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Chronic Kidney Disease, Overt (Symptomatic) 169

Client Education therapy (IV or SQ, depending on severity and AUTHORS: Catherine E. Langston, DVM, DACVIM;
Animals with occult CKD should be promptly underlying illness) may be required to interrupt Adam Eatroff, DVM, DACVIM
EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
VetBooks.ir illness because they may be less able to cope SUGGESTED READING Diseases and Disorders
this cycle.
presented to a veterinarian for signs of clinical
with extrarenal disorders, especially those that
predispose to dehydration. For instance, vomit-
ing from any cause may lead to dehydration, Quimby JM: Update on medical management of
clinical manifestations of chronic kidney disease.
which may worsen renal function, leading to Vet Clin North Am Small Anim Pract 46:1163-
exacerbation of all extrarenal clinical signs, as 1181, 2016.
well as manifestations of uremia. Prompt fluid

Chronic Kidney Disease, Overt (Symptomatic) Client Education
Sheet

BASIC INFORMATION basenjis, beagles, Bedlington terriers, Bernese • Seizures (seen rarely; end-stage uremia)
mountain dogs, boxers, Brittany spaniels, • Abnormal hemostasis (rarely spontaneous
Definition bull terriers, bullmastiffs, cairn terriers, bleeding; increased risk of bleeding with
• Chronic kidney disease (CKD): an abnormal- chow chows, cocker spaniels, Dalmatians, invasive procedures)
ity in renal structure or function existing for Doberman pinschers, Dutch kooikers,
longer than 3 months English foxhounds, English springer spaniels, PHYSICAL EXAM FINDINGS
• International Renal Interest Society (IRIS) German shepherds, golden retrievers, kees- Some or all may be present.
staging system for CKD: classification scheme honds, Lhasa apsos, miniature schnauzers, • Signs of dehydration
for canine and feline CKD based on serum navostas, Newfoundlands, Norwegian elk- • Kidney palpation: small, irregular kidneys
creatinine, with substages for proteinuria and hounds, Pembroke Welsh corgis, rottweilers, (common) or large kidney (rare)
blood pressure (p. 167) Samoyeds, Shar-peis, shih tzus, soft-coated ○ In cats, renal asymmetry is common
• Overt CKD: CKD that manifests clinical Wheaten terriers, standard poodles, and West after obstructive nephropathy or chronic
signs, most commonly secondary to uremia. Highland white terriers. ascending pyelonephritis.
Usually corresponds to IRIS stage III or IV, ○ Typically not painful on kidney palpation
but clinical signs occasionally are present in RISK FACTORS unless an acute insult is concurrent with
stages I and II. Advanced age, prior episode of acute kidney CKD
• Azotemia is an increased concentration injury (including nephrotoxic exposure, • Uremic halitosis
of blood urea nitrogen and/or creatinine. obstructive disease, or infection), familial/ • Oral ulceration (with severe azotemia)
Uremia is the constellation of clinical signs breed disposition • Poor haircoat
associated with excretory renal failure (i.e., • Poor body/muscle condition
not all azotemic animals are uremic). ASSOCIATED DISORDERS • Mucous membrane pallor (if anemic)
• Occult CKD: incidentally discovered, not In addition to disorders that occur concurrently • Heart murmur or gallop rhythm (cats)
producing overt signs (p. 167) with occult CKD (p. 167), comorbidities that
occur in overt CKD include anemia, dehydra- Etiology and Pathophysiology
Synonyms tion, electrolyte disorders, metabolic acidosis, See Chronic Kidney Disease, Occult (p. 167).
• Clinical CKD, decompensated CKD, ulcers (gastric or oral), vomiting, and weight
symptomatic CKD, uremic CKD loss/malnutrition. DIAGNOSIS
• Kidney failure and chronic renal failure are Clinical Presentation
no longer preferred terms. Diagnostic Overview
DISEASE FORMS/SUBTYPES CKD may be diagnosed based on gross
Epidemiology • Incidentally diagnosed in apparently healthy structural (e.g., nephrolithiasis, renal size/
SPECIES, AGE, SEX animals (occult CKD, typically IRIS stages shape changes, polycystic disease) or func-
• CKD is one of the most common geriatric I or II) tional (e.g., proteinuria, azotemia, persistent
diseases of cats, but it can occur in cats of • Overtly ill (symptomatic) but stable patients isosthenuria) abnormalities. Azotemia is
any age. (managed as outpatients) always present if there are clinical signs of
• Canine CKD occurs less frequently but • Decompensated patients (require hospitaliza- uremia.
manifests in both geriatric and juvenile tion until stabilized)
patients (e.g., congenital renal disease). Differential Diagnosis
HISTORY, CHIEF COMPLAINT Chronic kidney disease, occult (p. 167)
GENETICS, BREED PREDISPOSITION Some or all may be present. • Hemodynamic (i.e., prerenal) azotemia
• Multiple studies have not identified a breed • Polyuria/polydipsia (very common) • Azotemia with inadequately concentrated
predisposition in cats, but reports exist of • Anorexia urine
increased frequency in Maine coon, Abys- • Weight loss ○ CKD
sinian, Siamese, Russian blue, Burmese, and • Lethargy ○ Hemodynamic azotemia with extrarenal
Ragdoll cats. • Halitosis impairment of urine concentration (e.g.,
• Familial nephropathies may lead to early- • Vomiting occurs in decompensated (uremic) diuretics, hypoadrenocorticism, osmotic
onset CKD. Familial nephropathies reported animals. diuresis, diabetes insipidus)
in Abyssinian cats, Persian cats, Siamese • Altered consciousness (general dullness) in • Postrenal azotemia (e.g., urinary obstruction,
cats, Oriental cats, Alaskan malamutes, decompensated (uremic) animals rupture)

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