Veterinary Medicine - December 2007 - (Page 798)

Chronic kidney disease O P E E R - R E V I E W E D separate clinic visits before establishing the need for therapeutic intervention. The goal of therapy is to reduce blood pressure to below 160/100 mm Hg. Amlodipine is the first-choice drug for managing elevated blood pressure in cats with chronic kidney disease (evidence grade 2).17 It is typically highly effective in reducing blood pressure in cats, often by as much as 20 to 50 mm Hg. Amlodipine is administered at a dose of 0.625 mg/cat in cats less than 11 lb (5 kg) and 1.25 mg/cat in cats 11 lb or greater. The dose may be doubled if response fails to meet treatment goals. Hypertension in dogs appears to be more resistant to drug therapy. Because ACE inhibitors reduce intraglomerular pressure even when systemic blood pressure is not effectively ameliorated, these drugs have a therapeutic advantage as first-line drugs in dogs with chronic kidney disease in mitigating the renal effects of hypertension. However, since ACE inhibitors are often relatively ineffective antihypertensive drugs in dogs, amlodipine is typically CE You can earn two hours of Continuing Education credit from Kansas State University by answering the following questions on treating chronic kidney disease. Circle only the best answer for each question, and transfer your answers to the form on page 800. Article #1 1. Which is not a clinical consequence of chronic dehydration? a. Prerenal azotemia b. Predisposition to acute kidney injury c. Increased appetite d. Constipation e. Lethargy phosphorus concentration of 7 mg/dl c. A dog with stage 4 disease with a phosphorus concentration of 8 mg/dl d. A dog with stage 2 disease with a phosphorus concentration of 7 mg/dl e. None of the above c. Renal diets can delay the onset of uremia. d. A cat with a creatinine concentration of 1.5 mg/dl should be placed on a renal diet. e. Both A and B 6. Which statement regarding potassium in patients with chronic kidney disease is false? a. The serum potassium concentration should fall between 3.5 and 5.5 mEq/L. b. Potassium gluconate is a good choice for hypokalemic patients. c. The primary clinical consequence of hypokalemia is cardiotoxicosis. d. Treatment for hyperkalemia may involve reducing the dose of drugs that block the renin-angiotension system. e. Hypokalemia can produce muscle weakness and impair kidney function. 2. Which would be a first-choice phosphate-binding agent for patients with elevated phosphorus concentrations? a. Calcium carbonate b. Aluminum hydroxide c. Sevelamer hydrochloride d. Calcium acetate e. Lanthanum carbonate 9. Which statement regarding systemic hypertension in patients with chronic kidney disease is false? a. A cat with stage 1 disease and a blood pressure consistently > 180/120 mm Hg should receive amlodipine. b. A dog with stage 3 disease and a blood pressure consistently > 180/100 mm Hg should receive amlodipine and an ACE inhibitor. c. Amlodipine can lower a cat’s blood pressure by as much as 40 to 50 mm Hg. d. Hypertensive retinopathy or central nervous system signs necessitate immediate therapy to lower a patient’s blood pressure. e. Two separate blood pressure measurements consistent with elevated pressure indicate the need for drug intervention. 3. Which gastrointestinal sign may occur in patients with chronic kidney disease? a. Diarrhea b. Hemorrhagic colitis c. Halitosis d. Nausea e. All of the above 7. Which problem should be ruled out before starting erythropoietin treatment in a dog with anemia and chronic kidney disease? a. Infection b. Blood loss c. Poor nutrition d. Iron deficiency e. All of the above 4. Which drugs are appropriate to treat the clinical signs of gastritis associated with uremia? a. Famotidine or ranitidine b. Sucralfate c. Maropitant or ondansetron d. Prednisone e. A, B, and C 10. Which drug would not be indicated to reduce proteinuria in a patient with chronic kidney disease? a. Enalapril b. Losartan c. Lisinopril d. Darbepoetin e. Irbesartan 8. Which statement regarding renal diets is true? a. The only difference between renal and standard diets is that renal diets are low in protein. b. Renal diets cannot prevent the onset of uremia. 5. In which patient with chronic kidney disease would calcitriol be indicated? a. A dog with stage 3 disease with a phosphorus concentration of 5 mg/dl b. A cat with stage 3 disease with a 798 December 2007 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - December 2007

Veterinary Medicine - December 2007 Contents Letters Editors' Guest Thanking Our Valued Reviewers The Veterinary Medicine Interview: Dr. Joseph Harari Clinical Exposures Idea Exchange Answers to Three Commonly Asked Questions About Lyme Disease Practical Ideas for Managing Common Internal Medicine Problems A Tip for Interpreting Leptospira Species Titers Investigating Proteinuric Kidney Disease Counseling New Puppy Owners: Normal Play vs. Aggressive Tendencies 11 Guidelines for Conservatively Treating Chronic Kidney Disease CE Form Product Preview Advertiser Index Marketplace/Classifieds Mind Over Miller Merial Insert

Veterinary Medicine - December 2007

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