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Which treatment of CRF is overall most important?
dietary phosphorus restriction
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What is goal of treating uremia?
- make animal feel better
- reduce oral lesions
- prevent/slow further loss of renal function
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What are some reversible causes of CRF signs that you should look for and treat?
- pyelonephritis
- obstruction (neoplasia/urolith)
- hyperCa
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What feature of CRF leaves the patient more prone to UTI, so culture/sensitivity testing should be checked?
low specific gravity = more prone to infection
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Initial conservative treatment for CRF?
- dietary restriction of phosphorus and protein (and sodium)
- phosphorus binders
- H2 receptor blockers (famotadine)
- encourage water/energy intake
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What secondary disease needs to be tested/treated?
renal secondary hyperparathyroidism, hypertension, anemia
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When are special renal diets helpful?
before the animal is obviously sick; can hopefully increase interval to uremic crisis
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what is possible complication of too much protein restriction/
cachexia (catabolize own tissues)
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How does CRF effect the GI system? what are treatment options to help/
- uremia stimulates gastrin production (severity of gastrinemia correlates w/severity of disease) --> anorexia, GI bleeding, vomiting
- -proton pump inhibitors (omeprazole) or H2 blockers (famotidine)
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what is important about timing for giving phosphorous binders? what is cheapest, most common binder given?
- give with meal
- aluminum salts (aluminum hydroxide)
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what is a phosphate binder that has no taste aversion and will NOT cause hypercalcemia?
epakitin (shellfish exoskeleton)
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which phosphate binder is less effective than aluminum and needs to be carefully monitored in patients also receiving calcitriol for hyperPTH?
calcium carbonate (can cause hyperCa)
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What food additive is a phosphate binder and has anti-oxidant effects but is only off label in US?
renalzin
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what phosphate binder does not contain any Ca or Al but is expensive?
sevelamer HCl
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what are some positive effects of CRF patients treated w/EPO?
- resolved anemia
- wt gain, improved appetite
- improved hair coat
- improved alertness/activity
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When is it time to give EPO/
- PCV<20%
- (frequent dose at first then reduce to once or twice weekly to reach target of 30-40%)
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what is most important adverse effect of EPO?
- antibody formation
- (can also see vomit, seizure, hypertension, uveitis, hypersensitivity reaction)
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what is the name of the engineered version of EPO which will not cause Ab formation?
Darbepoetin
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Why would you give a CRFpatient calcitriol (vit. D)?
- promote Ca absorption and treats renal 2ndary hyperPTH
- (reduces PTH secretion by binding calcitriol receptors on parathyroid gland)
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What mineral value needs to be monitored in addition to phosphorus when giving calcitriol?
calcium (can become elevated, esp. if also giving P-binders)
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when do you decide to treat hypertension?
- BP > 160mmHg consistently (maybe even lower if CRF)
- or high BP + fundic lesions
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will diuretics benefit a CRF patient?
no, harmful because can exacerbate dehydration (esp. loops diuretics like furosemide)
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What is the most important drug to give to a CRF patient? what is a good drug to add with it?
- enalapril (ACE inhibitor w/modest BP effect but other potentially beneficial effects on kidney)
- amlodipine (Ca blocker) also helpful for reducing BP
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Are SQ fluids helpful in management of CRF patient at home?
yes, best to manage as outpatient whenever possible
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What is most common form of CRF?
idiopathic (so not well understood and variable survival times)
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what are some findings that give poorest prognosis?
- severe intractable anemia (can't keep giving infusions)
- inability to maintain fluid balance/progressive azotemia
- advanced osteodystrophy (w/young familial)
- progressive wt loss
- severe end stage lesions on biopsy
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