Felis ISSN 2398-2950

Kidney: chronic kidney disease

Synonym(s): Chronic kidney failure, CKD

Contributor(s): Penney Barber, Melissa Wallace, Nicki Reed

Introduction

  • Gradual, progressive loss of renal tissue   →   inability of kidney to perform normal functions of waste excretion, fluid/electrolyte/acid-base homeostasis and endocrine functions.
  • Cause: in younger animals usually either congenital or familial; in older animals usually acquired.
  • Signs: initially polyuria/polydipsia   →   uremia (vomiting, anorexia, oral ulceration) if >75% of renal tissue not functioning.
  • Diagnosis: biochemistry, urinalysis, histopathology.
  • Treatment: dietary managment +/- phosphate binding agents; ACE inhibitor; IV fluid therapy; H-2 blockers, +/- erythropoietin.
  • Prognosis: guarded - early detection and management of chronic renal failure will ameliorate the signs of uremia and may, in some cases, slow down the progression of disease.
    Print off the owner factsheet Kidney disease in your cat  Kidney disease in your cat to give to your client. 

Pathogenesis

Etiology

Young animals

  • Juvenile renal diseases; renal cortical hypoplasia, renal dysplasia, hereditary nephritis, glomerulopathy, polycystic disease, familial amyloidosis, etc.

Older animals

Pathophysiology

  • Damage to one component of nephron   →   generalized nephron failure   →   scarring and compensatory changes   →   chronic generalized nephropathy.
  • Reduction of functional nephrons   →   loss of ability to concentrate urine and retention of waste products.
  • Hyperfiltration of remaining nephrons   →   self-perpetuating destruction of remaining nephrons.
  • Metabolic acidosis   →   renal ammoniagenesis   →   toxic and inflammatory effect on renal interstitium.
  • Uremia   →   erythropoietin deficiency and a shortened RBC lifespan   →   normochromic, normocytic, non-regenerative anemia.
  • Hyperphosphatemia, due to inability to excrete phosphate   →   hyperparathyroidism   →   osteodystrophy and nephrocalcinosis which increases renal damage.
  • Lack of active vitamin D3   →   initiates and exacerbates hyperparathyroidism.

Timecourse

  • Some animals can be managed for a long period, while others may decompensate and deteriorate rapidly (acute-on-chronic disease).

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Jepson R E, Brodbelt D, Vallance C et al (2009) Evaluation of predictors of the development of azotemia in cats. J Vet Intern Med 23 (4), 806-813 PubMed.
  • Roudebush P, Polzin D J, Ross S J et al (2009) Therapies for Feline Chronic Kidney Disease. What is the evidence?​ J Feline Med Surg 11 (3), 195-210 PubMed.
  • Syme H (2009) Proteinuria in cats: Prognostic marker or mediator? J Feline Med Surg 11 (3), 211-218 PubMed.
  • Boyd L M, Langston C, Thompson K et al (2008) Survival in cats with naturally occurring chronic kidney disease (2000-2002). J Vet Intern Med 22 (5), 1111-1117 PubMed.
  • King J N, Tasker S, Gunn-Moore D A et al (2007) Prognostic factors in cats with chronic kidney disease. J Vet Intern Med 21 (5), 906-916 PubMed.
  • King J N, Gunn-Moore D A, Tasker S et al (2006) Tolerability and efficacy of benazepril in cats with chronic kidney disease. J Vet Intern Med 20 (5), 1054-1064 PubMed.
  • Hostutler R A, DiBartola S P, Chew D J et al (2006) Comparison of the effects of daily and intermittent-dose calcitriol on serum parathyroid hormone and ionised calcium concentrations in normal cats and cats with chronic renal failure. J Vet Intern Med 20 (6), 1307-1313 PubMed.
  • Ross S J, Osborne C A, Kirk C A et al (2006) Clinical evaluation of dietary modification for treatment of spontaneous chronic kidney disease in cats. J Am Vet Med Assoc 229 (6), 949-957 PubMed.
  • Syme H M, Markwell P J, Pfeiffer D et al (2006) Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria. J Vet Intern Med 20 (3), 528-535 PubMed.
  • Elliott J, Rawlings J M, Markwell P J et al (2000) Survival of cats with naturally occurring chronic renal failure: effect of dietary management. JSAP 41 (6), 235-242 PubMed.
  • Barber P J, Rawlings J M, Markwell P J et al (1999) Effect of dietary phosphate restriction on renal secondary hyperparathyroidism in the cat. JSAP 40 (2), 62-70 PubMed.
  • Barber PJ & Elliott J (1998) Feline chronic renal failure- clinical findings in 80 cases diagnosed between 1992 and 1995. JSAP 39 (2), 78-85 PubMed.
  • Barber P J & Elliott J (1998) Feline chronic renal failure- calcium homeostasis in 80 cases diagnosed between 1992 and 1995. JSAP 39 (3), 108-116 PubMed.

Other sources of information

  • Sanderson S L (2009) Measuring glomerular filtration rate: practical use of clearance tests. In: Kirks Current Veterinary Therapy XIV, (ed) J Bonagura & D Twedt, Elsevier Saunders pp 868-871.
  • Polzin D J, Osborne C A & Ross S (2009) Evidence-based management of chronic kidney. In: Kirks Current Veterinary Therapy XIV, (ed) J Bonagura & D Twedt, Elsevier Saunders pp 872-879.
  • Elliott J & Watson A D J (2009) Chronic kidney disease: Staging and management. In: Kirks Current Veterinary Therapy XIV, (ed) J Bonagura & D Twedt, Elsevier Saunders pp 883-892
  • Elliott J (2008) The role of phosphate in chronic kidney disease (CKD) progression: Part 1. UK Vet 13 (2), 23-28 VetMedResource.
  • Elliott J (2008) The role of phosphate in chronic kidney disease (CKD) progression: Part 2. UK Vet 13 (2), 37-41 VetMedResource.
  • International Renal Interest Society: www.iris-kidney.com


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