Practitioner reality – How I deal with chronic renal insufficiency (Proceedings)

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Practitioner reality – How I deal with chronic renal insufficiency (Proceedings)

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Apr 01, 2009
12Next Permanent damage to any part of the nephron Multiple possibilities for inciting cause Any age or sex cat, more common in older cats Progressive disease Signalment History of polyuria/polydipsia Usually weight loss Anorexia +/- vomiting Bad breath Lethargy Physical exam findings Dehydration Unkempt cat Kidneys may palpate small and irregular, occasionally large. Usually not painful upon palpation Uremic breath, ulcers present in cats usually only end-stage Diagnosis Elevated BUN, Creatinine Hypokalemia Hyperphosphatemia +/- anemia Isosthenuria +/- hypertension Differential diagnosis Prerenal azotemia – dehydration, high protein diet Renal azotemia o ARF o CRF o Diabetes o Diuretics Postrenal azotemia IRIS staging Stage 1: USG <1.030 with proteinuria or <1.025 without proteinuria, no azotemia, creatinine <1.6 Stage 2: Mild azotemia, creatinine 1.6-2.8, PU/PD and other clinical signs absent or minimal Stage 3: Moderate azotemia, creatinine 2.8-5, clinical signs generally present Stage 4: Severe azotemia, uremic syndrome, creatinine >5 Treatment Fluids Control vomiting/nausea Dietary therapy Phosphorus binders Potassium supplements Appetite stimulants Manage anemia Manage hypertension Manage proteinuria Calcitriol? Practical management Stage 1: Full bloodwork, BP, UA, +/- urine P/C ratio, +/- urine culture. Phosphorus binder if phosphorus over 3 (want to keep under 4), start dietary therapy? Recheck every 6 months with weight, UA, bloodwork Stage 2: As above, but definite UP/C. Recheck every 4 months with weight and UA, Electrolytes +/- bloodwork as determined by history and PE, BP every 6 months Stage 3: As above, recheck every 3 months. UA every visit +/- urine culture prn, culture every 6-9 months if otherwise stable. Bloodwork and BP every 6 months. Stage 4: Hospitalize and stabilize, recheck monthly. 12Next