Both clinical evaluation and laboratory exams have a key role in the therapeutic approach to dogs and cats affected from CKD. Early diagnosis of disorders associated to the progression of renal disease makes it possible to set an adequate therapy, slowing the progression of the disease. Many disorders, although clinically suspected, are not detectable without laboratory exams. Among them, for example, either electrolytic and metabolic alterations and more: kidney disease itself cannot be diagnosed without the serum creatinine of the patient or other markers of renal damage.
Clinical Exam– Other than general and particular clinical examination, a special attention goes to the nutritional condition of the patient, determined by body weight, Body Condition and Muscle Condition Score (available both for dogs and cats at WSAVA). Nutritional status of patients affected by CKD is related to risk of developing uremic crisis and mortality: bad nutritional condition is associated to higher risk of uremic crisis and mortality for renal related causes. Blood pressure is determined too and hypertensive patients are put under treatment.
Laboratory exams– Once CKD has been diagnosed, Veterinarian proceeds to request the laboratory exams useful to identify concurrent pathologies known to determine renal damage or the progression of kidney disease. After the initial evaluation of a complete blood count, biochemistry and urinalysis the Veterinarian will be requesting further exams based on patient’s laboratory results and clinical history. In order to better understand the clinical utility of laboratory exams for a right approach to renal patients, below are IRIS stages, most common disorders by stage (modified from Polzin, 2006 and 2013) and possible necessity for laboratory exams.
|
Clinical signs |
IRIS stage |
Laboratory exams |
|
Polyuria/Polydipsia |
2-4 |
No |
|
Proteinuria |
1-4 |
Yes |
|
Hypertension |
1-4* |
No |
|
Urinary infection |
1-4 |
Yes |
|
Hyperphosphatemia |
2-4 |
Yes |
|
Hypopotassemia |
3-4 |
Yes |
|
Anemia |
3-4 |
Yes |
|
Metabolic Acidosis |
3-4 |
Yes |
|
Anorexia and weight loss |
3-4 |
No |
|
Vomit |
3-4 |
No |
|
Dehydration |
3-4 |
No |
*although it is possible to identify hypertensive patients in any stage of the disease, the prevalence of hypertension increases with increasing of IRIS staging
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