Today's Veterinary Practice

MAR-APR 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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27 MARCH/APRIL 2018 ‚óŹ TVPJOURNAL.COM CONTINUING EDUCATION Finding the Balance in Your Patients with Cardiovascular and Renal Disease Audrey K. Cook, BVM&S, DACVIM, DECVIM, DABVP (Feline) Ashley B. Saunders, DVM, DACVIM (Cardiology) Texas A&M University Cardiovascular and renal disease are commonly diagnosed in cats and dogs; incidence increases with patient age. Each condition is irreversible and progressive. These conditions are particularly challenging when they occur simultaneously; what is good for one system may be counterproductive for the other. For example, fluid therapy is routinely administered to patients with acute or substantial renal compromise but may be problematic for patients with cardiac disease; and multiple medications administered to patients with cardiovascular disease can affect the kidneys, electrolytes, and blood pressure. In this article, we describe the physiologic interactions between these 2 systems, disease classifications, techniques for detecting one condition in the presence of the other, and strategies for managing patients with these co-existing conditions. PHYSIOLOGIC LINK BETWEEN HEART AND KIDNEYS Both the heart and the kidneys play a role in volume regulation and can directly or indirectly influence endocrine responses that affect fluid balance. The kidneys are one of the body's primary "volume monitors." Glomerular filtration rate (GFR) is a surrogate indicator of extracellular volume status. If an animal is dehydrated or acutely volume depleted, renal perfusion will drop and GFR will decrease. This response triggers the release of renin from the juxtaglomerular apparatus in the kidney, the starting point for the renin-angiotensin- aldosterone system (RAAS) ( FIGURE 1 ). DETECTING HEART DISEASE Most heart disease in dogs is unmasked by clues detected during physical examination (eg, murmur, arrhythmia, or jugular pulses). CONTINUING EDUCATION CARDIOLOGY AND ENDOCRINOLOGY

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