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Clinical Reproduction & Urology I > CKD in Small Animals > Flashcards

CKD in Small Animals Flashcards

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1
Q

definition of CKD

A

structural &/or fxnl abnormalities of 1+ kidneys continuously present for >3 mos

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2
Q

Renal dz is characterised by

A
  • permanent reduction in no. of fxn’ing nephrons
  • evidence of structural & fxnl derangements
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3
Q

CKD is an… dz

A

ireversible, progressive dz

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4
Q

What population of dogs is more commonly affected by CKD

A

older dogs

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5
Q

What breeds of cats are more prone to CKD

A

Maine coon, abyssinian, siamese, russian blue, burmese

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6
Q

Causes of CKD in dogs

A
  • familial & congenital conditions
    1. chronic tubulointerstitial nephritis
    2. glomerulonephropathy
    3. amyloidosis
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7
Q

Causes of CKD in cats

A
  1. tubulointerstitial nephritis
  2. glomerulonephropathy
  3. lymphoma
  4. amyloidosis
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8
Q

CKD is a syndrome secondary to…

A

loss of kidney fxn

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9
Q

impaired glomerular, tubular, endocrine fxns leads to

A

retention of toxic metabolites & body fluid imbalances

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10
Q

Clinical presentation of CKD

A
  • PU/PD
  • anorexia, nausea, V
  • oral ulceration, stomatitis, necrosis, halitosis
  • D/melena, haematochezia
  • wt loss/cachexia
  • lethargy/depression
  • urinary incontinence
  • anaemia
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11
Q

primary fxn of kidneys

A

maintain water & electrolyte balance

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12
Q

decline in GFR means there is an increase in…

A

excretion of water & electrolytes per nephron

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13
Q

80% reduction of GFR does NOT impair

A

Na, K, water balance

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14
Q

disturbed excretion of electrolytes & water have limited compensatory mechanisms meaning…

A

failure towards end stage

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15
Q

clinical manifestation of disturbed excretion of electrolytes & water

A
  • oedema
  • hypertension
  • hyponatraemia
  • hyperkalaemia
  • hyperphosphataemia
  • metabolic acidosis
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16
Q

CKD has a what main clinical consequences?

A
  • disturbed excretion of electrolytes & water
  • reduced excretion of organic solutes
  • impaired renal hormone synthesis
  • arterial hypertension & CV consequences
  • renal secondary hyperparathyroidism
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17
Q

glomerular filtration of solutes is done by

A

tubular reabsorption

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18
Q

abnormalities due to reduced excretion of organic solutes

A
  • inhibition of Na-K-ATPase
  • inhibition of platelet fxn
  • leukocyte dysfxn
  • insulin resistance
  • loss of RBC membrane lipid asymmetry
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19
Q

