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My pet has chronic renal failure!

A veterinary practic

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My pet has chronic renal failure!

  1. 1. Now what?By Jacquelyn H. Burns, DVM © Jacquelyn H. Burns 2012 All rights reserved
  2. 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. 3.  No, but patients often feel tired, queasy or nauseated and maybe just disinterested in life
  4. 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. 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. 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. 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. 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. 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. 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. 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. 12.  Kidneys can be evaluated by various kinds of diagnostic imaging  X-rays  Ultrasound
  13. 13.  Renal biopsyThough it often doesn’tchange the outcome, arenal biopsy is the mostdefinitive test to assesscause of and prognosisfor kidney disease.
  14. 14. ???????
  15. 15.  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
  16. 16.  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
  17. 17.  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
  18. 18.  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
  19. 19.  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
  20. 20.  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
  21. 21.  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
  22. 22.  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.
  23. 23.  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.
  24. 24.  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 veterinarians 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  )
  25. 25.  Jacquelyn H. Burns, DVM Holmes Veterinary Hospital 1001 Church Street Laurens, SC 29360 www.holmesvethospital.comAll rights reservedCopyright © 2012 by Jacquelyn H. Burns, DVM