Page 2710 - Cote clinical veterinary advisor dogs and cats 4th

1406 Chronic Kidney Disease: Management

Chronic Kidney Disease: Management
VetBooks.ir ↑ BUN ↑ Creatinine USG 1.035 (cat) Prerenal or postrenal disease

1.030 (dog)

USG 1.035 (cat)
1.030 (dog)
• Diuretic treatment
Exceptions • Hypoadrenocorticism Renal fine-needle
Likely kidney disease • Diabetes insipidus Solid aspirate or biopsy
• Other causes NDI
Evaluate renal size Large Ultrasound Hydronephrosis Obstruction Yes Relieve obstruction

Small Polycystic kidneys or No
perinephric pseudocyst

Restricted protein/phosphorus diet

Check for proteinuria, and address if present Evaluate for manifestations of uremia

Dehydration Vomiting Hyperphosphatemia Hypokalemia Acidosis Anemia Anorexia Verified
hypertension

IV or SQ H2-blocker/ Phosphate K gluconate Clinical Treatment
fluids proton pump restricted diet or K citrate signs of for GI Proteinuria

inhibitor orally or KCI anemia ulcers
Unresolved Unresolved in IV fluids Yes No
Maropitant, No Amlodipine
Maropitant Intestinal K citrate or appetite

phosphate stimulant Persistent
Unresolved binders Na bicarb Yes hypertension
Place
Metoclopramide feeding Amlodipine +
and/or tube ACE inhibitor
phenothiazine
Unresolved Consider rhEPO Monitor Persistent
(or darbepoietin) PCV hypertension
and iron
Ondansetron/
dolasetron

ACE, Angiotensin-converting enzyme; bicarb, bicarbonate; BUN, blood urea nitrogen;
GI, gastrointestinal; IV, intravenous; NDI, nephrogenic diabetes insipidus; PCV, packed
cell volume; rhEPO, recombinant human erythropoietin; SQ, subcutaneous, USG, urine
specific gravity.
Reproduced from the third edition in modified form
THIRD EDITION AUTHOR: Cathy E. Langston, DVM, DACVIM
EDITOR: Leah A. Cohn, DVM, PhD, DACVIM

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