💊Chronic Kidney Disease💊
Causes of CKD top two? and others?
idiopathic tubulointerstitial dx-most common, other big one is glomerular dx -50% of dogs
These are some etiologies of AKI (3 big categories)
hemodynamic/prerenal (severe hypotension, trauma, blood loss, sepsis, ANES (big one), vascular occlusion, severe hyperthermia, severe hypertension,
intrinsic renal injury: nephrotoxins, infectious causes (lepto, pyelonephritis, FIP, lyme dx), neoplasia, acute on chronic ckd.
post renal, due to urethral obstruction or bilateral ureteral obstruction
Clinical signs of TCC and see where anatomically?
pollakuria, hematuria, stranguria
trigone
These are the normal mechanisms the kidney has to prevent protein loss and they filter these type of proteins
1) glomerulus filters proteins by size and charge. prevents high molecular wt. proteins from going into the urine and most of albumin.
2) proximal tubule sucks proteins back into the blood, the remaining albumin and the low molecular wt. proteins
** Three cardinal signs of lower urinary tract dx are
pollakiuria, stranguria, hematuria
List the clinical consequences seen with CKD
uremic toxins accumulation (due to decreased GFR)
anemia from low EPO
renal secondary hyperparathyroidism due to low calcitriol.
arterial hypertension which can lead to end organ damage
Decreased GFR is associated with? and what occurs?
ischemic injury, medullary tubules are particularly suspectable. get sloughing of tubular cells (renal casts) which cause obstruction and further exacerbates reduced GFR and ischemia
Diagnostics for TCC
imaging done
TX?
CBC, chem, urinalysis, BRAF,
cytology-to confirm diagnosis with cath up there. traumatic cath
abdominal, thoracic rads, ultrasound CR
piroxicam, chemo, radiation, photodynamic therapy, antibiotics, urethral stent
more invasive is SX, or SX and chemo
for chemo doxubicin, cisplatin
radiation can cause colitis or urethral stricture
Name some causes of pre-renal proteinuria
tubular proteinuria
glomerular proteinuria
post-renal proteinuria
1) excess plasma proteins, myoglobin from rhadomyoslsis, severe intravascular hemolysis
2) leptospirosis, CKD, toxins, enoplasia
3)hypertension, cushings, DM, immune complex glomerulonephritis, amyloidosis, glomeruloscelerosis
4)inflammation below the collecting ducts such as infection, stones, neoplasia, renal hilus, ureter, neoplasia
Three types of UTI
cystitis: sporadic cystitis (simple of uncomplicated) recurrent cystitis-3 or more a year, implies a predisposing factor
prostatitis
pyelonephritis
Lab findings seen with CKD
azotemia (with BUN and creatine, SDMA is better for muscle wasted animals and earlier CKD)
hyperphosphatemia (and risk of soft tissue mineralization with elevated ca)
low or high k. low k seen with cats CKD. end stage see hyperkalemia more.
metabolic acidosis (secretory from loss of bicarb in urine, titraional with accumulation of uremic toxins)
poorly [] urine
proteinuria
CBC-dehydration
Chem-azotemia, hyperphosphatemia, metabolic acidosis K high or low
urinalysis- decreased USG, proteinuria (severe in GN), cylinduria, and more depending on the cause
urethral diversion
This is the most common glomerular dx in dogs and some examples of them are
immune complex glomerulonephritis (ICGN) 50%
FIP, CAV-q, ehlichia, lyme, heartworm, babesia, blasto, endocarditosis, lupus, lymphoma and more
Diagnosis of bacterial cystitis is made via?
TX?
urinalysis-rods. pyuria supportive.
quantitative urine culture (positive culture without clinical signs not bacterial cystitis, subclinical bacteriuria, or asymptomatic bacteriuria gen. no tx)
AB rads/ultrasound-for uroliths and tumors. CBC/chem-screen predisposing factors.
TX: amoxillin or TMS for 3-5 days
if resistant switch to C and S results still 3-5 days.
if relapse or persistence 7-14 days for recurrent bacterial cystitis
-creatine
-proteinuria (based on protein:creatintine ratio [UPC] )
-hypertension
These are the tx goals for AKI (7)
1) restore hemodynamic stability
2) replace fluid deficit and maintain hydration
3) correct electrolyte and acid-base disturbances
4) ensure urine production
5) address underlying cause
6) supportive care
7) transition to home care
50% of canine kidney tumors are while cat tumors are?
carcinomas, TCC, RCC, hemangiosarcoma, lymphosarcoma, nephroblastoma
in cats lymphoma whick like to replase to the CNS
These are complications of glomerular dx
Hypertension (due to Raas activation)
hypercoagulability (from loss of LMW), see clots PTE, saddle thrombus
fluid accumulation (ascites, pleural effusion, tissue edema)
PLN
nephrotic syndrome
Pyelonephritisis is both a
signs can be?
UTI and a cause of AKI
asymptomatic to life threatening. see systemic
Tx goals of CKD and tx
TX-renal diet-protein restrict, p restrict, etc
Begin renal diet stage 3, late stage 2. but if proteinuria restrict even in stage 1.
hypertension-ace inhibitors, calcium channel blockers-amlodipine, direct vasodilator-hydalazine
TX hyperphosphatemia-phosphate binders will not work without restricition. only add in binder if lot of P
anemia if below <20%, darpepoetin or EPO
Acute on chronic-fluids, suportive care
with ckd may need fluids to maintain hydration
appetite, antiemetics
What are some prognostic factors of AKI and what is one that is not
prognostic factors: oliguria, hypokalemia, hypothermia, renal histopathology (is BM intact to heal, or not)
initial severity of azotemia is not a prognostic indicator
These type of tumors are seen in the prostate
diagnostic done
and can mestasis to the
TCC, adenocarcinoma
prostatic wash, mineralization on imaging
lumbar spine (bone can occur)
How is diagnosis of glomerular dx made?
for TX?
Dipstick/urinarlysis -screen for proteinuria (in [] urine key if above 2+, any in non [] urine) -glomerular dx only is []. if tubular extended to dilute
UPC (urine protein: creatine ratio), high the proteinuria more likely glomerular in orgin. >.5 is proteinuric
CBC-normocytic normochromic anemia, thrombocytosis
Chem-hypoalbuminemia, azotemia/high P, hyperlipidemia
BP-hyptension common
infectious dx screening
advanced diagnostics to look for cause (thoracic rads, ab us. SLE testing)
renal biopsy only way to distringuish between primary glomerular dx such as amyloid vs icgn vs glomerulosclerosis
2) TX: Diet protein restriction, PUFA supplementation, restrict Na,
ARBS-telmisartan (block raas),
amlodipine, hydralazine-potent hypertension
anti-platelet-clopidogrel, aspirin
diuretics-spirolactone, hydrocholothiazine-for fluid accumulation
amylodidosis-colchine for shair pai fever
TX for pyelonephritis
empiric abx fluroquinolone or third gen cephalosporin-10-14 days.
if systemic 48-72 hours intravenous abx.
if creatine rise tx for aki