Felis ISSN 2398-2950

Dietetic diet: for chronic kidney disease (CKD)

Contributor(s): Marge Chandler

Pathophysiology

  • While the underlying cause of most cases of feline CKD   Kidney: chronic kidney disease   remains obscure, a number of different etiologies have been documented, eg chronic tubulointerstitial nephritis, glomerulonephritis   Glomerulonephritis  , pyelonephritis   Pyelonephritis  , polycystic renal disease   Kidney: autosomal dominant polycystic kidney disease   (congenital or acquired), amyloidosis   Amyloidosis   (familial or acquired), nephrotoxins  (eg ethylene glycol   Ethylene glycol poisoning  , aminoglycoside antibiotics, lilies   Lilies (Lilium and Hemerocallis species)  grapes/raisins, hypercalcemia   Hypercalcemia: overview  , hydronephrosis   Hydronephrosis / hydroureter  (eg  from a blocked ureter),  renal lymphoma or other neoplasia  Kidney: neoplasia  , and as an eventual result of untreated pre-renal or post-renal failure   Kidney: acute renal failure  .
  • The most common histopathological finding is of chronic interstitial nephritis; however, the cause of this is uncertain, but in some cases may involve chronic pyelonephritis or glomerulonephritis.
  • As the renal function decreases to less than about 1/3 of normal, the ability of the nephrons to concentrate urine decreases and the urine becomes less concentrated, resulting in polyuria and a secondary polydipsia.
  • Potassium and B vitamins are lost in increasing amounts as the amount of urine produced increases, and may result in deficiencies.
  • When the glomerular filtration rate (GFR) drops below 25% of normal, metabolites and uremic toxins may accumulate   Renal function assessment  . These include the metabolic products of protein metabolism which are reflected in the serum as increased urea   Blood biochemistry: urea   and creatinine   Blood biochemistry: creatinine  .
  • As the GFR decreases to less than about 15%, the excretion of phosphorus decreases and serum phosphorus increases   Blood biochemistry: phosphate  .
  • Along with the retention of phosphorus, parathyroid hormone concentrations may increase (renal secondary hyperparathyroidism   Renal secondary hyperparathyroidism  , contributing to signs of uraemia. Production of erythropoitin from the kidneys may decrease resulting in a non-regenerative anemia.
  • Decreased production of calcitriol (vitamin D) may contribute to renal secondary hyperparathyroidism.
  • Dehydration and loss of bicarbonate leads to a tendency for metabolic acidosis.
  • Signs of chronic kidney disease include polyuria, polydipsia, weight loss, poor appetite, hypertension   Hypertension  , weakness, and anemia   Anemia: overview  .
  • Therapeutic interventions may be based upon the International Renal Interest Society (IRIS), although the strength of evidence varies among treatments.

Dietary requirements

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Special considerations

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Diets for cats with chronic kidney disease

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Further Reading

Publications

Refereed papers
  • Recent references fromPubMed.

Other sources of information

  • Elliott D A ( 2012)Nutritional management of kidney disease.In: Applied Veterinary Clinical Nutrition.Editors Fascetti AJ and Delaney SJ. Wiley Blackwell , West Sussex, UK. pp 251-268.
  • Polzin D J, Osborne C A, Ross S (2009)Evidence-based management of chronic kidney disease.In:  Kirks Current Veterinary Therapy XIV.Editors Bonagura JD, Twedt DC. Saunders Elsevier, St Louis, Mo. pp872 - 879.
  • Squires R A(1996) Uraemia.In: BSAVA Manual of Canine and Feline Nephrology and Urology.Editors: Bainbridge J and Elliott J.  BSAVA, Gloucestershire, UK. pp52-67.


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