CPD ACCREDITED ARTICLE
Sediment: due to the lower SG false negative results
for bacterial UTI can occur. Send for culture if you
suspect this complication
UPC: UPC correlates well with 24-hour urine protein
loss. Check sediment first to exclude lower urinary
tract inflammation as a source of protein. In a healthy
cat UPC is generally very low (UPC <0.1). In health,
filtered proteins reabsorbed in the proximal convoluted
tubule by endocytosis so proteinuria is generally low.
The UPC must be a repeatable finding.
A UPC > 0.4 = proteinuric, UPC 0.2 – 0.4 = borderline
proteinuric and a UPC <0.2 = non-proteinuric.
Proteinuria occurs due to hyperfiltration, glomerular
hypertension and altered glomerular permselectivity.
Endogenous markers for GFR
Creatinine
Creatinine is specific marker for the kidney. It is
affected by the muscle mass of the patient and is
positively correlated to increased muscle proportion
body mass and negatively correlated with age (very
young and old). The sensitivity of creatinine is low and
it will only pick up renal disease when GFR is <75% of
normal.
With creatinine interpretation patient normals are
much more reliable than population based ranges.
Creatinine shows very little individual variation in
healthy adult animals and any trends on patient
creatinine are very sensitive. Changes within the
normal ranges may already be an indicator of a
decrease in GFR.
Urea
Changes in urea are not very specific for renal disease
as GIT haemorrhage and haemolysis can cause
elevation. It is not very sensitive either as it parallels
creatinine with increases only at about 75% renal
damage.
However:
• some healthy cats on wet food may have
a low SG
• some early CKD cats can still concentrate
to SG 1.035
• a 15% increase on any previous creatinine
is significant
• CKD with renal origin proteinuria and no
azotaemia in the early stages does occur.
Systemic Hypertension
Systemic hypertension occurs in 20% of cats
diagnosed with CKD and about 60% of cats
with hypertension have azotaemic CKD. There
is a positive association between age and
increasing blood pressure in cats and there is
also an increased risk of hypertension in cats
with CKD compared to healthy cats. Blood
pressure measurement should be part of
the health check in all older cats. Systemic
hypertension may exhibit ocular, cardiac renal
and central nervous system effects.
Table 2 Normal IRIS stages of SBP in cats
Normal SBP < 150 mmHg
Stage 1 SBP 150 – 160 mmHg
Stage 2 SBP 160 – 179 mmHg
Stage 3 SBP ≥ 180 mmHg
The maladaptive renal response to injury is the
cause of progression of CKD: haemodynamic
adaptations, activation of RAAS, systemic
hypertension,
proteinuria,
hypoxia
and
secondary hyperparathyroidism
Symmetric methylarginine (SDMA)
SDMA is an endogenous protein, formed by the
methylation of arginine, which is released into the
blood and of which ≥ 90% is excreted by the kidneys
and doesn’t undergo any biotransformation. It is an
accurate and precise assay for dogs and cats and on
average increases with only 40% loss in renal tissue.
The Prrrfect CKD Solution
MAKING A DIAGNOSIS OF CKD IN CATS:
SEMINTRA ® 4 mg/ml oral solution for cats. Each ml of Semintra 4 mg/ml contains 4 mg telmisartan
as active ingredient and benzalkonium chloride 0,1 mg as preservative.
Registration no.: 14/5.3.2/06 (Act 101 of 1965). Namibian reg. no.: V18/5.3.2/1398 (Act 13 of 2003).
CUSTOMER HELPLINE: 086 063 7425. Veterinary medicine. Registration Holder: Ingelheim
Pharmaceuticals (Pty) Ltd. Tel: +27 (011) 348-2400. Email: [email protected].
BI Ref.: VXX/2018 (Aug)
100%
A diagnosis of CKD is made on an increase in serum
creatinine >140umol/L together with an inappropriately
low SG (<1.035) and evidence of sustained changes
for at least 3months.
The Prrrfect CKD S
SEMINTRA ® 4 mg/ml oral solution for cats. Each ml of Semintra 4 mg/ml contains 4 mg
as active ingredient and benzalkonium chloride 0,1 mg as preservative.
Registration no.: 14/5.3.2/06 (Act 101 of 1965). Namibian reg. no.: V18/5.3.2/1398 (Act 1
CUSTOMER HELPLINE: 086 063 7425. Veterinary medicine. Registration Holder: Ingel
Pharmaceuticals (Pty) Ltd. Tel: +27 (011) 348-2400. Email: salesAH@boehringer-ingelhe
BI Ref.: VXX/2018 (Aug)
The Prrrfect CKD Solution
SEMINTRA ® 4 mg/ml oral solution for cats. Each ml of Semintra 4 mg/ml contains 4 mg telmisartan
as active ingredient and benzalkonium chloride 0,1 mg as preservative.
Issue 05 | NOVEMBER
Registration no.: 14/5.3.2/06 (Act 101 of 1965). Namibian reg. no.: V18/5.3.2/1398
(Act 13 of 2003).
CUSTOMER HELPLINE: 086 063 7425. Veterinary medicine. Registration Holder: Ingelheim
Pharmaceuticals (Pty) Ltd. Tel: +27 (011) 348-2400. Email: [email protected].
BI Ref.: VXX/2018 (Aug)
2018 | 7