small animal Chronic kidney disease

Typically AKI is __________ while CKD is ____________

• reversible

• irreversible

Once their are <_______ f nephrons global homeostasis fails

25%

Nephron damage that persists for longer than ___ months is considered chronic

3

What are common historical findings youd see in an animal with CKD

• PU/PD

• weight loss

• inappetence

• vomiting

• lethargy

While creatinine is a good indicator of kidney health ______ increases earlier than creatinine and is not affected by _____________

• SDMA

• muscle mass

The first sign of CKD in cats may be __________

a drop in USG

The first sign of CKD in dogs may be ___________

proteinuria

A cats normal USG is ________ and anything less than ____ is consistent with CKD

• 1.040

• 1.035

A dog with a USG less than ______ is consistent with CKD

1.025

Urine culture is used to rule out what two conditions

• UTI

• pyelonephritis

Typically animals with chronic kidney disease will have what lab test results

• hypokalemia

• non regenerative anemia

• inactive urine sediment

IRIS staging is done based on the __________________

serum creatinine of a stable patient

You should only Iris stage after _____________

diagnosis

What are the IRIS stages for CKD in cats

• stage 1

• stage 2

• stage 3

• stage 4

• <1.6

• 1.6-2.8

• 2.9-5

• >5

What are the IRIS stages for CKD in dogs

• stage 1

• stage 2

• stage 3

• stage 4

• <1.4

• 1.4-2.8

• 2.9-5

• >5

In addition to staging based on creatinine you can also substage based on what?

• blood pressure

• proteinuria

Iris substaging based on blood pressure assess risk of ____________ to a target organ

damage

What are the values of blood pressure that fit into these categories of IRIS substaging:

• normotensive

• borderline hypertensive

• hypertensive

• severely hypertensive

• 150/95

• 150-160//95-99

• 160-179/ 110-119

• 180/120

proteinuria substaging is based off of _______ ratio

UPC

What are the IRIS substaging values for proteinuria in cats:

• non proteinuric

• borderline proteinuric

• proteinuric

• <0.2

• 0.2-0.4

• >0.4

What are the IRIS substaging values for proteinuria in dogs:

• non proteinuric

• borderline proteinuric

• proteinuric

• <0.2

• 0.2-0.5

• >0.5

What is the difference in manifestation of chronic kidney disease between dogs and cats

• cats will get tublointestinal disease

• dogs will proteinuric glomerular disease

Cats ill have a _________ of CKD than dogs

slower progression

Both dogs and cats with CKD will have ___________ but in cats it will cause retinal damage

hypertension

What are common co morbidities that you will see in dogs and cats with CKD

• poor appetite

• hypertension

• anemia

• UTI

In cats weight loss is detected before diagnosis of _________ and accelerates after diagnosis

CKD

in relation to appetite the CNS ___ a meal while the GI ____ a meal

• stimulates

• terminates

_________ compounds activate hunger center and ______________ compounds activate the satiety center

• Orexigenic

• anorexigenic

CKD causes ___________ compounds to accumulated due to decreased ________

• anorexigenic

• GFR

What anorexigenic compound is most associated with decreased apatite in animals with CKD

des acyl ghrelin

in advanced CKD it is important to notice high ___________

phosphorus

in early CKD ________ is kept within normal ranges via secretion of __________

• phosphorus

• FGF-23

FGF-23 reduces _____ and increases _________

• intestinal absorption

• renal elimination

in late CKD ______ can no longer mitigate hyperphosphatemia and inhibits _________ synthesis

• FGF-23

• calcitriol

Due to decreased calcitriol _________ become elevated overall causing bone ________

• PTH

• deminerlization

Overall it is important to know that FGF-23 predicts onset of _______

azotemia

Make sure to perform multiple ________ measurements

blood pressure

You should treat you bp immediately in what situations

• retinopathy/encephalopathy

• >200

After 2-3 rechecks you should treat if the BP is persistently above what?

160

Animals with chronic kidney disease will typically have _______ anemia which prevelance increases with __________

• non regenerative

• IRIS staging

What causes anemia in CKD

• decreased erythropoiesis

• shortened RBC survival

• increased RBC loss

What is a consequence of non regenerative anemia that is present within the tissues of the kdiney

Peritubular capillary rarefaction

it is found that cats with CKD have intestinal _________

dysbiosis

CKD cats have increased uremic toxins. some of those toxins originate from _________ of proteins

colonic metabolism

What uremic toxins originate from colonic metabolism

• inoxyl sulfate

• p- cresol sulfate

Proteinuria in cats is associated with a __________

poor prognosis

Cats can have __________ secondary to _____________

• glomerulosclerosis

• tubulointerstitial disease

A cat presenting with plasma cell pododermatitis and some kidney signs might have what?

Immune complex glomerulo nephritis