Lecture 1 -- Chronic Kidney Disease (CKD) testing and treatment

A set of flashcards focusing on key concepts and treatments related to Chronic Kidney Disease (CKD) and renal function assessment.

What are the clinical signs associated with CKD?

• Lethargy

  • Due to anaemia (Kidney secretes erythropoietin)

• Anorexia and weight loss

  • Due to azotaemia

• Vomiting

  • Due to gastric irritant

• PUPD

  • Due to lack of the ability to concentrate urine

• Dehydration

  • Due to PU and inadequate intake

• Constipation

  • Due to anorexia and dehydration

• Hypertension

  • Due to pathology in renal vasculature

• Poor hair coat

  • Because the animal don’t look after themselves

What might be observed in physical examination of a case of CKD?

• Uraemic breath

  • Due to azotaemia

• Osteodystrophy (Rubber jaw)

  • Because the jaw start mineralised

• Pale mucous membrane

  • Due to anaemia

• Weird body postural

  • Due to hypokalaemia → Weakness in skeletal muscle

• Retinal lesion

  • Due to hypertension

• Small, firm and irregular kidney when palpation

• Oral ulceration

What are the special changes in blood biochemistry in renal disease?

• Increased urea and creatinine (Azotaemia)

• Increased phosphate

• Decreased bicarbonate

  • Metabolic acidosis

• Increased or decreased potassium (Depends on acute or chronic kidney disease)

How does renal disease cause secondary hyperparathyroidism?

• Kidney damage → ↓ GFR → ↓ phosphate excretion = Phosphate retention = Hyperphosphatemia

  • → Excess phosphate binds free calcium → ↓ serum calcium → Stimulates PTH secretion

  • → Excess phosphate decreases production of calcitriol

    • → ↓ intestinal calcium absorption

    • → loss of inhibition on parathyroid glands

• High phosphate + low calcium → ↑ PTH secretion

Result: Secondary hyperparathyroidism

What dietary changes are recommended for managing CKD?

• Low protein intake

  • to reduce nitrogenous waste production

• Low phosphorus

  • To prevent hypophosphatemia since kidneys are not able to excrete phosphate as usual

• Alkalinising agents e.g. citrate/ bicarbonate

  • To prevent metabolic acidosis

• Low sodium

  • To make the kidney to function as little as possible

• Feline diets often contain potassium supplementation

  • Since cats tend to not eat if they have CKD

• Water soluble B vitamines

• Fibre