Renal hormone synthesis normal includes secretion of…

A

EPO, calcitriol, prostaglandins, renin, kinins

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20
Q

Calcitriol is the most metabolically active form of…

A

Vit D

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21
Q

Vit D def leads to

A

renal secondary hyperparathyroidism

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22
Q

PTH has been id’d as a

A

uraemic toxin leading to renal osteodystrophy

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23
Q

EPO def leads to

A

chronic non-regen anaemia

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24
Q

CKD is the most common cause of secondary…

A

hypertension in dogs/cats

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25
secondary hypertension causes
* target organ damage - eyes, kidney, heart, brain * proteinuria * cardiac remodelling
26
fluid retention is the main cause of
hypertension in humans w/ CKD causing haemodialysis
27
diuretics are used to manage...
fluid overload to control hypertension
28
what are arterial hypertension & CV consequences of CKD?
* secondary hypertension * fluid retention * activation of RAAS
29
ischaemia/vascular lesions cause the enhancement of
renin secretion
30
activation of RAAS causes what in cats
retention of salt (elevated aldosterone, low renin)
31
ACEi are ineffective in...
cats
32
Pathogenesis of secondary renal hyperparathyroidism
* PO4 retention secondary to GFR decline -> elevation in FGF-23 * limits PO4 retention, inhibits 1-alphaH activity -> decreased calcitriol
33
Clinical consequences of renal secondary hyperparathyroidism
* renal osteodystrophy - uncommon cats/dogs --> bones of skull/mandible mostly -> demineralise & fibrous tissues (rubber jaw) * cystic bone lesion, bone pain * nephrocalcinosis - loss of renal fxn
34
diagnostic eval of CKD
* confirm presence of kidney dz * differentiate btw acute vs chronic * ID biochem & haemotological complications * determine type &/or cause of CKD * ID presence of comorbidities * Stage
35
What biochemical values should you use to determine CKD?
* creatinine * BUN * SDMA * USG * UA & culture * electrolytes - P, K, Ca
36
serum creatinine conc is a surrogate for...
GFR - minimum reabsorption
37
serum creatinine conc is insensitive in estimating...
GFR
38
every time GFR decreases by half, the S-creat...
doubles
39
S-creat conc is influenced by...
muscle mass
40
BUN is a surrogate for
GFR but is less specific/sensitive than Creatinine
41
BUN is a surrogate for all...
uraemic toxins
42
What is the goal of a low protein diet?
to limit uraemic toxin prod'n
43
BUN can increase w/
GI ulcers/bleeding enhanced protein catabolism dehydration/pre-renal azotaemia drugs
44
BUN low can be assoc'd w/
starvation
45
decreases in BUN can be impacted by which organ impairment/failure?
liver (hepatic failure, PSS)
46
SDMA is a produce to
protein degradation (methylation of arginine)
47
What % of SDMA is eliminated by glomerular filtration?
90%
48
SDMA is an ideal
biomarker
49
SDMA concentration correlates w/ what in dogs/cats?
GFR
50
SDMA is minimally impaired by...
muscle mass
51
USG should be obtained...
at the same time as blood
52
USG is essential to differentiate
pre-renal from primary renal
53
Dogs have primary renal azotaemia if USG is
<1.030
54
Cats have primary renal azotaemia if USG is
<1.030
55
Adv'd CKD causes USG to be...
isosthenuric b/c kidneys no longer modifying urine conc from plasma conc
56
complete UA & culture is mandatory for...
staging of CKD
57
Why does hyperphosphataemia occur in CKD
* decline in GFR = retention of phosphate = hyperphosphataemia as compensatory mechanism initially
58
Serum PO4 conc is directly linked to...
mortality in cats/dogs/humans w/ CKD
59
Higher PO4 conc in cats predicts...
progression to Stage III
60
reduced intake of PO4 is the only way to control & limit
PO4 retention
61
metabolic acidosis promotes...
anorexia, V, lethargy, muscle wasting, & wt loss
62
how do kidneys normally maintain acid-base balance?
tubular excretion of H via ammonium or PO4 & reabsorption of bicarb to maintain balance
63
when excretion of ammonium decreases w/ GFR it leads to
acidosis
64
Acidosis leads to
decreased PO4 & sulfate compound excretions + impaired tubular proton secretion
65
What is not typical of k9/fel CKD?
reduced reabsorption of bicarb
66
metabolic acidosis is commonly associated w/
Fanconi syndrome
67
how does iCa respond in CKD
increased or decreased but lower in cats w/ CKD than healthy cats but tCa may be hypercalcaemic
