SA Med, Q2, V
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Chronic renal/kidney disease can be broken down into what two categories?
- chronic renal insufficiency (<2/3 functioning; consistent isosthenuria)
- chronic renal failure
What major endocrine function is impaired with CRF?
lack of erythropoietin
what are 3 main functions of kidney that are impaired with CRF?
exretory, regulatory, endocrine
What are main findings in patients with CRF?
- retention of nitrogenous solutes
- fluid derangements
- alterations in electrolytes/acid-base balance
- failure of hormone production (EPO)
why are BUN/Crea values not very sensitive for detecting renal failure?
only see increases when 25% function remains
Is renal disease more prevalent in dogs or cats? which can survive longer with CRF?
cats and cats
What is major cause of CRF in dogs? What would biopsy show for this?
- chronic tubulointerstitial nephritis of unknown cause
- biopsy: lymphocytes + plasma cells of unknown cause
What are other causes of CRF in dogs?
- chronic pyelonephritis/GN/obstruction (hydronephrosis)
- familial renal dz
- hyperCa nephropathy
- sequel to AIRF (lepto)
what is main cause of CRF in cats?
chronic tubulointerstitial nephritis of unknown cause
What are other causes of CRF in cats?
same things as dogs + polycystic kidney dz (familial in persians) + neoplasia (lymphoma) + granulomatous nephritis from FIP
What is prevalence of CRF in geriatric dogs v. cats?
- dogs 0.5-1%
- cats 1-3% (so much more prevalent in cats)
What is most common finding in CRF patient? what are other non-specific findings often associated?
- PU/PD (most common)
- vomiting (dogs)/oral lesions (dogs >cats)
- wt loss/low BCS/poor hair coat
what physical exam finding is consistent with young dogs with familial CRF?
osteodystrophy (ck parathyroid gland --. hypertrophies due to elevated phosphorus)
what is radiographic finding with renal secondary hyperparathyroidism?
- "floating teeth" dt bone loss in mandible
- "rubber jaw"
What are expected CBC findings?
- nonregenerative anemia (normocytic/normochromic)
- stress leukogram (lymphopenia)
when does azotemia become apparent v. isosthenuria?
- azotemia at 75% nephron loss (3/4 lost)
- 67% for isosthenuria (2/3 lost)
does serum HCO3 increase or decrease?
Does severity of anemia correlate with severity of CRF?
- and EPO will be low even though pt is anemic
T/F: CRF will always progress to end stage renal disease once an initial critical mass of functioning nephrons are removed.
what mechanism contributes most to progression of CKD?
- hypertension (intraglomerular)
T/F: kidney disease can worsen hypertension and hypertension can worsen kidney disease.
What are some CV findings with hypertension?
- enlarged LV
- hypertrophy of arteries
What value is used to stage CRF? What are these values for a dog with stage 1-4?
- stage = creatinine
- 1 = <1.4 mg/dl
- 2 = 1.4-2
- 3 = 2.1-5
- 4 = >5.0
What is basis for substaging CRF?
- degree of proteinuria via UPC
- magnitude of systemic hypertension
- (NOT based on serum phosphorus or PTH)
What are creatinine values for stages of feline CRF? What stages are clinically apparent?
- stage = creatinine
- 1 = <1.6
- 2 = 1.6-2.8
- *3 = 2.9-5
- *4 = > 5.0
- *clinically apparent
Does dog or cat present more clinically ill with elevated creatinine?
dog presents more ill from elevated Crea
Dogs and cats both die more quickly with proteinuria. which species is even small traces of protein significant?
even mild proteinuria is significant in cats
What should you tell you client for life expectancy of cat with CRF v. dog?
- cat: months to years
- dog: <1yr
What would you like to do?
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