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Urinary Systems #2 > Management of CKD (Quimby) > Flashcards

Management of CKD (Quimby) Flashcards

(54 cards)

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1
Q

In what specie is the following more likely to occur?
- NOT pro-thrombotic
- Slower progression
- Tubulointerstitial disease
- Hypertension: retinal damage
- Hypokalemia

A

Cats

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2
Q

In what specie is the following more likely to occur?
- Pro-thrombotic
- Faster progression
- Proteinuric glomerular disease
- Hypertension: hard to control
- Hypoalbuminemia
-HYPERkalemia

A

Dogs

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3
Q

(T/F) Calcium oxalate urolithiasis tends to end up in n the cat’s ureters

A

True

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4
Q

(T/F) Uremic gastritis is what causes inappetence in animals

A

False

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5
Q
  • Activate the hunger center
  • Ghrelin, NPY, ARP
A

Orexigenic

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6
Q
  • Activate the satiety center
  • Leptin, CCK, POMC/CART
A

Anorexigenic

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7
Q

Appetite compounds arise from CNS or GI
- Stimulates a meal

A

CNS

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8
Q

Appetite compounds arise from CNS or GI
- Terminate a meal

A

GI

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9
Q

What compounds override hunger stimulation in disease states such as CKD?

A

Anorexigenic

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10
Q
  • Decreased uremic vomiting in cats
  • Degree to which it helps with nausea is not known
A

Maropitant (NK-1)

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11
Q
  • May decrease nausea and vomiting
A

Dolasetron and Ondansetron (5HT3)

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12
Q
  • Stimulates appetite
  • Increased weight and BCS
  • Decreases vomiting
  • Oral:
    - 1.88 mg q 48h cats
    - 1 mg/kg q 12h in dogs
A

Mirtazapine (5HT2c/H1/5HT3)

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13
Q
  • Evidence is poor for benefit
A

Famotidine or Omeprazole
(Efficacy: Omeprazole > Famotidine)

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14
Q
  • Approved for unintended weight loss in cats
  • Achieves therapeutic serum concentrations
  • Resulted in significant weight gain in comparison to placebo in a large efficacy trial
A

Transdermal Mirtazapine

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15
Q
  • Capromorelin (grelin mimetic)
  • Approved for both cats and dogs
  • Somewhat bitter
  • Careful monitoring in cats
    - Bradycardia
    - Hypotension
A

Entyce (Dogs) and Elura (cats)

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16
Q

When do we actively manage appetite?

A
  • As soon as they develop a picky appetite e
  • As soon as weight loss or muscle loss is seen
  • To maintain caloric intake
  • To get them to eat the diet you want
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17
Q

What are some known consequences of Hypertension?

A
  • Retinal Damage, Blindness
  • Worsening renal damage
  • Proteinuria
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18
Q

(T/F) BP has to be sky-high for retinal damage to happen

A

False

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19
Q

Managing Hypertension:
- Calcium channel blocker
- First choice for cats, secondary for dogs
- Shown to effectively lower BP in cats

A

Amlodipine

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20
Q

Managing Hypertension:
- First choice if proteinuric (dogs)
- Dogs often require dual therapy

A

ACEI (Enalapril, Benazepril)

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21
Q

Managing Hypertension:
- Recently FDA approved for cats
- Only use when BP <200
- Takes a bit longer
- Also used in dogs

A

ARB (Telmisartan)

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22
Q

When managing Hypertension, when do we recheck?

Study These Flashcards
A

In one week
- Increase dose if needed
- Add second med if needed (dog)
- ACEI + amlodipine or ARB + amlodipine

23
Q

What can Hypokalemia cause?

Study These Flashcards
A
  • Polyuria
  • Vomiting and diarrhea
  • Anorexia
  • Acidosis
24
Q

What are some consequences of Hypokalemia in cats?

