A veterinary practic

1. Now what?
By Jacquelyn H. Burns, DVM
© Jacquelyn H. Burns 2012
All rights reserved

2.  Kidney damage that is cumulative enough to cause
 Patient to not feel as well as he or she should
 Weight loss
 A consequence of decreased appetite
 Probably due to nausea/queasiness
 Loss of function
 Production of dilute urine (lots and lots of urine!)
 Patient drinks more water to compensate for this
 Buildup of waste products in blood stream
 Gastrointestinal irritation/ulceration
 Probable cause of decreased appetite
 Anemia

3.  No, but patients often feel tired, queasy or
nauseated and maybe just disinterested in life

4.  Acquired
 Toxins
 Anti-freeze (ethylene glycol)
 Certain toxic plants
 Recurrent untreated conditions
 Urinary tract infections/disease
 Other chronic diseases
 Glomerulonephritis
 Age-related?
 While I tell my clients “Old age is not a disease,” the majority of the
chronic renal failure (CRF) patients are middle-aged and older. An
insult here/an insult there, over time, can damage and scar the
kidneys, leading to loss of function. Older pets are more likely to have
accumulated damage causing loss of functional kidney tissue.
 Congenital
 Some breeds are more prone to it than others

5.  While we tell clients “Old age is not a
disease,” the majority of the chronic
renal failure (CRF) patients are middle-
aged and older. An insult here/an insult
there, over time, can damage and scar the
kidneys, leading to loss of function.
Older pets are more likely to have
accumulated damage causing loss of
functional kidney tissue.

6.  “Insults” can result from blood
clots, infections, trauma, shock, to
xins and drugs, and diseases
affecting other organs
Guy
 Cells that are “insulted” badly walks
enough die and are replaced by into a
scar tissue bar…
 Kidneys have an enormous
“reserve capacity” I don’t
 Up to 75% of functional tissue called get no
nephrons can be lost and the kidneys respect
still manage to keep up with their
work
 Once 76% or more of the nephrons
are damaged, the kidneys begin to
get behind in their work

7.  Toxins build up in the blood stream
 Which lead to gastrointestinal irritation
 Which cause heartburn, nausea, lethargy
 Which cause patient to eat less
 Which cause the patient to lose weight
• Kidneys can dilute the filtered
blood, but not re-concentrate
• Leads to dilute urine
• Leads to drinking more/urinating larger volume

8.  Hypertension  retains more fluidheart has
to work harder
 Protein loss in urine  low blood
proteinpatient feels badpatient eats poorly
 Lack of erythropoitinanemiapatient feels
badpatient eats poorly
 Electrolyte inbalances, ugh! Don’t get me
started!!! High phosphorouslow calcium

9.  Appetite loss or disinterest in food
 Sometimes anorexia
 Weight loss
 Increased thirst/increased interest in water
 Having to fill the water bowl up more often
 Increased urine volume
 More urine volume
 Bigger puddles
 More saturated litter box/having to change more often
 Urinating in house or on bedding
 Lethargy/listlessness
 Vomiting

10.  Weight loss or low body condition score
 Sometimes pale mucous membranes
 Lining of eyes
 Lining of mouth
 Noses on fair-skinned pets
 Sometimes kidneys palpate abnormally
 Most often small, hard and lumpy—pitted and
scarred
 Sometimes swollen
 Sometimes halitosis, thick saliva, oral ulcers

11.  Urinalysis
 Proteinuria
 Protein:Creatinine ratio test may be needed to assess.
 Low urine specific gravity
 This means the urine is very dilute
 Blood Tests
 High Creatinine and BUN (blood urea nitrogen)
 High phosphorous
 High potassium
 Anemia
 Low hematocrit

12.  Kidneys can be evaluated by
various kinds of diagnostic
imaging
 X-rays
 Ultrasound

13.  Renal biopsy
Though it often doesn’t
change the outcome, a
renal biopsy is the most
definitive test to assess
cause of and prognosis
for kidney disease.

15. ???????

16.  Pretty simple. KD=Kidney Diet
 Low protein content=lower workload for kidneys
 Less nitrogenous waste products to be filtered out
 Increased fat content
 Fat increases calories
 Fat increases palatability!
 Reduced levels of
 Sodium
 Potassium
 Phosphorous

17.  Not a drug but a nutraceutical
 Contains microbes that “digest” nitrogenous
waste products in the gastrointestinal tract
 Fewer waste products in G-I tract mean less to
be absorbed and filtered by the kidneys
 Goal to keep Creatinine and BUN low(er)
 Special precautions
 Refrigerate
 For best results, give capsules whole

18.  Also a nutraceutical
 Phosphorous in the G-I tract binds to it
 Reduces absorption of phosphorous in gut
 Makes for lower phosphorous blood levels
 Made from ground up crustacean shells
 Powdered and palatable
 What cat doesn’t like the taste of shrimp and crab?
 Not added to our treatment regimen until
phosphorous blood levels are increased

19.  Sucralfate, an gastro-intestinal protectant
 Binds to irritated stomach and intestinal lining
 Decreases heartburn, queasiness, nausea
 Pepcid AC, an antacid
 Reduces gastric acid secretions
 Decreases heartburn, queasiness, nausea
 Reglan, an anti-emetic
 Decreases nausea, vomiting

20.  Anti-hypertensives are helpful in many
cases, particularly in patients with
Glomerulonephritis, an inflammatory process
that adversely affects the kidneys and causes
protein loss via the urine

21.  I saved the fluids for last.
People are often intimidated
by the idea of administering
fluids at home. It can be
scary, but most people can
learn to do it. If
not, sometimes they bring
the pet in 2 to 3 times
weekly for fluid
administration by our
technicians

22.  Most often are
prescribed for cats
 Needle is placed under
the loose skin on the
shoulder/neck area
 Fluids run by gravity
 Take 5 to 10 minutes to
do
 Usually done 2 to 3
times weekly

23.  Our technicians can show
you how to do this at
home.
 Requires:
 A bag of LRS
 An IV Line
 18 or 20 gauge hypodermic
needles
 USE A FRESH, UNUSED
NEEDLE EACH TIME.
The IV line is multi-use if
you are very clean with it.

24.  Regular checkups to include
BUN, Creatinine, Phosphorous, Calcium, Sodiu
m and Potassium
 Intervals between checkups to be determined by
your veterinarian.
 Of these, we are most concerned with creatinine and
phosphorous
 Numbers matter, but only insofar as the patient
feels well. We want our pets to feel well
enough to eat, play and love with gusto, no
matter how low or high their creatinine is.

25.  This material is intended to help veterinary clients
understand chronic kidney disease and how it
affects their pet, as well as one veterinary practice’s
general approach to treatment. Each patient is an
individual and must be assessed and treated by his
or her own veterinarian, according to that
veterinarian's clinical judgment and that patient’s
unique needs.
 For proper diagnosis and treatment, see your
veterinarian. ( preferably with a cup of urine in
your hand  )

26.  Jacquelyn H. Burns, DVM
 Holmes Veterinary Hospital
1001 Church Street
Laurens, SC 29360
www.holmesvethospital.com
All rights reserved
Copyright © 2012 by Jacquelyn H. Burns, DVM