Monitoring Renal Disease Gary Coxon BVetMed MRCVS Veterinary Advisor Vetoquinol UK and Ireland.
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Transcript of Monitoring Renal Disease Gary Coxon BVetMed MRCVS Veterinary Advisor Vetoquinol UK and Ireland.
![Page 1: Monitoring Renal Disease Gary Coxon BVetMed MRCVS Veterinary Advisor Vetoquinol UK and Ireland.](https://reader030.fdocuments.net/reader030/viewer/2022032702/56649cc35503460f9498bbbd/html5/thumbnails/1.jpg)
Monitoring Renal Disease
Gary Coxon BVetMed MRCVS
Veterinary Advisor Vetoquinol UK and Ireland
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Agenda
• Consequences of renal failure• Aims of management• Medications and monitoring
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IRIS (International Renal Interest Society)
• Website at www.iris-kidney.com• Group of specialists that have created guidelines for
• Staging kidney disease• Treatment at various stages of kidney disease in cats and
dogs• Good education section on proteinuria, urine collection, USG
etc
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Renal Failure
• Multiple underlying causes with same outcome
• Progressive and dynamic condition• Clinical signs vary and only appear when 66-
75% of functional tissue has been lost• Replaced by fibrous or scar tissue• GFR no longer adequate
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Diagnosis
• Clinical signs• Changes in urine specific gravity• Changes in blood levels (Urea / Creatinine)
Urine changes (specific gravity)
Blood changes (urea/creat)
¾ Loss
2/3 Loss
Clinical sign Proportion of cats affected Dehydration 67%Anorexia 64%Lethargy/depression 52%Weight loss 47%PU/PD 32%Vomiting 30%Macrorenale 25%Microrenale 19%Pale mucosae 7%Oral ulceration 5%Diarrhoea 4%Retinal detachment 4%Less common clinical signs Haematuria/dysuria, Poor
coat, Halitosis, Osteodystrophy,
Constipation
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Management
• Directed at complications of decreased kidney function
• “Conservative medical management”• Needs to be monitored
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Goals of Management
• Correct imbalances and deficits in fluids and electrolytes
• Limit progressive loss of functional tissue• Manage clinical signs• Ensure adequate but correct nutrition
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Major Factors That Lead to Progression
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1. Hyperphosphataemia and its consequences
• Controlling phosphate proven to increase life expectancy
• The earlier treatment is started the better the prognosis
• Prevent mineralisation and therefore prevent chronic inflammation
Renal secondary hyperparathyroidism
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Phosphate Management
• Restrict dietary phosphorus• Decrease intake• Decrease absorption eg. Ipakitine
• Maintain phosphate in levels set out by experts• Gives extension to lifespan
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Serum Phosphate
• Establish “stage” of renal failure• IRIS guidelines ( www.iris-kidney.com )
• Look up target phosphate level• Adjust phosphate binder and/or food
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Target Phosphate Levels
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“Normal” serum
phosphate ranges
recommended by
commercial
laboratories
and in-house
analyzers for cats
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Survival of cats Median survival times of catswith serum phosphate outside orinside new stipulated phosphate
reference ranges2
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Calcium carbonateCompound with proven phosphate binding properties
ChitosanDerived fromchitin, the main buildingmaterial ofthe exoskeleton of arthropods
Speci c molecular properties
Adsorbant in the intestines
PhosphatesSomeuraemic toxins
Ipakitine®
The original UK phosphate binderformulated speci cally for veterinary use
For cats and dogs
Tasteless powder for addition to food
Contents
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Formulations
• 50g• 150g• 1g/5kg BID• MUST be added to food
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2. Systemic Hypertension• May be a cause or consequence of renal disease• Occurs in up to 66% of cats with CRF• Causes end organ damage – renal, ocular, CNS• In the kidney persistent glomerular hypertension lead to
hypertensive damage and nephron death• Reduction in GFR Activation of RAAS Angiotensin II CO and peripheral vascular resistance BP
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Treatment of Hypertension• Calcium channel blocker
• Amlodipine (Istin) 5mg tablets• Typical dose 0.625-1.25mg/cat SID• 1/8 – 1/4 tablet!• Aim to get BP<170mmHg• Adjust dose as necessary
• ACE inhibitors• Not the most effective for systemic hypertension• May be used if amlodipine alone isnt effective
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3. Proteinuria• Is a marker of glomerular damage
• Glomerulonephritis• Glomerular hypertension• Amyloidosis
• Proteins directly damage the renal tubules causing further nephron loss
• Can be measured via• Dipstick• Urine Protein Creatinine Ratio (UP:C)
• Gives quantitative measure of protein and significance• Prognostic indicator• Treatment decisions• Monitor response to treatment
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Treatment of Proteinuria
• Renal diet
• ACEi (if UP:C >0.4)
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Tests• Haematology
• Anaemia• Biochemistry
• Urea, Creatinine, K+, Na+, Ca+, Phosphate, Proteins• Urinalysis
• USG/dipstick, Sediment, Protein (UP:C), C&S• Systolic BP
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Case 1 – 13 y MN DSH • Clinical signs
• PUPD, Lethargy, weight loss• Bloods
• Urea – 14.3, Creatinine – 178, phosphate normal
• Urinalysis• USG- 1.024, rest including
UP:C normal• Blood pressure
• 225mmHg
Treatment??
•Renal diet•Amlodipine 1/8 tablet SID
•Aim to get BP<170mmHg
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Case 2 – 8y MN Xbreed • Clinical signs
• PUPD, lethargy, weight loss• Bloods
• Urea-16.2, Creatinine-290, phosphate 2.3 (<1.61)
• Urinalysis• USG-1.016, rest including
UP:C normal• Blood pressure
• 145 mmHg
Treatment???
•Renal diet and retest phosphate 4w later
•Phosphate 4w later – 1.97•Add in Ipakitine and aim for <1.61
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Case 3 – 14y FN DSH• Clinical signs
• PUPD, Lethargy, weight loss• Bloods
• Urea-19.1, Creatinine-279, Phosphate – 2.7 (<1.61)
• Urinalysis• USG 1.019, UP:C- 0.8
• Blood Pressure• 160 mmHg
Treatment???
• Renal diet•ACE inhibitor
•But wouldn’t eat food so Ipakitine added to normal food•Retest bloods(inc Phosphate) and UP:C in 4w
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QUESTIONS?