Today's Veterinary Practice

SEP-OCT 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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PEER REVIEWED 12 SEPTEMBER/OCTOBER 2018 Diagnostic imaging can provide additional useful information. Abdominal radiographs may enable assessment of kidney size, the presence of renal mineralization, and/or obstructive ureterolithiasis. Abdominal ultrasonography can offer additional information about the presence of decreased corticomedullary distinction (associated with CKD), hydronephrosis (often associated with ureteral obstruction), cysts, or infarcts. STAGES OF CKD Currently IRIS categorizes CKD into 4 stages: ■ Stage 1: nonazotemic ■ Stage 2: mild ■ Stage 3: moderate ■ Stage 4: severe CKD in cats can progress at highly variable rates; for some cats, progression from stage 1 to stage 2 may take years. If repeated diagnostics indicate CKD, be cautious about prescribing a nonsteroidal anti- inflammatory drug for arthritis and consider switching high-protein, high-phosphorus diets to diets with more moderate protein and phosphorus levels. Note, however, that switching to a protein-restricted renal diet for a cat that does not have CKD may have undesirable effects. Such a diet can be detrimental because high-calorie, restricted-protein diets can promote unwanted weight gain and loss of lean muscle. Thus, confirmation of CKD is important. After a diagnosis of CKD has been established and the disease stage determined, you can create a patient management plan that includes medication and dietary modification. The next issue of Today's Veterinary Practice will cover nutritional management of CKD in cats in a follow-up Nutrition Notes article. References 1. Lulich JP, Osborne CA, O'Brien TD, et al. Feline renal failure: questions, answers, questions. Compend Cont Educ Pract Vet 1992;14:127-152. 2. Marino CL, Lascelles BD, Vaden SL. Prevalence and classification of chronic kidney disease in cats randomly selected from four age groups and in cats recruited for degenerative joint disease studies. J Feline Med Surg 2014;16(6):465–472. 3. Freeman LM, Lachaud MP, Matthews S, et al. Evaluation of weight loss over time in cats with chronic kidney disease. J Vet Intern Med 2016;30(5):1661-1666. 4. Bijsmans ES, Jepson RE, Change YM, et al. Changes in systolic blood pressure over time in healthy cats and cats with chronic kidney disease. J Vet Intern Med 2015;29(3):855-861. 5. Hall JA, Yerramilli M, Obare E, et al. Comparison of serum concentrations of symmetric dimethylarginine and creatinine as kidney function biomarkers in cats with chronic kidney disease . J Vet Intern Med 2014;28:1676-1683. 6. Braff J, Obare E, Yerramilli M, et al. Relationship between serum symmetric dimethylarginine concentration and glomerular filtration rate in cats. J Vet Intern Med 2014;28(6):1699-1701. 7. Kopke MA, Burchell RK, Ruaux CG, et al. Variability of symmetric dimethylarginine in apparently healthy dogs. J Vet Intern Med 2018;32:736–742. 8. Rishniw M, Bicalho R. Factors affecting urine specific gravity in apparently healthy cats presenting to first opinion practice for routine evaluation. J Feline Med Surg 2015;17(4):329-337. 9. Syme HM, Markwell PJ, Pfeiffer D, Elliott J. Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria. J Vet Intern Med 2006;20:528–535. 10. Peterson ME, Varela FV, Rishniw, Poizin DJ. Evaluation of serum symmetric dimethylarginine concentration as a marker for masked chronic kidney disease in cats with hyperthyroidism. J Vet Intern Med 2018;32:295-304. Valerie J. Parker Dr. Parker received her DVM from Tufts University. She then completed a small animal internship at the Animal Medical Center in New York City, followed by a small animal internal medicine residency at Iowa State University and a clinical nutrition residency at Tufts University. She is a diplomate of both the American College of Veterinary Internal Medicine and the American College of Veterinary Nutrition. Dr. Parker's primary areas of interest include kidney disease, gastrointestinal disease, and vitamin D metabolism, as well as nutritional management of dogs and cats. STAGING OF CKD CKD in cats can progress at highly variable rates; for some cats, progression from stage 1 to stage 2 may take years. KHEMNGERN

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