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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measurements of GFR and usually increases before serum creatinine levels suggest renal compromise. 8 Alternatively, a dog with well-concentrated urine but substantial proteinuria may have renal disease that might be missed without further testing (eg, urine protein:creatinine ratio). For dogs with proteinuria, heartworm testing is appropriate. Cats Because cats naturally have well-concentrated urine, early CKD is often overlooked. Specific gravity <1.035 strongly suggests CKD in this species, and further staging with renal imaging and urine protein:creatinine ratio, with or without urine culture, is indicated. In cats with muscle wasting, serum SDMA concentrations may be a more accurate reflection of renal function than creatinine values. 8 MANAGING PATIENTS WITH CONCURRENT CARDIOVASCULAR AND RENAL DISEASE Balancing management of patients with concurrent cardiovascular and renal disease is challenging. You may need to prioritize one organ system above the other, bearing in mind that overall treatment goals are to maintain appetite and body condition, decrease clinical signs, and provide a good quality of life for the patient. Dogs If the Primary Condition is Cardiovascular Disease Understanding the characteristics of common heart diseases in dogs can help predict which complications are more likely. For example, dogs with dilated cardiomyopathy have reduced ventricular systolic function, leading to reduced cardiac output and possible systemic hypotension, which may reduce GFR and trigger renin release. Therapeutic goals for all dogs with reduced ventricular systolic function, including dilated cardiomyopathy, are to improve ventricular function with positive inotropes to maintain adequate cardiac output, blood pressure, and renal perfusion. For dogs with CHF, medical therapies should be considered carefully; diuretics should be prescribed at the lowest dose necessary to resolve clinical signs. Recommended therapy for CHF in dogs typically consists of furosemide, pimobendan, and an angiotensin-converting enzyme (ACE) inhibitor. 9 However, multiple medications used to manage cardiovascular disease (eg, diuretics, ACE inhibitors, and angiotensin-receptor blockers) can affect the RAAS and the kidneys, alter electrolytes, and influence blood pressure. For some patients, ACE inhibitors may need to be decreased or discontinued if poorly tolerated and/or if they substantially increase serum creatinine levels. Therefore, kidney function and electrolytes should be assessed before starting cardiac medications, and creatinine and electrolytes should be re-assessed within 10 to 14 days. Electrolyte changes can affect renal function and contribute to arrhythmias and should be identified and addressed promptly (eg, parenteral or oral potassium supplementation for hypokalemia). When multiple cardiovascular medications are started simultaneously, patients with concurrent kidney disease are vulnerable to acute azotemia because of Clinically proven to improve GI signs in 21 days 1,2 and derm signs in 30 days 1 Crafted with highly hydrolyzed chicken protein and a single purified carbohydrate source Rich aroma, color and new kibble shape dogs can't resist ADVERSE REACTIONS TO FOOD Taking purity to the next level Prescription Diet ® z/d ® ©2018 Hill's Pet Nutrition, Inc. ®/™ Trademarks owned by Hill's Pet Nutrition, Inc. 1 Loeffler A, Lloyd DH, Bond R, et al. Dietary trials with a commercial chicken hydrolysate diet in 63 pruritic dogs. Vet Rec. 2004;154:519-522. 2 Fritsch DA, Roudebush P, Allen TA, et al. Effect of two therapeutic foods in dogs with chronic nonseasonal pruritic dermatitis. Intern J Appl Res Vet Med. 2010;8(3)146-154.

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