Step 3: Treat CKD

Stage 1 Stage 2 Stage 3 Stage 4

Treatment Use nephrotoxic drugs Same as Stage 1 Same as Stage 2 Same as Stage 3
recommendations with caution
Renal therapeutic diet Keep phosphorus Keep phosphorus
Correct prerenal and <5.0 mg/dL <6.0 mg/dL
Treat hypokalemia in cats
postrenal abnormalities (<1.6 mmol/L) (<1.9 mmol/L)
Fresh water available at Treat metabolic acidosis Consider feeding tube for
all times nutritional and hydration
Consider treatment
support and ease of
Monitor trends in creatinine of anemia
medicating
and SDMA to document
Treat vomiting,
stability or progression
inappetence, and nausea
Investigate for and treat
Increased enteral or
underlying disease and/or
subcutaneous fluids may
complications
be required to maintain
Treat hypertension if systolic hydration
blood pressure persistently
Consider calcitriol therapy
>160 or evidence of
in dogs
end-organ damage
Treat persistent proteinuria
with renal therapeutic diet
and medication
(UPC >0.5 in dogs;
UPC >0.4 in cats)
Keep phosphorus
<4.6 mg/dL (<1.5 mmol/L)
If required, use renal
therapeutic diet 
plus phosphate binder

See www.iris-kidney.com for more detailed staging, therapeutic, and management guidelines.