Page 772 - Small Animal Clinical Nutrition 5th Edition

800 Small Animal Clinical Nutrition

that can be used to increase therapeutic success and thus
Table 37-13. Reassessment of patients with chronic improve the lifespan and quality of life for dogs and cats with
VetBooks.ir kidney disease. CKD.
Physical examination
Abdominal palpation (size and contour of kidneys, presence
of ascites)
Blood pressure measurement ACKNOWLEDGMENT
Body condition/muscle mass
Body weight
Fundic examination (retinal hemorrhage, detached retina) The authors and editors thank Dr. David J. Polzin for his con-
Hair and coat quality tribution to this chapter in the previous edition.
Hydration status
Oral examination (uremic odor, ulcers, mucous membrane
color)
Laboratory evaluation ENDNOTES
Serum biochemistries (urea nitrogen, creatinine, albumin,
phosphorus)
Serum electrolytes (calcium, potassium, chloride, sodium, a. Sulfosalicylic acid (5%). Ricca Chemical Company, Ar-
magnesium) lington, TX, USA.
Total serum carbon dioxide or venous blood gases (blood pH, b. E.R.D.-HealthScreen. Heska Corporation, Loveland, CO,
bicarbonate, base excess) to evaluate acid-base status
Urinalysis USA.
Microscopic sediment exam (pyuria or bacteriuria may c. VetTest Urine P:C ratio. IDEXX Laboratories, Inc., West-
indicate urinary tract infection) brook, ME, USA.
Urine specific gravity (crude index of tubulointerstitial
function) d. Prescription Diet u/d Canine. Hill’s Pet Nutrition, Inc.,
pH (very crude index of acid-base status) Topeka, KS, USA.
Urine protein-creatinine ratio (assess proteinuria and response e. Prescription Diet k/d Canine. Hill’s Pet Nutrition, Inc.,
to treatment)
Diagnostic imaging Topeka, KS, USA.
Abdominal radiographs (assess kidney shape and size, f. Whiskas Feline Low Protein Diet. Waltham, Effem, Austria.
reference L vertebra on ventrodorsal view) g. Whiskas Feline Low Phosphorus, Low Protein. Waltham
2
Excretory urogram (assess obstruction due to nephroliths)
Ultrasound (assess kidney and prostate gland, presence of Veterinary Diet, Masterfoods, Bruck, Austria.
hydronephrosis, hydroureter, uroliths) h. Prescription Diet k/d Feline. Hill’s Pet Nutrition, Inc.,
Topeka, KS, USA.
i. Epogen. Amgen Inc., Thousand Oaks, CA, USA.
j. Fortekor. Norvartis Animal Health, Basel, Switzerland.
sium). In addition to key nutritional factors, it is important to k. Remeron. Organon, West Orange, NJ, USA.
consider available evidence supporting effectiveness of specific
veterinary therapeutic renal foods as well as other treatments
for CKD. Individual patient needs and responses and owner REFERENCES
preferences must also be considered to design an optimal ther-
apeutic regimen.Transitioning to a therapeutic renal food often The references for Chapter 37 can be found at
requires a team approach and effective communication involv- www.markmorrisinstitute.org.
ing the owner and health care team. There are many strategies

CASE 37-1

Hematemesis in a Shih Tzu
Larry G. Adams, DVM, PhD, Dipl. ACVIM (Small Animal Internal Medicine)
Purdue University
School of Veterinary Medicine
West Lafayette, Indiana, USA

Patient Assessment
The referring veterinarian initially evaluated a four-year-old intact male Shih Tzu for hematuria, anorexia and vomiting. The dog
had been diagnosed with chronic kidney disease (CKD) and a possible urinary tract infection. The suspected urinary tract infec-
tion had been treated with a combination of trimethoprim and sulfamethoxazole. The dog had also developed thrombocytopenia
3
3
(platelet count 11 x 10 /µl [reference range 300 to 900 x 10 /µl]) and progressive anemia in the month before referral. The
trimethoprim-sulfamethoxazole combination was discontinued and the dog was treated with prednisone for thrombocytopenia and
suspected immune-mediated hemolytic anemia.The current history included vomiting, hematemesis, hematochezia and decreased