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    CS - Step 2 - Feline Kidney Disease

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    Shar Thorn
    1) Chronic kidney disease (CKD) affects 1-3% of cats, increasing to 35% in geriatric cats. Damage from CKD is usually irreversible and progressive as nephrons are replaced by fibrosis over months to years. 2) The IRIS staging system classifies CKD into 4 stages based on serum creatinine levels, and further characterizes proteinuria and blood pressure. Staging helps guide appropriate diagnostic and therapeutic efforts. 3) Diagnostics focus on characterizing the primary renal disease, assessing stability of renal function over time, and how decreased function affects the cat. Renoprotective treatments like renal diets, phosphorus management, and ACE inhibitors aim to slow

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    CS - Step 2 - Feline Kidney Disease

    Uploaded by

    Shar Thorn
    37 views2 pages
    1) Chronic kidney disease (CKD) affects 1-3% of cats, increasing to 35% in geriatric cats. Damage from CKD is usually irreversible and progressive as nephrons are replaced by fibrosis over months to years. 2) The IRIS staging system classifies CKD into 4 stages based on serum creatinine levels, and further characterizes proteinuria and blood pressure. Staging helps guide appropriate diagnostic and therapeutic efforts. 3) Diagnostics focus on characterizing the primary renal disease, assessing stability of renal function over time, and how decreased function affects the cat. Renoprotective treatments like renal diets, phosphorus management, and ACE inhibitors aim to slow

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    Feline kidney disease

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    CS_Step 2_Feline Kidney Disease

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    1) Chronic kidney disease (CKD) affects 1-3% of cats, increasing to 35% in geriatric cats. Damage from CKD is usually irreversible and progressive as nephrons are replaced by fibrosis over months to years. 2) The IRIS staging system classifies CKD into 4 stages based on serum creatinine levels, and further characterizes proteinuria and blood pressure. Staging helps guide appropriate diagnostic and therapeutic efforts. 3) Diagnostics focus on characterizing the primary renal disease, assessing stability of renal function over time, and how decreased function affects the cat. Renoprotective treatments like renal diets, phosphorus management, and ACE inhibitors aim to slow

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    37 views2 pages

    CS - Step 2 - Feline Kidney Disease

    Uploaded by

    Shar Thorn
    1) Chronic kidney disease (CKD) affects 1-3% of cats, increasing to 35% in geriatric cats. Damage from CKD is usually irreversible and progressive as nephrons are replaced by fibrosis over months to years. 2) The IRIS staging system classifies CKD into 4 stages based on serum creatinine levels, and further characterizes proteinuria and blood pressure. Staging helps guide appropriate diagnostic and therapeutic efforts. 3) Diagnostics focus on characterizing the primary renal disease, assessing stability of renal function over time, and how decreased function affects the cat. Renoprotective treatments like renal diets, phosphorus management, and ACE inhibitors aim to slow

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    STEP 2:

    Team Education Primer

    Feline Kidney Disease


    at a Glance

    Gregory F. Grauer, DVM, MS, DACVIM


    Kansas State University

    CKD affects approximately 1% to 3% of all cats, and its prevalence


    increases with age, with up to 35% of geriatric cats in referral
    hospital populations having CKD.1 Damage of nephrons (the
    structural/functional units of the kidney) associated with CKD is
    usually irreversible and can be progressive. A primary cause is often
    not determined for feline CKD. Other renal diseases linked with CKD
    include pyelonephritis, nephrolithiasis, polycystic kidney disease,
    amyloidosis, and neoplasia. In some cases, the initial underlying
    renal insult remains undetected or untreated and continues to
    damage nephrons. It is also possible that progressive kidney
    dysfunction becomes self-perpetuating.
    Healing of irreversibly damaged
    nephrons occurs by replacement
    fibrosis. CKD occurs over months
    or years and is a leading cause
    of death in cats.2 It is often not
    possible to improve renal function
    in CKD, and treatment is therefore
    aimed at stabilizing renal function.
    There is increasing evidence
    that dietary and antiproteinuric
    treatments are renoprotective
    and can decrease the progressive
    nature of CKD.
    IRIS STAGING SYSTEM
    The IRIS CKD Staging System
    (Table 1) was developed
    to improve communication
    surrounding CKD and link
    appropriate diagnostic and
    therapeutic efforts to cats with
    varying degrees of CKD.

