypokalemia and what does it result in?
It’s d/t reduced intake and increased renal potassium loss
Results in:
- neuromuscular weakness
- anorexia –> wt loss
- impaired protein synthesis –> wt loss
- decreased renal fxn (reversible!)
- promotes PU/PD
Where are our calcium levels at in CKD?
Total calcium unchanged or slightly decreased
HyperCa can lead to secondary renal failure or cause renal failure
Why does metabolic acidosis happen?
Reduced excretion of H+ ions by kidney
Tends to be mild in CRF
Why do we see non regenerative anemia?
Erythropoietin deficiency Decreased life span of RBC Effect of PTH on bone marrow and RBCS Anemic of chronic dz GI hemorrhage
Results in lethargy and inappetance
What else should we look for on our urinalysis?
Evidence of concurrent UTI
T/F Proteinuria may cause CRF and vice versa
True
