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

Management of CKD (Quimby) Flashcards

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?

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?

A
  • Polyuria
  • Vomiting and diarrhea
  • Anorexia
  • Acidosis
24
Q

What are some consequences of Hypokalemia in cats?

A
  • Muscle weakness (neck and pelvic limbs)
    - Delete in muscle even if serum K is normal
  • Constipation
  • Anorexia
  • Worsening renal disease
25
Q

What is the Goal when treating Hypokalemia in cats?

A
  • To get the serum K+ > 4.0 mEq/L
  • Don’t wait until K+ is below normal
    - Acidosis: shifts K+ out of cells
26
Q

What are contributing factors of Hyperkalemia in dogs?

A
  • ACEI therapy (most dogs)
  • ARB therapy
  • Kidney diets
27
Q

What are some Effects of dehydration (physiologic)?

A
  • Stimulation of vasopressin (ADH) release
  • Stimulation of RAAS
  • Poor perfusion – can exacerbate hypoxia
28
Q

(T/F) Erythropoietin stimulates RBC production

A

True

29
Q

(T/F) Erythropoietin comes from the kidney and thus production is decreased in CKD

A

True

30
Q

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

A

Decreased Erythropoiesis

31
Q

Causes of Anemia of CKD
*Uremic toxins
*Hemolysis
*Premature removal

A

Shortened RBC Survival

32
Q

Causes of Anemia of CKD
*Thrombocytopathy
*Gastrointestinal ulcers
*Blood sampling

A

Increase RBC Loss

33
Q

What are ways to manage anemia?

A
  • Blood transfusion
  • Erythropoiesis-stimulating agents
34
Q

Erythropoiesis-stimulating agents
* Given three times weekly
* Effective for increasing PCV in cats
* Potentially ~33% antibody formation

A

Epoetin (Epogen, Procrit)(historic)

35
Q

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

A

Darbepoetin alpha (Aranesp)

36
Q

(T/F) Uremic toxins come from colonic metabolism of proteins

A

True

37
Q

(T/F) Uremic toxins have multiple negative effects and are associated with progression

A

True

38
Q

CKD cats have increased uremic toxins:

A
  • Indoxyl sulfate**
  • P-cresol sulfate
39
Q

What are some things we can do to address Uremic Toxins?

A
  • Diet (highly digestible)
  • Azodyl (commonly given, but low on the list)
  • Porus One
    - Absorbent binds indoxyl sulfate
    - Mixed in food
40
Q

Hyperphosphatemia
* Decreased activation of Vitamin D3 (calcitriol) in CKD
* Normally inhibits parathyroid gland
* ↑Phos further decreases calcitriol activation

A

Renal secondary hyperparathyroidism (CKD-MBD)

41
Q

Therapy for Canine PLN:

A
  • Kidney diet
  • ACE inhibitors
  • Angiotensin Receptor Blockers
  • Anti-thrombotic therapy
  • Omega 3 Fatty Acids
  • +/-Immunosuppression
42
Q

Proteinuria in Feline CKD:

A
  • 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
Q

What is a good treatment for proteinuria in cats is more effective than benazepril?

A

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
Q

(T/F) 50-72% of profoundly proteinuric cats have immune-mediated glomerular disease

A

True

45
Q

Match the following conditions with the medication that you would prescribe to address that problem:
Hypertension (cat)

A

Amlodipine or Telmisartan (Semintra)

46
Q

Match the following conditions with the medication that you would prescribe to address that problem:
Hyperphosphatemia

A
  • Renal Diet
  • Then Phosphate Binder
47
Q

Match the following conditions with the medication that you would prescribe to address that problem:
Anemia

A

Darbepoetin

48
Q

Match the following conditions with the medication that you would prescribe to address that problem:
Poor appetite

A

Mirtazapine (Mirataz)

49
Q

Match the following conditions with the medication that you would prescribe to address that problem:
Vomiting

A

Maropitant (Cerenia)

50
Q

Match the following conditions with the medication that you would prescribe to address that problem:
Proteinuria (Cat)

A

Telmisartan (Semintra)

51
Q

Match the following conditions with the medication that you would prescribe to address that problem:
Hypokalcemia

A

Potassium gluconate or potassium citrate

52
Q

Match the following conditions with the medication that you would prescribe to address that problem:
Dehydration

A

Increased water ingestion, then subcutaneous fluids

53
Q

Match the following conditions with the medication that you would prescribe to address that problem:
Hypertension (Dog)

A

Telmisartan or ACEI or amilodipine or combo

54
Q

If a cat has a UTI, which antibiotic would be the least ideal choice for a cat with CKD?

A

Enrofloxacin

Urinary Systems #2 (9 decks)

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