Despite these potential confounding issues, longitudinal assessment of blood creatinine concentrations (analyzed by consistent methodology), is an excellent tool to assess renal function and diagnose early CKD. greyhound) that will tend to increase the breadth of reference ranges 9 rendering blood creatinine concentration an insensitive marker of decreased kidney function in some breeds, when the interpretation of blood creatinine concentrations is dichromic (i.e., within or outside the reference interval). There can be a large variation in muscle mass in dogs (e.g., miniature poodle vs. 8 Blood Creatinine Concentrations (mg/dl) and IRIS CKD Stages for Dogs and Catsīlood creatinine concentrations must always be interpreted in light of the patient's muscle mass, urine specific gravity, and physical examination findings in order to rule out pre- and post-renal causes of azotemia. 6,7 Reference ranges need to be individualized to each laboratory but many veterinary nephrologists have suggested that renal azotemia may begin with blood creatinine concentrations lower than most reference ranges (i.e., 1.4 and 1.6 mg/dl in dogs and cats, respectively). One of the most disconcerting aspects of interpretation of blood creatinine is the relatively large variation in reference intervals between laboratories which can lead to false-positive and false-negative azotemia. Blood creatinine concentrations can also be influenced by the method of analysis (Jaffe's reaction vs. Creatinine is produced from the non-enzymatic degradation of creatine and creatine phosphate in skeletal muscle and therefore serum creatinine concentrations reflect the patient's muscle mass as well as GFR. Blood creatinine concentration is the most commonly used marker of glomerular filtration rate (GFR) in dogs and cats. In most cases, however, CKD is diagnosed on the basis of persistent azotemia superimposed on an inability to adequately concentrate urine (some cats with CKD retain the ability to concentrate urine). Image copyrighted by the University of Georgia Educational Resources CenterĮarly diagnosis of CKD: Blood creatinine concentrationĮarly, non-azotemic CKD (IRIS Stage 1) can be diagnosed in dogs and cats with abnormal renal palpation or renal imaging findings, persistent renal proteinuria, or urine concentrating deficits due to renal disease. There is firm evidence for dietary treatment and increasing evidence that anti-proteinuric treatments can slow the progressive nature of azotemic CKD.ĪA = afferent arteriole, EA = efferent arteriole, RAAS = renin angiotensin aldosterone system Although it's not possible to improve renal function in CKD, it's logical to assume that early diagnosis of CKD might improve clinical outcomes for dogs and cats. Soft tissue mineralization, systemic hypertension, intraglomerular hypertension, and proteinuria have been associated with progression of CKD (Figure 1). Animals may be stable for a long period of time but then experience an abrupt, unpredictable decline in renal function. Cats may have stable renal for months to years and be relatively unaffected by the CKD or they may have slowly progressive disease over several years. In dogs, where proteinuric kidney disease occurs more frequently, the progressive loss of renal function tends to be common, linear, and relatively rapid compared with cats. 3-5 Nephron damage associated with CKD is usually irreversible and often progressive. It has been estimated that as many as 30-50% of cats 15 years of age or older have CKD. The prevalence of CKD has been estimated to be 0.5-1.0% in dogs and 1.0-3.0% in cats, 1,2 but it increases with age, especially in cats. Chronic kidney disease (CKD) is a major cause of morbidity and mortality in dogs and cats.
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