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HLW
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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
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What major endocrine function is impaired with CRF?
lack of erythropoietin
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what are 3 main functions of kidney that are impaired with CRF?
exretory, regulatory, endocrine
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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)
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why are BUN/Crea values not very sensitive for detecting renal failure?
only see increases when 25% function remains
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Is renal disease more prevalent in dogs or cats? which can survive longer with CRF?
cats and cats
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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
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What are other causes of CRF in dogs?
- chronic pyelonephritis/GN/obstruction (hydronephrosis)
- amyloidosis
- familial renal dz
- hyperCa nephropathy
- sequel to AIRF (lepto)
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what is main cause of CRF in cats?
chronic tubulointerstitial nephritis of unknown cause
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What are other causes of CRF in cats?
same things as dogs + polycystic kidney dz (familial in persians) + neoplasia (lymphoma) + granulomatous nephritis from FIP
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What is prevalence of CRF in geriatric dogs v. cats?
- dogs 0.5-1%
- cats 1-3% (so much more prevalent in cats)
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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)
- inappetance/anorexia/dehydration/pale
- wt loss/low BCS/poor hair coat
- lethargy
- ascites/edema
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what physical exam finding is consistent with young dogs with familial CRF?
osteodystrophy (ck parathyroid gland --. hypertrophies due to elevated phosphorus)
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what is radiographic finding with renal secondary hyperparathyroidism?
- "floating teeth" dt bone loss in mandible
- "rubber jaw"
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What are expected CBC findings?
- nonregenerative anemia (normocytic/normochromic)
- stress leukogram (lymphopenia)
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when does azotemia become apparent v. isosthenuria?
- azotemia at 75% nephron loss (3/4 lost)
- 67% for isosthenuria (2/3 lost)
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does serum HCO3 increase or decrease?
decreased (acidosis)
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Does severity of anemia correlate with severity of CRF?
- yes
- and EPO will be low even though pt is anemic
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T/F: CRF will always progress to end stage renal disease once an initial critical mass of functioning nephrons are removed.
true
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what mechanism contributes most to progression of CKD?
- hypertension (intraglomerular)
- hyperproteinemia
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T/F: kidney disease can worsen hypertension and hypertension can worsen kidney disease.
true
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What are some CV findings with hypertension?
- enlarged LV
- hypertrophy of arteries
- murmurs/gallops
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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
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What is basis for substaging CRF?
- degree of proteinuria via UPC
- magnitude of systemic hypertension
- (NOT based on serum phosphorus or PTH)
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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
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Does dog or cat present more clinically ill with elevated creatinine?
dog presents more ill from elevated Crea
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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
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What should you tell you client for life expectancy of cat with CRF v. dog?
- cat: months to years
- dog: <1yr
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