68
HypoK is common in
cats w/ CKD NOT IN DOGS
69
HypoK can induce
* a decline in GFR -> Na restriction -> activation of RAAS -> enhanced kaliuresis (+ hypertension), reduced food intake, dehydration * DDX: Primary hyperaldosteronism in geriatric cats
70
how do you differentiate primary hyperaldosteronism from CKD
Aldosterone:renin ratio (elevated) + imaging
71
haematology of CKD may show
non-regen anaemia
72
testing required for CKD
* haematology * serum biochem * UA/culture * Blood gas & electrolytes * BP * UPC * rads, U/S * infectious dz screening: UTI +/- pyelonephritis; lepto; borrelia; fip * any specialised tests PRN
73
AKI vs CKD
AKI: potentially reversible once injury corrected due to adaptive/compensatory mechanisms CKD: irreverisble & progressive loss of kidney fxn for 3+ mos
74
staging of CKD is based on...
P's creatinine or SDMA
75
Stage 1/2 CKD
non-azotaemic (1)/ mild azotaemia (2) no clin signs or mild (PU/PD, wt loss, selective appetite) clin signs assoc'd w/ underlying cause (pyelonephritis, nephrolithiasis) clin signs secondary to complications (proteinuria, hypertension)
76
proteinuria & hypertension can be detected at
any stage
77
mgmt of CKD
Supportive conservative medical mgmt - ameliorate clin signs - improve fluid deficits/excesses - electrolyte, acid-base, nutritional balance
78
Diet therapy of CKD
* renal diets have the greatest benefit * Omega 3's/antioxidants - dogs * protein restriction?
79
commercial renal diets limit
phosphate intake - indicated for Stage 2 p's to slow progression & reduce mortality
80
it is best to initiate the conversion to a renal diet prior to the onset of...
nausea
81
phosphorous mgmt in CKD
* intake must be reduced as GFR decreased to avoid retention * diet PO4 restrictions * intestinal binding agent to trap PO4 in intestines & prevent absorption (Aluminum hydroxide)
82
What is a caution w/ Al-containing products for PO4 management?
* Decreased palatability & cause constipation * toxicosis in adv'd CKD in dogs
83
Lanthanum is used as a
PO4 binder
84
Why is Al hydroxide sometimes used over Lanthanum?
cost
85
Ca-based chelating agent used for PO4 mgmt
Calcium carbonate
86
Calcitriol is used in PO4 mgmt to...
reduce PTH lvls
87
how does dehydration occur in CKD
if PU is not compensated by PD & water intake
88
dehydration can promote...
poor appetite, lethargy, constipation, pre-renal azotaemia/AKI (dz progression)
89
dehydration can be worsened by...
V/D
90
SQF can be admin'd in
chronically dehydrated P's (cats>>dogs)
91
Why are SQF good for CKD?
balanced electrolyte sln
92
how often should SQF be given?
q 1-3 days
93
What is the dose of SQF for cats?
75-125 ml/dose; can be increased but caution w/ fluid overload
94
GI mgmt in CKD
* anti-emetics * appetite stimulation * O-tube or gastrostomy feeding tube
95
what class of anti-emetic therapy is ideal?
proton pump inhibitors
96
the chemoreceptor trigger zone is stimulated by
uraemic toxins causing Nausea & V
97
What drugs act on the CTZ (chemoreceptor trigger zone)
maropitant ondansetron
98
What is an appetite stimulant commonly used in CKD?
mirtazepine
99
adverse effects of mirtazepine
hyperexcitability, tremors, vocalisation
100
signs of hypertension
lethargy, blindness, retinal haemorrhage, retinal detachment, seizures, stupor, cardiac remodeling (ventricular hypertrophy)
101
hypertension is assoc'd w/
proteinuria - promoting progression of CKD
102
indications for therapy of hypertension
* treat &/or prevent target organ damages * 180 mmHg > BP >160 mmHg - rechecked 3x over 2 mos to confirm persistence * BP > 180 mmHg - recheck w/i 1-2 wks & if confirmed = severe hypertension * **stages I-IV w/ confirmed or severe hypertension**
103
guideline for txt of hypertension
* reducing BP <180 mmHg except in p's w/ severe acute ocular or neuro lesions
104
drugs used in a stable dog for hypertension
1. ACEi - Benazepril/enalapril 2. Add Ca channel blocker - Amlodipine 3. Add Angiotensin receptor blocker (ARB) - Sartan Note: may discontinue ACEi prior to Sartan or monitor closely for HyperK, Hypotension, azotaemia
105
Drugs used in stable cat for hypertension
1. Ca channel blocker - Amlodipine 2. ARB - Sartan
106
mgmt of anaemia in CKD
* erythrocyte stimulating agents (Darbopoetin)
107
Managing progression of CKD
* diet + increasing Rx PRN * control BP * control proteinuria * control phosphorus lvl * monitor QOL * restage when uraemic crisis & azotaemia worsens

Clinical Reproduction & Urology I (29 decks)

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