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Chronic Kidney Disease - Diagnosis and Management
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Chronic kidney disease (CKD) in the horse may be divided by clinical and pathologic findings into two broad categories: primary glomerular disease (glomerulonephritis [GN]) and primary tubulointerstitial disease (chronic interstitial nephritis [CIN]). However, pathology in one portion of the nephron usually leads to altered function and eventual pathology in the entire nephron such that CKD is an irreversible disease process characterized by a progressive decline in glomerular filtration rate (GFR). More importantly, the rate of decline in GFR is variable in horses with CKD making the short-term (months to a few years) prognosis guarded to favorable while the long-term prognosis remains poor.
Clinical signs and laboratory findings:
The most common clinical sign observed in horses with CKD is weight loss. A small plaque of ventral edema, usually between the forelimbs, is another frequent finding. Moderate polyuria and polydipsia (PU/PD) are also usually present at some stage of the disease process. Accumulation of dental tartar, especially on the incisors and canine teeth and oral ulcers are other findings that may be detected in horses with CKD. Decreased performance may be an early complaint in competitive horses while growth is generally stunted in young horses with renal hypoplasia, dysplasia, or polycystic kidney disease. Most horses with clinical signs of CKD have moderate to severe azotemia (creatinine concentration [Cr] usually 5 mg/dL [440 mol/L] or greater at initial evaluation) unless early CKD is detected during evaluation for another clinical problem. Mild hyponatremia and hypochloremia are sometimes found in horses with CKD. Hypercalcemia, with serum concentrations sometimes exceeding 20 mg/dL (5 mmol/L), appears to be a laboratory finding that is unique to horses with CKD. The magnitude of hypercalcemia is dependent on calcium content of the diet. Acid base balance usually remains normal until CKD becomes advanced but metabolic acidosis may be found in horses with end stage disease. Many horses with CKD are moderately anemic (packed cell volume 25-30%) as a consequence of decreased erythropoietin production. Horses with GN may have hypoalbuminemia and hypoproteinemia while horses with advanced CKD of any cause may also have mild hypoproteinemia associated with intestinal ulceration. […]
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Affiliation of the authors at the time of publication
Department of Large Animal Clinical Sciences, Michigan State University,
East Lansing, Michigan, USA.
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