Renal failure

Question 1

What is the difference between renal disease and failure?

Answer 1

Failure - when compensatory mechanisms of diseased kidneys are no longer able to maintain the functions of the kidney
Disease needs to be severe to cause failure

Question 2

What is the cause of pre-renal acute kidney insufficiency?

Answer 2

Poor perfusion to kidneys

Question 3

What is the cause of renal acute kidney insuffciency?

Answer 3

acute toxicities
Kidney pathology

Question 4

What is the cause of post-renal acute kidney insufficiency

Answer 4

Obstruction of urinary tract
Leak/rupture

Question 5

Outcome of acute kidney insufficiency

Answer 5

Azotaemia
Hyperkalaemia
Acidosis

Question 6

What are the clinical findings of acute kidney insufficiency

Answer 6

Rapid and progression
VERY sick

Lethargy
Depression
Anorexia
Vomiting
Dehydration
No urine (anuria) or little urine (oliguria
Large painful bladder and kidneys

Question 7

Describe chronic kidney disease (CKD)

Answer 7

common
prolonged loss of renal tissue
Progressive - chronic interstitial nephritis
Irreversible
Clinical signs aren’t apparent until significant loos of functioning renal tissue

Question 8

Clinical signs of CKD

Answer 8

PU/PD (first to appear
Vomiting
Anorexia
Weight loss
Lethargy
Small knobble knees
non-regenerative Anaemia
Poor haircoat
Oral lesions
Pale mucous membranes
Dehydration
Osteodystrophy
Ascites or oedema
Poor platelet function

Question 9

How can you differentiate between CKD and AKI?

Answer 9

CKD has history of PU/PD
Small kidneys in CKD, swollen in AKI
Non-regenerative anaemia in CKD
Parathyroid glands large in CKD
Hyperkalaemia in AKI
Poor haircoat and skin in CKD

Question 10

Why does CKD cause osteodystrophy?

Answer 10

in young growing dogs with CKD
Kidneys are unable to maintain Ca levels so body gets Ca from bone

Question 11

Why does CKD cause ascites or oedema?

Answer 11

Protein loss in urine - not enough protein to maintain oncotic pressure in blood => fluid leaks ojut

Question 12

Why does CKD cause PU/PD?

Answer 12

Progressive nephron loss => declining GFR
Compensatory rise in functional nephron reserve GFR => hyperfiltration
Cannot reabsorb water due to increased GFR => polyuria

Question 13

Describe secondary renal hyperparathyroidism

Answer 13

Low iCa due to renal failure:
- phosphate is retained and binds iCa
- urinary losses of iCa
- lower dietary intake of calcium due to inappetance
- less absorption from gut (compromised calcitriol)
=> increased PTH to compensate for iCa loss
=> increased FGF-23 to reduce phosphate levels

Question 14

What is the treatment for renal hyperphosphataemia?

Answer 14

Diet with reduced phosphate
Oral phosphate binders
Oral calcitriol therapy