IRIS-Stage 4 CKD in a Dog: Diagnostic Approaches and Staging of Chronic Kidney Disease: A Case Study

Michael Gunawan; Frizky Amelia; Ni NengahYogiswari Resyana; ZulfaIchsanniyati R.C.F; Siti Zaenab; Tiara Widyaputri

doi:10.18006/2023.11(1).216.225

Authors

Michael Gunawan Student of Faculty of Veterinary Medicine, Universitas Brawijaya Kampus 2, Puncak Dieng Street, Malang, East Java, Indonesia 65151
Frizky Amelia Student of Graduate School of IPB University, KampusDramaga, Bogor, Indonesia 16680
Ni NengahYogiswari Resyana My Vets, Jl.Kalimantan No. 23, BSD City, Tangerang, Indonesia 15310
ZulfaIchsanniyati R.C.F My Vets, Jl.Kalimantan No. 23, BSD City, Tangerang, Indonesia 15310
Siti Zaenab My Vets, Jl.Kalimantan No. 23, BSD City, Tangerang, Indonesia 15310
Tiara Widyaputri Lecturer of Faculty of Veterinary Medicine, Universitas BrawijayaKampus 2, Puncak Dieng Street, Malang, East Java, Indonesia 65151

DOI:

https://doi.org/10.18006/2023.11(1).216.225

Keywords:

CKD, Glomerular filtration, Hematological evaluation, IRIS staging

Abstract

Chronic kidney disease (CKD) is a devastating disease of the kidneys that often arise from unresolved acute injury. As a chronic disease, CKD is challenging to diagnose, thus it needs a good combination of a comprehensive understanding of the kidney’s anatomy and physiology and thorough planning for a framework of diagnostic tools to be utilized. This study is intended to provide the diagnostic planning used to determine CKD in an approximately 5-year-old intact male dog that was brought to My Vets Animal Clinic for a check-up visit. On presentation, the dog was emaciated, mildly dehydrated, halitotic, and infested with ticks. A complete blood count (CBC) indicated a normocytic, normochromic, non-regenerative anemia, and lymphopenia. The blood chemistry panel indicated azotemia, elevated symmetric dimethylarginine (SDMA), hypocalcemia, and hyperphosphatemia. Elevated SDMA level (64 μg/dL, reference value: 0-14 μg/dL) and hypercreatinemia (5.9 mg/dL, reference value: 0.5-1.8 mg/dL) indicated impaired glomerular filtration. Physical and clinical pathological findings signified the presence of CKD in this dog, with a stage-4 severity based on International Renal Interest Society (IRIS) CKD staging criteria. The prognosis of this case was highly guarded, and the dog eventually passed away on the sixth day of hospitalization. In a case with an uncertain outcome, accuracy in both diagnosis and staging of CKD in dogs will aid the therapy regimen planning, which may improve the patient’s conditions.

References

Acierno, M. J., Brown, S., Coleman, A. E., Jepson, R. E., Papich, M., Stepien, R. L., & Syme, H. M. (2018). ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. Journal of Veterinary Internal Medicine, 32(6), 1803. https://doi.org/10.1111/JVIM.15331 DOI: https://doi.org/10.1111/jvim.15331

Ahmed, A., Jorna, T., & Bhandari, S. (2016). Should We STOP Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in Advanced Kidney Disease? Nephron, 133(3), 147–158. https://doi.org/10.1159/000447068 DOI: https://doi.org/10.1159/000447068

Bagus, I., & Ardana, K. (2017). Laporan Kasus : Ehrlichiosis Pada Anjing Kintamani Bali. Indonesia Medicus Veterinus, 6(1), 68–74. https://doi.org/10.19087/imv.2017.6.1.71

Bartges, J. W. (2012). Chronic Kidney Disease in Dogs and Cats. Veterinary Clinics of North America - Small Animal Practice, 42(4), 669–692. https://doi.org/10.1016/j.cvsm.2012.04.008 DOI: https://doi.org/10.1016/j.cvsm.2012.04.008

Breshears, M. A., & Confer, A. W. (2016). The Urinary System. In J. Zachary & M. McGavin (Eds.), Pathologic Basis of Veterinary Disease (6th ed.). Elsevier.

Burton, W., Drake, C., Ogeer, J., Buch, J., Mack, R., McCrann, D., & Coyne, M. J. (2020). Association Between Exposure to Ehrlichia spp. and Risk of Developing Chronic Kidney Disease in Dogs. Journal of American Animal Hospital Association, 56. https://doi.org/10.5326/JAAHA-MS-7012 DOI: https://doi.org/10.5326/JAAHA-MS-7012

DiBartola, S. P. (2012). Introduction to Acid-Base Disorders. Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice, 231–252. https://doi.org/10.1016/B978-1-4377-0654-3.00016-0 DOI: https://doi.org/10.1016/B978-1-4377-0654-3.00016-0

DiBartola, S. P., & Bateman, S. (2012). Introduction to Fluid Therapy. Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice, 331–350. https://doi.org/10.1016/B978-1-4377-0654-3.00021-4 DOI: https://doi.org/10.1016/B978-1-4377-0654-3.00021-4

DiBartola, S. P., & Westropp, J. L. (2014). Urinary Tract Disorders. In R. W. Nelson & C. G. Couto (Eds.), Small Animal Internal Medicine (5th ed., p. 629). Elsevier.

Ha, Y. S., Hopper, K., & Epstein, S. E. (2013). Incidence, Nature, and Etiology of Metabolic Alkalosis in Dogs and Cats. Journal of Veterinary Internal Medicine, 27(4), 847–853. https://doi.org/10.1111/jvim.12122 DOI: https://doi.org/10.1111/jvim.12122

Hall, J. A., Yerramilli, M., Obare, E., Yerramilli, M., Almes, K., & Jewell, D. E. (2016). Serum Concentrations of Symmetric Dimethylarginine and Creatinine in Dogs with Naturally Occurring Chronic Kidney Disease. Journal of Veterinary Internal Medicine, 30(3), 794–802. https://doi.org/10.1111/JVIM.13942 DOI: https://doi.org/10.1111/jvim.13942

Harley, L., & Langston, C. (2012). Proteinuria in dogs and cats. Canadian Veterinary Journal, 53(6), 631–638.

Hemstreet, B. A. (2001). Use of sucralfate in renal failure. The Annals of Pharmacotherapy, 35(3), 360–364. https://doi.org/ 10.1345/APH.10117 DOI: https://doi.org/10.1345/aph.10117

Hou, F. F., Zhang, X., Zhang, G. H., Xie, D., et al. (2006). Efficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency. New England Journal of Medicine, 354(2), 131–140. https://doi.org/10.1056/nejmoa053107 DOI: https://doi.org/10.1056/NEJMoa053107

Hruska, K. A., Mathew, S., Lund, R., Qiu, P., & Pratt, R. (2008). Hyperphosphatemia of Chronic Kidney Disease. Kidney International, 74(2), 148. https://doi.org/10.1038/KI.2008.130 DOI: https://doi.org/10.1038/ki.2008.130

Jiang, Z., Zhang, X., Yang, L., Li, Z., & Qin, W. (2016). Effect of restrictd protein diet supplemented with keto analogues in chronic kidney disease: a systematic review and meta-analysis. International Urology and Nephrology, 48(3): 409-418. https://doi.org/10.1007/s11255-015-1170-2 DOI: https://doi.org/10.1007/s11255-015-1170-2

Johns, S. M., Stern, J. A., & Nelson, O. L. (2011). ECG of the Month. Journal of the American Veterinary Medical Association, 238(8), 982–984. https://doi.org/10.2460/javma.238.8.982 DOI: https://doi.org/10.2460/javma.238.8.982

Kovarikova, S. (2015). Urinary biomarkers of renal function in dogs and cats: A review. Veterinarni Medicina, 60(11), 589–602. https://doi.org/10.17221/8527-VETMED DOI: https://doi.org/10.17221/8527-VETMED

Krapf, R., Seldin, D. W., & Alpern, R. J. (2008). Clinical Syndromes of Metabolic Acidosis. In R. J. Alpern & S. C. Hebert (Eds.), Seldin and Giebisch’s The Kidney (4th ed., pp. 1667–1720). Academic Press. https://doi.org/10.1016/B978-012088488-9.50062-0 DOI: https://doi.org/10.1016/B978-012088488-9.50062-0

Kraut, J. A., & Madias, N. E. (2010). Metabolic acidosis: Pathophysiology, diagnosis and management. Nature Reviews Nephrology, 6(5), 274–285. https://doi.org/10.1038/ NRNEPH.2010.33 DOI: https://doi.org/10.1038/nrneph.2010.33

Lippi, I., Perondi, F., Lubas, G., Gori, E., Pierini, A., D’addetta, A., & Marchetti, V. (2021). Erythrogram patterns in dogs with chronic kidney disease. Veterinary Sciences, 8(7). https://doi.org/10.3390/vetsci8070123 DOI: https://doi.org/10.3390/vetsci8070123

Liguori, T.T.A., Melchert, A., Takahira, R.K., Ramos, P.R.R., Padovani, C.R., Barretti, P., & Guimarãles-Okamoto, P.T.C. (2018). Randomized controlled clinical trial of ketoanalogues supplementation in dogs with chronic kidney disease. PesquisaVeterinariaBrasileira,, 38(3): 489-495. http://doi.org/10.1590/1678-5150-pvb-5245 DOI: https://doi.org/10.1590/1678-5150-pvb-5245

Martello, E., Perondi, F., Capucchio, M. T., Biasato, I., Biasibetti, E., Cocca, T., Bruni, N., & Lippi, I. (2020). Efficacy of a new dietary supplement in dogs with advanced chronic kidney disease. PeerJ, 8. https://doi.org/10.7717/peerj.9663 DOI: https://doi.org/10.7717/peerj.9663

Naigamwaila, D. Z., Webb, J. A., & Giger, U. (2012). Iron deficiency anemia. The Canadian Veterinary Journal, 53(3), 250. /pmc/articles/PMC3280776/

Nesti, D. R., Baidlowi, A., Ariyanti, F., & Tjahajati, I. (2019). Deteksi Penyakit Zoonosis Ehrlichiosis pada Pasien Anjing di Klinik Hewan Jogja. Jurnal Nasional Teknologi Terapan (JNTT), 2(2), 191. https://doi.org/10.22146/jntt.42966 DOI: https://doi.org/10.22146/jntt.42966

Pak, S. I. (2000). The clinical implication of sodium-potassium ratios in dogs. Journal of Veterinary Science (Suwon-Si, Korea), 1(1), 61–65. https://doi.org/10.4142/jvs.2000.1.1.61 DOI: https://doi.org/10.4142/jvs.2000.1.1.61

Palmer, B. F. (2015). Regulation of Potassium Homeostasis. Clinical Journal of the American Society of Nephrology, 10(6), 1050. https://doi.org/10.2215/CJN.08580813 DOI: https://doi.org/10.2215/CJN.08580813

Parham, W. A., Mehdirad, A. A., Biermann, K. M., & Fredman, C. S. (2006). Hyperkalemia Revisited. