Page 962 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Urinary system 937

VetBooks.ir 7.18 7.19

Fig. 7.18 CKD. Note complete loss of the Fig. 7.19 Transabdominal ultrasonogram of
corticomedullary junction in the right kidney. The the left kidney in a horse with suspected CKD.
arrow indicates an area of mineralisation. Hyperechogenic areas between the crosses indicate
mineralised debris or the presence of a renal calculus.

Supportive management is essential. A palatable Prognosis
diet low in protein, calcium and phosphorous should The long-term prognosis is grave but proper sup-
be provided. This could consist of high-quality grass portive care can have a significant effect on the
forage, corn and oats. Supplementation with fat length and quality of life. The rate of deterioration
(high-fat pellets, rice bran, vegetable oil) should be is hard to predict but with good management and
used if increased caloric intake is desired. Legumes regular monitoring of the disease progression, the
should be avoided because they are high in protein horse may achieve a fair short-term prognosis for
and calcium. Bran should also be avoided, as it is life. Athletic performance and breeding capabilities
high in protein and phosphorous. are limited.
Occasionally, with severe proteinuria, dietary The prognosis is poor for horses with anuria
protein needs may increase. Corn gluten, wheat or oligura, severe weight loss, acute weight gain
gluten, distiller’s grains, casein or soybean meal (up due to hypervolaemia (overhydration or fluid over-
to 0.5 kg/horse/day) can be fed to increase protein load), severe elevations in blood urea and creati-
intake. However, it is not advisable to increase pro- nine or where azotaemia responds poorly to fluid
tein in the diet of horses that have increased blood therapy.
urea levels. Vitamin supplementation should be pro-
vided to compensate for excessive polyuria-induced SPECIFIC AETIOLOGIES ASSOCIATED
losses of B vitamins. WITH CHRONIC KIDNEY DISEASE
Free access to water is critical. Supplementation
with oral electrolytes (NaCl 25–50 g/day p/o, sodium Congenital diseases of the kidney
bicarbonate 50–100 g/day p/o) is also important. Renal agenesia, hypoplasia and dysplasia are rare in
Potassium chloride (up to 50 g/day) can be admin- horses. Unilateral renal agenesis has been identi-
istered if hypokalaemia develops. Hypokalaemia fied incidentally in mature horses. Renal function of
in CKD is related to increased use of diuretics and the remaining kidney is normal, but because there
malnutrition, which may impose additive deleterious is less renal reserve, such horses are more prone to
effects on renal outcomes. Pyelonephritis warrants development of renal failure. Bilateral renal agenesis,
specific antimicrobial therapy and is discussed else- which is not compatible with life, has been reported
where (p. 938). in a foal.