    32

    veterinaryteambrief.com March 2014

    TABLE 1
    IRIS CKD Staging System
    Serum Creatinine
    (SrCr) Concentration

    mg/dl

    Stage 1
    (Nonazotemic CKD)

    <1.6

    Stage 2
    (Mild renal azotemia)

    1.62.8

    Stage 3
    (Moderate renal azotemia)

    2.95.0

    Stage 4
    (Severe renal azotemia)

    Although the staging is based


    primarily on SrCr, it cannot be
    applied to cats with pre- or postrenal azotemia or cats with acute
    or decompensated (sometimes
    termed acute on chronic) kidney
    disease. The IRIS Staging
    System should only be applied
    to cats with stable CKD (ie, 23
    SrCr determinations that vary
    <10%20% over 24 weeks). In
    addition, SrCr must be interpreted
    with the patients urine specific
    gravity and examination findings
    (eg, hydration status, lean body
    mass) to rule out pre- and postrenal causes of azotemia. Almost
    all normal cats should have a
    SrCr <1.6 mg/dl, regardless of the
    laboratory reference range.
    FURTHER CLASSIFICATION
    The IRIS Staging System is
    further classified by the presence
    or absence of proteinuria and
    systemic hypertension (Tables 2
    and 3).

    >5.0

    Characterization of renal disease and its stability is


    most important in the earlier stages of CKD, when
    appropriate treatment has the greatest potential to
    stabilize renal function.

    CLINICAL SUITE | FELINE CHRONIC KIDNEY DISEASE

    TABLE 2
    Urine Protein:Creatinine Ratio

    Classification

    <0.2

    Nonproteinuric (NP)

    0.20.4

    Borderline proteinuric (BP)

    >0.4

    Proteinuric (P)

    TABLE 3
    Systolic Blood Pressure
    (mm Hg)

    Arterial Pressure
    Classification

    Risk for Target Organ


    Damage

    <150

    AP0

    Minimal

    150159

    AP1

    Low

    160179

    AP2

    Moderate

    >180

    AP3

    High

    ADVANCED DIAGNOSTICS
    Once CKD has been diagnosed
    and staged, diagnostics are
    focused on 3 areas:
    Characterization of the primary
    renal disease
    Characterization of stability of
    the renal disease/function
    Characterization of how the
    decreased renal function
    adversely affects the cat.
    Further definition of the
    primary renal disease beyond
    proteinuria and blood pressure
    assessments should include
    urine culture and kidney imaging
    (and possibly a fine-needle
    aspirate or biopsy of the kidney).
    Stability of renal function is
    assessed by serial monitoring
    of abnormalities identified
    during initial characterization
    of the disease. This monitoring

    should always include serum


    biochemistry profiles, urinalyses,
    quantification of proteinuria (urine
    protein:creatinine ratios), and
    blood pressure measurements,
    but may also include followup ultrasonography and urine
    cultures.
    Characterization of renal disease
    and its stability is most important
    in the earlier stages of CKD,
    when appropriate treatment has
    the greatest potential to stabilize
    renal function. Assessment of
    patient problems becomes more
    important in later stages, when
    signs tend to be more severe.
    MANAGEMENT
    The therapeutic approach should
    be tailored to the disease stage.
    For example, disease-specific
    treatments for nephroliths, renal
    lymphosarcoma, and bacterial
    pyelonephritis, as well as

    treatments to slow progression of


    renal disease (ie, renoprotective
    treatments), will be of most value
    in the early to middle CKD stages.
    Renoprotective Treatments
    Renoprotective treatments
    include diets formulated to reduce
    serum phosphorus concentrations
    and angiotensin-converting
    enzyme inhibitors (ACEI) designed
    to normalize blood pressure and
    reduce proteinuria. Amlodipine
    has also been shown to decrease
    proteinuria in hypertensive cats
    and is often more efficacious in
    reducing systemic blood pressure
    compared with ACEI. Cats
    should be slowly transitioned
    to renal diets early (eg, Stage
    2) to increase diet acceptance.
    It is ideal to maintain serum
    phosphorus concentrations <4.5
    mg/dl with renal diets and, if
    necessary, enteric phosphate
    binders.
    Risks & Progression
    Risk factors for CKD progression
    include proteinuria, hypertension,
    nephroliths, and urinary tract
    infections (UTIs). In the later
    stages of CKD, treatment tends to
    be focused on reducing the signs
    associated with decreased renal
    function (eg, anorexia, vomiting,
    acidosis, potassium depletion,
    hypertension, anemia).

    STEP 3

    Communication Keys h
    March 2014 Veterinary Team Brief

    33

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