Please enable JavaScript.

Coggle requires JavaScript to display documents.

Chronic Renal Failure - Coggle Diagram

- - - - uncommon in mixed breed cats
      - familial in Abyssinians
    - - familial in persian
    - - renal lymphoma
- - - - bone demineralisation
      - renal secondary hyperparathyroidism
  - - - hyperfiltration increaes protein movement across the glomerular capillaries into bowman space and mesangium
    - - the decline in total GFR is initially offset by increase in the activity of the functional remnant nephrons (glomerular hyperfiltration)
      - in dogs and cats 85-95% of renal tissue must be destroyed to result in progression
    - - decreasing dietary phosphorus content can reverse renal secondary hyperparathyroidism and slow progression of renal disease
      - improvement in proteinuria and renal morphologic changes may be associated with decreased caloric intake
      - supplementation with PUFAs may have benefits
      - hypertension and urinary tract infection can lead to progression
  - - - may damage kidney further by causing renal vasoconstriction and interstitial mineralisation
  - - - GI blood loss observed more in dogs than cats
      - risk of haemorrhage is correlated with buccal mucosal bleeding time
  - - - tongue tip necrosis in ureic dogs
    - - platelet dysfunction
      - ammonia production from urea by bacteria in the GIT
      - ischaemia caused by vascular lesions
      - increased concentrations of gastrin due to impaired renal excretion
    - - stimulation of chemoreceptor trigger zone by a uraemic toxin
  - - - ocular abnormalities
        
        retinal detachment
        
        retinal haemorrhages
        
        retinal vascular tortuosity
      - CVS abnormalities
        
        LV enlargment
        
        medial hypertrophy of arteries
        
        murmurs
        
        gallop rhythms
- - - - vomiting more common in dogs than cats
      - diarrhoea uncommon and late finding in ureic dogs
  - - - fibrous osteodystrophy can be dramatic in young growing dogs with uraemia (rubber jaw)
- - - - studies shown to prolong survival
      - decreased protein, phosphorus, sodium
        
        15-17% protein
        
        dogs require minimum of approx 5% of calories from protein, whereas cats require 20% from protein
        
        cats also require taurine and prefer diets higher in fat
        
        if necessary oral phosphate binders can be added
        
        risk = aluminium toxication with no safe dosage evidence
      - increased b vitamins, soluble fibre, omega 3 fatty acids and antioxidants
      - often recommended when moderate azotaemia present in a stable hydrated patient with CKD (IRIS stage 2 cats, stage 3 dogs)
      - gradual transition from previous diet for 2-4 weeks
      - once started the BUN concentration will decrease as a result of dietary modification alone and no longer be a good indicator of renal function
        
        serum creatinine not substantially influenced by diet
  - - - H2 receptor antagonists block gastrin-mediated increases in gastric acid secretion
        
        useful for decreased appetite, nausea, vomiting and GI haemorrhage
        
        Famotidine commonly used
        
        add anti-emetic if this alone is not effective
        
        e.g. metoclopraminde, ondansetron, maropitant
        
        gastroprotectants such as sucralfate can be used if GI ulceration and haemorrhage suspected
  - - - resolution of anaemia, weight gain, improved appetite, improved haircoat and improved sociability with owner
      - 20-40% risk of anti-EPO antibody formation within 30-90days of intiating therapy
        
        severe anaemia and subsequent transfusion dependence + other adverse side effects e.g. seizures, vomiting, hypertension, uveitis
    - - useful in management of renal secondary hyperparathyroidism
      - only use after hyperphosphataemia controlled by low phosphorus diet and oral phosphorus binders if necessary
      - serial serum calcium concentration monitoring for hypercalcaemia