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Mark Dunning
Urea
Creatinine
Phosphate
(acid-base status)
(potassium)
Urinalysis you cannot investigate renal disease without a urine
sample
Recent studies looking into determining whether this markers enable determination of CKD
Some evidence for increased concentration of urine RBP as indicator of tubular damage
Mounting evidence that NAG is suggestive of tubular pathology as this is present in lysosyme granules
of the proximal tubule
Both of these markers was found to be elevated in aged dogs with CKD
Recent studies looking into determining whether this markers enable determination of CKD
Some evidence for increased concentration of urine RBP as indicator of tubular damage
Mounting evidence that NAG is suggestive of tubular pathology as this is present in lysosyme granules
of the proximal tubule
Both of these markers was found to be elevated in aged dogs with CKD
To determine absolute degree of renal function when disparity between creatinine and urea
concentrations
To determine progression in renal disease over time
To calculate appropriate reduction in drug dose in a given patient
Hyperphosphataemia*
Metabolic acidosis*
Hyperparathyroidism*
Hypertension
Hypokalaemia
Proteinuria(*)
Uraemic GI disease
Anaemia*
Anorexia
Weight loss
Dehydration*
These benefits have been recognised to aid with limiting progression in CKD and improving
survival
At present studies have not shown a benefit in cats, although limited literature on
subject
Recent studies have shown very early elevation in PTH and thus is such cases there may be an argument for
introduction of calcitriol
Total calcium concentration does not accurately predict ionised concentrations and thus should not be used
If these conditions are not met, or change during therapy calcitriol may promote soft tissue mineralisation
If hypercalcaemia develops then the dose should be altered to every other day dosing at twice the previous
daily concentration
Measurement of PTH and possibly vitamin D
Monitoring should be every 2-4 weeks at beginning and then every 3-6 months once stable
May be more notable in cats than dogs with CKD, possibly due to longer
periods of time asleep
More frequent episodes of dehydration leads to more intermittent
exacerbations in acute on chronic disease. This will lead to a more
rapid progression in disease
Dehydration is more likely to lead to lethargy, anorexia, constipation, all
of which increase the risk of developing acute on chronic kidney injury
and also negatively impact on quality of life
Individual case basis particularly useful when you know the azotaemia responds to IVFT
Sieve analogy
Body weight is a good measure of hydration and can be used to determine the need to
supplement
Cats may be easier to treat than dogs via SC route
Caution in these situations as excessive NA intake may impair efficacy of anti-hypertensive therapy and renal
perfusion
SC route most commonly chosen via IV catheter and standard giving set
Can also use surgically placed button/cannula
Due to complications and poor tolerance of SC route, consider PEG tube placement for
home fluids is reasonable
This enables pure water intake preventing electrolyte dyscrasias often seen
with admin of LRS and Saline
Can also enable feeding of patients to maintain calorific intake
School of Veterinary Medicine and Science
O3FAs
Evidence for reduction of cholesterol, reduce inflammation, inhibit
coagulation, improve intra-renal haemodynamics and limit intra-renal
calcification
Dogs provided with omega 3 FA showed reduced mortality, slower
progression in their renal disease (histological assessment), less
proteinuria and lower cholesterol concentrations
School of Veterinary Medicine and Science