renal

Question 1

CKD definition

Answer 1

decrease in GFR-> increase in serum waste-> tubulointerstitial nephritis

Question 2

CKD causes

Answer 2

primary renal disease (congenital)
FIV, morbilivirus
ureteroliths
environment/diet
vaccination
AKI

Question 3

AKI model of CKD

Answer 3

acute AKI-> poor repair-> CKD

Question 4

SDMA

Answer 4

excreted exclusively by kidneys-> early detection (40% loss)
not affected by muscle, hyperT4

Question 5

CKD C/S

Answer 5

weight loss, PU/PD, inappetence, v+, UTI, lethargy

Question 6

IRIS staging

Answer 6

use SDMA (>14= stage1)
>25 cats, >35 dogs-> stage 3
>54 dog, >38 cats-> stage 4

Question 7

CKD diagnosis

Answer 7

renal azotemia w inappropriate USG
inappropriate USG alone
structural damage
SDMA >14

Question 8

IRIS substaging

Answer 8

proteinuria >0.2-0.4
BP over 150

Question 9

feline CKD prognosis

Answer 9

stage 2 1151d
stage 3 679d
stage 4 35d

Question 10

CKD treatment goals

Answer 10

improve QOL
prolong life
slow progression

Question 11

CKD tx

Answer 11

ensure hydration- hydracare
stimulate appetite (mirtazapine)
treat nausea (cerenia)
check for hypertension
screen for proteinuria
SQ fluid for stage 3/4-> 10-20ml/kg q12

phosphate binder- aluminum hydroxide, calcium carbonate, lanthanum carbonate

Question 12

secondary renal hyperparathyroidism

Answer 12

common in CKD (stage 4)
increased PTH and FGF23

Question 13

geriatric monitoring

Answer 13

Question 14

CKD monitoring

Answer 14

Question 15

proteinuria causes

Answer 15

pre renal: too many smaller proteins brought to kidney
(myoglobin,hemoglobin)

renal:
glomerular injury (GN, PLN)
tubular injury (decreased reabsorption)-> dogs, UPC>2
CKD->cats, usually UPC <2

post renal:
lower urinary signs (UTI, stones, FLUTD)

Question 16

glomerular causes (PLN)

Answer 16

glomerulonephritis:
1. primary/idiopathic

2. secondary-> infectious, immune mediated, inflammatory (often pre renal to start), meds, endocrinopathy, hypertension, neoplasia
3. amyloidosis (shar pei, beagles)
4. familial (bernese, samoyed)

Question 17

proteinuria C/S

Answer 17

GN:no C/S until kidneys are damaged-> azotemia

Question 18

proteinuria workup/dx

Answer 18

CKD: r/o pre/postrenal causes of azotemia-> IRIS staging

GN: no C/S, medical imaging to r/o pre/post renal causes, BP-> infectious disease testing

Question 19

proteinuria dx

Answer 19

dipstick- 1-2+ okay, can have false +ves

UPC- <2 CKD, >2GN

usually hypertensive

Question 20

proteinuria tx

Answer 20

tx underlying systemic disease-> CKD, pre/post renal causes
treat azotemia/hypertension-> follow IRIS guidelines,
tx renal proteinuria-> if >2 for GN
CKD cat >0.4 dog >0.5

diet: renal diet, omega 3s

meds to inhibit RAAS:
ACEi: 0.5mg/kg/d->
telmisartan: 1mg/kg/d (for GN)-> add mycophenolate

recheck in 1wk, increase dose if still too high

Question 21

hypertension

Answer 21

mostly secondary to another disease, idiopathic in cats
(cushings, thyroid, CKD, GN)

Question 22

hypertension C/S

Answer 22

retinopathy, cardiac murmur (gallop), neuro signs, vascular accident (stroke)

results in: organ damage, CHF/hypertrophy, renal damage, brain damage, retinal damage, death

Question 23

hypertension dx

Answer 23

Question 24

hypertension tx

Answer 24

tx primary disease
goal <150
ACEi for dogs 0.5-1mg/kg, calcium channel blockers second (amlodipine)

amlodipine for cats: 1.25mg, telmisartan 1-2mg/kg