Chronic renal failure

Chronic renal failure (CRF)

Causes of CRF in dogs

Causes of CRF in cats

Causes of CRF in large animals

Differentiation of CRF from ARF

Uremia as an intoxication

Concept of hyperfiltration

Proteinuria and glomerular sclerosis in remnant nephrons are adverse effects of hyperfiltration that may lead to progression of renal disease

Concept of hyperfiltration

Factors contributing to the progressive nature of renal disease

Progession of renal disease: Species differencres and extent of reduction in renal mass

Progression of renal disease: Functional and morphologic changes in remnant renal tissue

Progression of renal disease: Time followed

Progression of renal disease: Diet

Diet and progression of renal disease: Protein restriction

Diet and progression of renal disease: Phosphorus restriction

Diet and progression of renal disease: Caloric restriction

Diet and progression of renal disease: Lipids

Beneficial effects of _-3 PUFA in renal disease

Progression of renal disease: Systemic complications of renal insufficiency

Progression of renal disease: Therapeutic interventions

Concept of external balance

Intact nephron hypothesis (Bricker)

Maintenance of glomerulotubular balance in progressive renal disease

“Trade off” hypothesis (Bricker)

“Trade off” hypothesis

Different responses for different solutes

BUN, creatinine (no regulation)

Water balance (complete regulation)

Impaired concentrating ability

Why does polyuria develop?

PPT Slide

Na+ balance in CRF: Complete regulation

K+ balance in CRF: Complete regulation

Ca+2 balance in CRF: Complete regulation

Ca+2 balance in CRF

Phosphorus balance in CRF: Limited regulation

Renal secondary hyperparathyroidismClassical theory

Renal secondary hyperparathyroidism

Renal secondary hyperparathyroidism Alternative hypothesis: Role of calcitriol

Renal secondary hyperparathyroidism

Renal secondary hyperparathyroidism: Phosphorus restriction

Acid-base regulation: Limited regulation

Anemia of CRF

Anemia of CRF: Contributory factors

Hemostasis in CRF

Gastrointestinal disturbances in CRFOral lesions

Gastrointestinal disturbances in CRFGastric lesions

Metabolic complications of CRF

Less commonly recognized disturbances in CRF

Hypertension in CRF

Hypertension in CRF Mechanisms

Hypertension in CRFClinical Manifestations

Clinical history in CRFFindings are non-specific

Physical findings in CRF

Laboratory findings in CRF

Laboratory findings in CRF: Urinalysis

Management of CRF: General principles

Conservative medical management of CRF

Conservative medical management of CRF: Protein restriction?

Conservative medical management of CRF: Protein restriction

Commercial diets for CRF management (dry matter basis)

Conservative medical management of CRF: Monitoring patient response

Conservative medical management of CRF: Non-protein calories

Conservative medical management of CRF: Sodium chloride

Conservative medical management of CRF: Alkali and potassium replacement

Conservative medical management of CRF: Phosphorus restriction

Conservative medical management of CRF: Phosphorus binders

Conservative medical management of CRF: Phosphorus restriction

Conservative medical management of CRF: Phosphorus binders

Medical Management of CRF: Uremic Gastroenteritis

Medical Management of CRF: H2 Receptor Blockers

Medical Management of CRF: Endocrine replacement therapy

Medical Management of CRFHormonal Replacement: Erythropoietin

Medical Management of CRFErythropoietin: Adverse Effects

Medical Management of CRFErythropoietin: The future

Medical Management of CRFHormonal Replacement: Calcitriol

Medical Management of CRF:Anabolic steroids

Medical Management of CRF:Blood Pressure Assessment

Medical Management of CRF Hypertension: “White Coat Artifact”

Medical Management of CRF:Blood Pressure Assessment

Medical Management of CRFHypertension: To treat or not?

Medical Management of CRF:Treatment of Hypertension

Medical Management of CRF:Avoid stress

Medical Management of CRF:Why is survival time so variable?

Medical Management of CRF:Findings indicative of a poor prognosis