Term
| What is chronic kidney dz? |
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Definition
| -primary renal failure existing for an extended period f time (approx 3m) |
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Term
| Why is CKD a double-edged sword? |
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Definition
-Downside: not going to get any better
-Upside: not going to die tomorrow |
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Term
| What is the species and age signalment of CKD? |
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Definition
-cats > dogs >> horse, cow
->30% of cats > 15y |
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Term
| Characterize the loss of renal function seen with CKD? |
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Definition
| -loss isoften slow over an dprogressive over time |
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Term
| What percentage of concentrating function must be lost for concentrating ability to be lost? |
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Definition
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Term
| What percentage of concentrating function must be lost for azotemia to develop? |
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Definition
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Term
| What do we use to estimate GFR clinically? |
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Definition
-creatinine clearance: requires timed urine collection
-Iohexol clearance: can be donw w/out timed urine collection (injection followed by 3x blood draw) |
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Term
| What is BUN? Why is it relevant? |
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Definition
-end product of protein metabolism
-altered by diet (ex: Hill's k/d)
-inc w/ GI hemorrhage (common in uremia) |
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Term
| What does creatinine relate to physiologyically? Why is it relevant? |
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Definition
-directly correlates to muscle mass
-it is iffy at best but it is even less reliable when the animal is cachectic |
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Term
| What does an SMDA test show? |
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Definition
| -symmetrical dimethyl arginine is cleared by renal filtration so it measures this |
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Term
| How does SDMA relate to creatinine? |
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Definition
| -SDMA becomes inc an ave of 17m before creatine |
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Term
| How do dogs and cats compare functionally with CKD? |
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Definition
-Dogs at stage III can live about 6-12m
-Cats at stage III can live about 1-3y
-cats have slower progression than other spp |
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Term
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Definition
| -a group of clinical signs and biochemical abnormalities that result from inadequate renal functions |
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Term
| What are some examples of uremic toxins? |
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Definition
-urea (BUN)
-guanadine cpds
-PTH |
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Term
| How does CKD have a prgressive nature? |
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Definition
| -initial cause => red functional renal mass => compensatory responses => hyperfiltration of remaining nephrons/inc intraglomerular P => inc load on remaining nephrons = additional damage => cycle continues |
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Term
| What are the general mechanisms of progression of CKD? |
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Definition
-persistance of primary dz
-hyperfiltration theory
-proteinuria
-arterial hypertension
-renal mineralization |
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Term
| What are the consequences of dec GFR on Ca-P? |
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Definition
-P retention
-Ca:P complex leads to tissue mineralization = secondary hyperparathyroidism |
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Term
| What is the mass law effect of hyper-PTH0ism? |
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Definition
| -Ca:Pi cplx reduce serum Ca = inc PTH |
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Term
| Describe the Reduced Calcitriol (Vit D)mechanism for hyper-PTH? |
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Definition
| -dec Vit D => dec serum Ca2+ => inc PTH |
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Term
| What are the effects of inc PTH? |
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Definition
-skeletal demineralization: rubber jaw
-mental depression
-immunodeficiency
-anorexia
-skeletal muscle dysfunction |
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