CKD

With optimal management, dogs and cats with chronic kidney disease (CKD) often live for months or years with a good quality of life. Although no treatment can correct existing irreversible lesions, the consequences of decreased kidney function can be addressed and hopefully progression delayed with appropriate management(1). This presentation will be based on clinical patients (dogs and cats) with CKD. Emphasis will be placed on optimizing diagnosis, work up and clinical management.

CKD is frequently encountered in companion animal medicine. In theory, CKD is defined as: 1) presence of kidney damage for ≥ 3 months (with or without decline in GFR). Or as 2) decrease in GFR by > 50 % for ≥ 3 months. Diagnosis is based on the presence of compatible signs and renal azotemia which implies that a urinalysis should be performed. Diagnosing non-azotemic CKD is more challenging. Staging of cats and dogs with CKD according to the IRIS system (International Renal Interest Society) is essential as it directs management and provides a prognostic guide(2). Staging is based on serum creatinine concentrations. It must be emphasized that patients need to be stable before an IRIS stage is acknowledged and that creatinine serum concentrations should be assessed on at least 2 occasions. Further substaging is based on proteinuria (assessed by UPC) and blood pressure measurement. See IRIS website for details. Recently the IRIS guidelines were updated. 1) Substaging by arterial blood pressure has become more descriptive. 2) Recommendation is made to initiate treatment for proteinuria in IRIS stage 1. 3) SDMA (symmetric dimethylarginine) blood concentrations have been added to the interpretation of serum creatinine. Timely diagnosis and staging should facilitate initiation of adequate therapy and therefore prognosis. […]