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Urinary Systems #2 > Diagnosis and Staging of CKD (Quimby) > Flashcards

Diagnosis and Staging of CKD (Quimby) Flashcards

1
Q

Dogs tend to get _________________

A

proteinuric kidney disease

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2
Q

Does a patient have to be azotemic to have CKD?

A

You can have renal disease without any azotemia at all

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3
Q

Clinical signs of kidney failure

A

Uremia

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4
Q

(T/F) Kidney disease is the presence of any structural or functional damage

A

True

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5
Q

CKD:
What are the structural damages that can occur?

A
  • Nephroliths and/or Mineralization
  • Polycystic Kidney Disease
  • Renal dysplasia
  • Infarcts
  • Masses
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6
Q

CKD:
Common historical Findings are:

A
  • PU/PD
  • weight loss
  • Inappetence
  • Vomiting
  • Lethargy
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7
Q

CKD:
Physical Exam Findings

A
  • Poor BCS and Muscle mass
  • Dehydration
  • Small irregular kidneys, or big kidney & little kidney
  • Uremic halitosis, uremic ulcers
  • Poor hair coat
  • Pale gums
  • Heart murmur
  • Blindness/ detached retinas
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8
Q

What does having poor muscle mass do to creatinine?

A

Lowers Creatinine

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9
Q

What can creatinine be affected by?

A
  • Hydration status
  • Muscle mass
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10
Q

Serial increase in creatinine should be noted and must be interpreted with ___________

A

USG

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11
Q

What is something that is going to tell us about GFR?

A

SDMA (Symmetric dimethylarginine)
- Byproduct of protein methylation
- Excreted primarily by renal clearance

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12
Q

What is the following describing?
- Correlated with creatinine and GFR
- INCREASES earlier than creatinine
- NOT affected by muscle mass like creatinine

A

SDMA test

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13
Q

(T/F) SDMA is always correct

A

False, It can sometimes be a little wonky

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14
Q

(T/F) Creatinine can be interpreted without USG

A

False

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15
Q

(T/F) Drop in USG may be the first sign of disease in cats

A

True

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16
Q

(T/F) Proteinuria may be first sign of disease in cats

A

False, first sign of disease in dogs

17
Q

A USG < 1.035 in cats is consistent with _______________

A

CKD

18
Q

A USG < 1.040 in cats merits ______________

A

monitoring

19
Q

In cats a USG of _______________ is expected

A

> 1.040

20
Q

(T/F) Dog’s USG varies more widely due to drinking habits

A

True

21
Q

A USG of <1.025 in dogs could be consistent with ________________

A

CKD

22
Q

When is UPC (Urine-protein creatinine ratio) appropriate?

A
  • When sediment doesn’t have an indication of infection or inflammation
    - < 250 RBC/hpf on sediment
  • Small amount of RBC/WBC expected with cystocentesis
    - 50 RBC/ 1-2 WBC
  • No gross hematuria
  • Urinary tract infection has been ruled out
23
Q

What do you do if you have a first-time azotemic patient?

A

You have to get a UA (URINE CULTURE) to make sure that the reason they are azotemic, isn’t due to an infection

24
Q

What percentage of cats with UTI have CKD?

A

66%
- Do bloodwork for these patients

25
Q

What percentage of cats with stable CKD develop UTI?

A

30%
- patients with CKD have low USG which sometimes leads to UTI

26
Q

Is the following describing Acute or Chronic?
- Sudden onset
- Previously healthy
- No weight loss
- Little or no PU/PD
- Maybe drugs or toxin
- Recent anesthesia

A

Acute

27
Q

Is the following describing Acute or Chronic?
- Progressive illness
- Weight loss
- Anorexia
- PU/PD
- No obvious inciting cause

A

Chronic

28
Q

Is the following describing Acute or Chronic: according to Lab Tests?
- Azotemia
- High phosphorus
- Acidosis
- K high or normal
- Normal PCV
- Active urine sediment

A

Acute

29
Q

Is the following describing Acute or Chronic: according to Lab Tests?
- Azotemia
- High Phosphorus
- Acidosis
- K LOW or normal
- Non-reg anemia
- INACTIVE urine sediment

A

Chronic

30
Q

What is the one big thing that is going to differentiate between Acute & Chronic?

A

The Non-reg anemia for CKD

31
Q

Acute vs Chronic: Imaging
- Kidney may be large or swollen
- Could also be normal

A

Acute

32
Q

Acute vs Chronic: Imaging
- Kidneys may be small or irregular
- Could also be normal

A

Chronic

33
Q

What is IRIS Staging?

A
  • A way to characterize the severity of the disease
    - Based on serum creatinine in a stable patient
    - Stage can also be amended based on SDMA
  • A way to characterize complications of disease that have been tied to prognosis
    - Proteinuria (UPC)
    - Hypertension (Blood pressure)
34
Q

When do you IRIS Stage?

A
  • AFTER diagnosis of CKD
  • In a patient that is:
    - Stable
    - Decently hydrated
    - At home
    - No new medications, diet etc
    - No new medical complications
35
Q

What are some examples of information you can use to substantiate a decision about whether or not kidney disease is present and chronic?

A
  • Weight loss
  • Unkempt haircoat
  • Muscle wasting
  • Poorly concentrated urine
  • Anemia
  • Abnormal kidney structure
36
Q

(T/F) CKD patients require more supportive care during a medical crisis than a patient that is otherwise normal and healthy. A few of the reasons for electing to hospitalize the CKD patient may include azotemia (over baseline), and electrolyte disturbances

A

True

37
Q

(T/F) CKD patients who are severely azotemic should have their hydration corrected as quickly and aggressively as possible to prevent further damage to the kidney. A fluid monitoring plan may include daily PCV/TP, frequent physical assessment, and QID weight

A

False
- Can cause fluid overload
- The fluid monitoring plan statement is however, true

38
Q

(T/F) Pyelonephritis is a common complication in CKD and factors that differentiate it from a lower urinary tract infection may include elevated creatinine from baseline, systemic signs of illness, kidney pain, and inflammatory leukogram. However, not all of these signs have to be present for it to be pyelonephritis, and it’s important to think about whether the patient might fit this clinical picture because it affects the intensity of care and monitoring

A

True

Urinary Systems #2 (9 decks)

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