Diagnosis and Management of Chronic Kidney Disease in Dogs and Cats

Chronic Kidney Disease Chronic kidney disease (CKD) is defined as primary renal disease that has persisted for months to years. Chronic kidney disease has been referred to as chronic renal failure, chronic renal insufficiency, etc. These terms are not very useful in categorizing a patient to facilitate treatment and prognosis recommendations. In human nephrology, there is an elaborate staging scheme that facilitates the application of appropriate clinical practice guidelines for diagnosis, prognosis, and treatment. Recently, The International Renal Interest Society (IRIS) has recently introduced a staging system for the classification and stratification of chronic kidney disease in dogs and cats. (See IRIS staging charts following notes) The purpose of the staging system is to facilitate the application of clinical practice guidelines for evaluation and management of each stage of chronic kidney disease. Patients are assigned a specific stage of renal disease based on kidney function as determined by serum creatinine concentration. The patient is then further classified according to their systolic blood pressure and the presence or absence of proteinuria. Both hypertension and proteinuria have been identified as important contributors to progressive renal injury in many species, including the cat. Although the specific cut-off values used to categorize patients with CKD into these stages are inherently arbitrary, staging is useful for establishing prognosis and managing patients with CKD.