CKD AND SDMA

LEARNING OBJECTIVES
• Introduce IRIS guidelines for proper staging of kidney disease
• Emphasize importance of refractometer and SDMA
• Available treatment option for kidney disease
INTERNATIONAL RENAL INTEREST SOCIETY (IRIS)

www.iris-kidney.com

MISSION
To help veterinary practitioners better diagnose, understand and treat kidney disease in cats
and dogs
WHY DO WE STAGE?
PARA KUNYARI MATALINO
TAYO
PROGNOSIS
SURVIVAL TIME (CATS) BY IRIS
IRIS STAGE 2 3 4

Median survival 1,151 778 103

(Days)

n=211

Source: Boyd LM, Langston C, Thompson K, Zivin K, Imanishi M. Survival in cats with naturally occuring chronic kidney
disease (2000-2002) J Vet Intern Med. 2008;22:1111-1117
 PRIOR TO STAGING

C Acute or Chronic?

K Intrinsically Renal?

D is Da patient stable?
• +/- increase in BUN and CREA
• Polyuria/oliguria
• +/- iMetabolic acidosis (decrease HCO3 production decrease H excretion)
• Increase K (due to acidosis and decrease excretion)
• USG 1.008- 1.014 but can be <1.030 in dogs or <1.035 in cats (isothenuria)
• Increase Phosphorus
• +/- increase Ca
• proteinuria
NORMAL URINE SPECIFIC GRAVITY
• Not dehydrated
• Not dying
 75% of the
nephrons
are not
functioning

Creatinine
Muscle
Breed
wasting
SDMA
SDMA
• Symmetric DiMethylArginine
• A methylated form of arginine in intracellular proteins of all nucleated cells
• Released into circulation when intracellular proteins are processed
• Excreted by the kidneys
• Stable production of SDMA is part of daily activity
• Proven renal biomarker shown to correlate with glomerular filtration rate (GFR)) in
humans, dogs, and cats.
 PRACTICAL USE OF SDMA

Proper
IRIS
staging

SDM
A
Early
Prognosi
s
detectio
n
SUBSTAGING: BLOOD PRESSURE
MONITOR r
SUBSTAGING: BLOOD PRESSURE

ANTIHYPERTENSIVE
CALCIUM CHANNEL BLOCKER
Amlodipine
0.625-1.25mg per 5kg SID

ACE INHIBITORS
Enalapril/ Benazepril
0.5mg/kg BID
SUBSTAGING: PROTEINURIA
 Tx PROTEINURIA
ACE inhibitor
ENALAPRIL
(ARB) angiotensin receptor blocker
(TELMISARTAN or HYDRALAZINE)

Tx Low Albumin
Acetylsalicilic acid (aspirin) 1-5mg/kg SID

Clopidogrel 1.1-3mg/kg/orally SID

SUBSTAGING: PHOSPHORUS
IRIS CKD STAGE PHOSPHORUS TARGET
1 <4.6mg/dL
2 <4.9mg/dL
3 <5.0mg/dL
4 <6.0mg/dL

PHOSPHATE BINDERS
Aluminum Hydroxide
30-60 mg/kg/day

Calcium Carbonate
30-90 mg/kg/day
ANEMIA: ERYTHROPOETIN?
• Carries 20% to 40% risk of anti-EPO antibody formation within 30-90days of
initial therapy

• May result in severe anemia and subsequent transfusion dependence

SUBCUTANEOUS FLUIDS
RENAL N
CASES
KEISHA

• 8yo, Intact Female shih tzu, Peridontal ds

• Corneal ulceration
KEISHA
HACHIKO
• 7yo,
• Female
• Labrador
• No vomiting
• IA
• Muscle wasting
• Dating obese 26kg nalnag
• anemic
HACHIKO
RENAL N
: ALEXA

• 1year old, intact female Alaskan Malamute

• 1 day IA, vomiting, fever

• Last meal- Milo

• CBC: Thrombocytopenia, anemic,

• Chem 17: Kidney Ds
PRE RENAL: ALEXA

• Blood smear
• Icteric- hemolysis
• Snap4Dx negative
AYNSTAYN
• 5yo
• Male
• Mongrel
• BSC 3/5
AYNSTAYN
SMALL

8yo, male mongrel

CC: Vomiting, IA
QUESTION?
• ANG MAGTANONG MABABAOG!!!!!!!!!!!!!
• ANG MAGTANONG MABIBINGOT!!!!!!!!!!!!!
CAT DIAGNOSIS MADE EASY
(Benesisto, 2020)
SH*T PUSA
 DISCLAIMER
• This is purely Benesisto, 2020
• Batuhin niyo ko ng notebook pag may mali akong sinasabi hahaha
• This is just a guide
• Please READ
COMMON DISEASES
• 1. FIV
• 2. Panleukopenia
• 3. FLUTD
• 4. Chlamydial conjuctivitis
• 5. Haemobartonella
• 6. Calici
 FIV
• Not vaccinated
• Respiratory problem
• Unresponsive to treatment
• In severe cases with mucopurulent eye discharge

• Dx: test kit and CBC

 PANLEUKOPENIA
• Not vaccinated
• Parvo and Distemper in Cats
• Bloody diarrhea
• Cerebellar hypoplasia in fetus/kittens

• Dx: test kit and CBC

 FLUTD
• Anuria, dysurua, hematuria

• Dx: Radiograph, CBC, urinalysis

 CHLAMYDIAL CONJUCTIVITIS
• Kittens
• Rescued
• Close eyes
• Conjuctivitis
• Mucopurulent discharge

• Dx: Clinical sign and CBC

 HAEMOBARTONELLA

• Blood parasitism in cats

• Low platelet

• Dx: CBC
 CALICI
• Outdoor cat
• Ulcers inside the mouth

• Dx: CBC and clinical sign

 LEPTOSPIROSIS
• Icteric
• Not vaccinated
• Play/ate rats
JOKE! WALANG LEPTO SA CATS HAHAHAHA
PANCREATITIS TREATMENT PLAN
• Fasting 8hrs
• Gastrointestinal lowfat – frequent, small feeding
• NSAID (don’t give corticosteroid)
• Liver support
• probiotics