Updates on the management of chronic kidney disease

Presented by Sheri Ross BSc, DVM, PhD, Dipl. ACVIM

Continuing education questionnaire

CE credit: 1

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Questions

1. The International Renal Interest Society (IRIS) chronic kidney disease (CKD) stage is determined by the: *

Serum creatinine concentration

Renal biopsy

Glomerular filtration rate

Serum urea nitrogen (BUN) concentration

2. Once the IRIS CKD stage has been determined, the following two clinical/laboratory findings are used to further substage the patient: *

Serum phosphorous and calcium concentrations

Serum albumin and hematocrit

Systolic blood pressure and presence of proteinuria

Serum potassium and phosphorous concentrations

3. Which of the following statements concerning serum phosphorous concentration is true? *

Dietary phosphorous intake does not directly impact serum phosphorous concentrations

The target serum phosphorus concentration increases as the IRIS CKD stage increases

Aluminium hydroxide is the only effective phosphate binder used in feline CKD

The target serum phosphorus concentration decreases as the IRIS CKD stage increases

4. Which of the following statements concerning dietary management of CKD is true? *

Clinical evidence supports the use of a renal diet only in cats with IRIS stage 4 CKD

Clinical evidence shows that restriction of dietary phosphorus is the only nutrient modification to have any influence on the progression of CKD disease in cats

Clinical evidence supports the use of a renal diet (composite diet effect) in cats with IRIS stage 2 or greater CKD

Clinical evidence shows that restriction of dietary protein is the only nutrient modification to have any influence on the progression of CKD disease in cats

5. A patient presents to your clinic with IRIS stage 4 CKD. All of the clinical/laboratory findings below would be expected, except: *

Hypoproliferative anemia

Hyperphosphatemia

Muscle wasting and weight loss

Icterus

6. When transitioning a cat to a renal diet, which of the following statements is true? *

Adding aluminium hydroxide to a new food will improve intake

Cats prefer slightly chilled canned food

Most cats prefer to eat one large meal per day

Gradually transitioning to a new food will dramatically increase acceptance

7. Which of the following factors may contribute to hyperkalemia in IRIS stage 4 CKD? *

High dietary potassium content

Decreased renal potassium clearance

Therapy with telmisartan or benazepril

A, b and c

8. The major contributing factor in the development of hypoproliferative anemia in the later stages of CKD is: *

Chronic gastrointestinal blood loss

Shortened red blood cell survival time in circulation

Decreased renal production of erythropoietin (EPO)

Immune destruction of red blood cell precursors

9. Which of the following is an under-recognized and undertreated complication of the later stages of CKD? *

Metabolic acidosis

Respiratory alkalosis

Metabolic alkalosis

Respiratory acidosis

10. A 16-year-old spayed feline presents with constipation. Physical exam shows: normal hydration, a BCS of 3/9, significant spinal muscle wasting. Lab abnormalities are: BUN 200, creatinine 2.3, SDMA 55. What likely caused those kidney function values? *

She has significant muscle wasting which would result in a decreased serum creatinine. The BUN and SDMA would be better indicators of her true kidney functio

She likely has significant GI bleeding that is increasing her serum BUN and the creatinine is a better indication of her true kidney function

The BUN and creatinine are not disparate, and the SDMA is typically elevated in geriatric cats due to normal aging. The cat has IRIS stage 2 CKD and no further diagnostics are required

The SDMA and creatinine are falsely elevated due to the age of the cat and the BUN is the true indicator of the kidney function