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. 2016 Mar;18(3):219-39.
doi: 10.1177/1098612X16631234.

ISFM Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease

Affiliations

ISFM Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease

Andrew H Sparkes et al. J Feline Med Surg. 2016 Mar.

Abstract

Practical relevance: Chronic kidney disease (CKD) is one of the most commonly diagnosed diseases in older cats. In most cats, CKD is also a progressive disease and can be accompanied by a wide range of clinical and clinicopathological changes. These ISFM Consensus Guidelines have been developed by an independent panel of clinicians and academics to provide practical advice on the diagnosis and management of this complex disease.

Clinical challenges: Although CKD is a common clinical problem in cats, the manifestations of disease vary between individuals. Thus there is a need for careful and repeat evaluation of cats with CKD and adjustment of therapy according to individual needs. In addition to addressing problems arising from CKD and improving quality of life (QoL) for the patient, therapy may also target slowing the underlying progression of disease and hence prolonging life. While maintaining QoL is of paramount importance in our patients, this can be challenging when multiple therapies are indicated. In some cases it is necessary to prioritise therapy, given an understanding of what is likely to most benefit the individual patient.

Evidence base: In preparing these Guidelines, the Panel has carefully reviewed the existing published literature, and has also graded the quality of evidence for different interventions to help to provide practical recommendations on the therapeutic options for feline CKD. This is a field of veterinary medicine that has benefited from some excellent published clinical research and further research findings will undoubtedly modify the recommendations contained in these Guidelines in the future.

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Conflict of interest statement

Jonathan Elliott has acted as a paid consultant for CEVA Animal Health, Boehringer Ingelheim, Pfizer (now Zoetis), Bayer, Idexx, Novartis Animal Health, Waltham Centre for Pet Nutrition and Royal Canin; he has research grant funding and contracts to work on kidney disease in cats from CEVA Animal Health, Orion, Zoetis, Royal Canin and Novartis Animal Health (now Elanco Animal Health). Natalie Finch has received research funding from Boehringer Ingelheim. Catherine Langston is a paid consultant for Bayer and for Abaxis. Hervé Lefebvre has received grants/research contracts and/or performs consulting for Royal Canin, Novartis Animal Health, CEVA Animal Health and Bayer.

Figures

Figure 1
Figure 1
Typical histopathology of a kidney from a cat with chronic kidney disease (CKD), characterised by inflammatory infiltrate, tubular loss, increase in extracellular matrix and fibrosis x 20. Courtesy of Shannon McLeland
Figure 2
Figure 2
Blood pressure measurement should be part of the routine evaluation of all cats with proven or suspected CKD. Courtesy of Sarah Caney
Figure 3
Figure 3
Ocular examination (in this case distant indirect ophthalmoscopy) performed in a dark room is valuable, given the strong association between CKD and hypertension. Courtesy of Sarah Caney
Figure 4
Figure 4
Collection of a urine sample by lateral cystocentesis for routine monitoring of CKD. Courtesy of Sarah Caney
Figure 5
Figure 5
Collection of blood for routine monitoring of CKD (note the no restraint technique). Courtesy of Jessica Quimby
Figure 6
Figure 6
A small kidney and loss of corticomedullary distinction are ultrasound findings consistent with feline CKD. Courtesy of Jessica Quimby
Figure 7
Figure 7
Radiographs are helpful for identifying abnormalities such as stones within the urinary tract. Courtesy of Jessica Quimby
Figure 8
Figure 8
Multiple sources of fresh water are important for maintaining hydration. Courtesy of Jessica Quimby
Figure 9
Figure 9
Subcutaneous fluid therapy can be used on an outpatient basis or by owners at home. Courtesy of Sarah Caney
Figure 10
Figure 10
Muscle wasting and dehydration in a cat with CKD. Careful attention to body condition, muscle mass and caloric intake is important. Courtesy of Jessica Quimby
Figure 11
Figure 11
Anaemia is a recognised risk factor for progression of CKD. Courtesy of Cathy Langston
Figure 12
Figure 12
Enteral (oesophagostomy) tube in place to support food and fluid intake. Courtesy of Isuru Gajanayake
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References

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    1. White JD, Norris JM, Baral RM, et al.. Naturally-occurring chronic renal disease in Australian cats: a prospective study of 184 cases. Aust Vet J 2006; 84: 188–194. - PubMed
    1. Marino CL, Lascelles BD, Vaden SL, et al.. Prevalence and classification of chronic kidney disease in cats randomly selected from four age groups and in cats recruited for degenerative joint disease studies. J Feline Med Surg 2014; 16: 465–472. - PMC - PubMed
    1. Lulich JP, Osborne CA, O’Brien TD, et al.. Feline renal failure: questions, answers, questions. Compen Contin Educ Pract Vet 1992; 14: 127–152.
    1. O’Neill DG, Church DB, McGreevy PD, et al.. Longevity and mortality of cats attending primary care veterinary practices in England. J Feline Med Surg 2015; 17: 125–133. - PMC - PubMed

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