Study These Flashcards
A
  • Muscle weakness (neck and pelvic limbs)
    - Delete in muscle even if serum K is normal
  • Constipation
  • Anorexia
  • Worsening renal disease
25
What is the Goal when treating Hypokalemia in cats?
- To get the serum K+ > 4.0 mEq/L - Don't wait until K+ is below normal - Acidosis: shifts K+ out of cells
26
What are contributing factors of Hyperkalemia in dogs?
- ACEI therapy (most dogs) - ARB therapy - Kidney diets
27
What are some Effects of dehydration (physiologic)?
- Stimulation of vasopressin (ADH) release - Stimulation of RAAS - Poor perfusion -- can exacerbate hypoxia
28
(T/F) Erythropoietin stimulates RBC production
True
29
(T/F) Erythropoietin comes from the kidney and thus production is decreased in CKD
True
30
Causes of Anemia of CKD *Lack of erythropoietin *Inflammatory cytokines *Absolute iron deficiency *Functional iron deficiency *Uremic toxins *ACE inhibitors, Angiotensin receptor antagonists *Hyperparathyroidism *Marrow fibrosis/infiltration
Decreased Erythropoiesis
31
Causes of Anemia of CKD *Uremic toxins *Hemolysis *Premature removal
Shortened RBC Survival
32
Causes of Anemia of CKD *Thrombocytopathy *Gastrointestinal ulcers *Blood sampling
Increase RBC Loss
33
What are ways to manage anemia?
* Blood transfusion * Erythropoiesis-stimulating agents
34
Erythropoiesis-stimulating agents * Given three times weekly * Effective for increasing PCV in cats * Potentially ~33% antibody formation
Epoetin (Epogen, Procrit)(historic)
35
Erythropoiesis-stimulating agents * Current treatment of choice** * 0.5-1 mcg/kg subcutaneously * Given once weekly until normal PCV * Monitoring BP and PCV required * No antibody problems noted
Darbepoetin alpha (Aranesp)
36
(T/F) Uremic toxins come from colonic metabolism of proteins
True
37
(T/F) Uremic toxins have multiple negative effects and are associated with progression
True
38
CKD cats have increased uremic toxins:
- Indoxyl sulfate** - P-cresol sulfate
39
What are some things we can do to address Uremic Toxins?
- Diet (highly digestible) - Azodyl (commonly given, but low on the list) - Porus One - Absorbent binds indoxyl sulfate - Mixed in food
40
Hyperphosphatemia * Decreased activation of Vitamin D3 (calcitriol) in CKD * Normally inhibits parathyroid gland * ↑Phos further decreases calcitriol activation
Renal secondary hyperparathyroidism (CKD-MBD)
41
Therapy for Canine PLN:
* Kidney diet * ACE inhibitors * Angiotensin Receptor Blockers * Anti-thrombotic therapy * Omega 3 Fatty Acids * +/-Immunosuppression
42
Proteinuria in Feline CKD:
* Associated with poorer prognosis, progression * Few cats are profoundly proteinuric * Most often develops with later-stage disease * Cats with UPC repeatedly > 0.4 should be treated * NOT recommended for all cats with CKD * Close monitoring is required * CAUTION using ACEI in late-stage disease * Several studies examine benazepril therapy
43
What is a good treatment for proteinuria in cats is more effective than benazepril?
Telmisartan (Semintra®) - Angiotensin receptor blocker (ARB) - Demonstrated decreased blood pressure in cats - Demostrated to decrease proteinuria in cats - Need more info about effects in CKD cats
44
(T/F) 50-72% of profoundly proteinuric cats have immune-mediated glomerular disease
True
45
Match the following conditions with the medication that you would prescribe to address that problem: Hypertension (cat)
Amlodipine or Telmisartan (Semintra)
46
Match the following conditions with the medication that you would prescribe to address that problem: Hyperphosphatemia
- Renal Diet - Then Phosphate Binder
47
Match the following conditions with the medication that you would prescribe to address that problem: Anemia
Darbepoetin
48
Match the following conditions with the medication that you would prescribe to address that problem: Poor appetite
Mirtazapine (Mirataz)
49
Match the following conditions with the medication that you would prescribe to address that problem: Vomiting
Maropitant (Cerenia)
50
Match the following conditions with the medication that you would prescribe to address that problem: Proteinuria (Cat)
Telmisartan (Semintra)
51
Match the following conditions with the medication that you would prescribe to address that problem: Hypokalcemia
Potassium gluconate or potassium citrate
52
Match the following conditions with the medication that you would prescribe to address that problem: Dehydration
Increased water ingestion, then subcutaneous fluids
53
Match the following conditions with the medication that you would prescribe to address that problem: Hypertension (Dog)
Telmisartan or ACEI or amilodipine or combo
54
If a cat has a UTI, which antibiotic would be the least ideal choice for a cat with CKD?
Enrofloxacin

Urinary Systems #2 (9 decks)

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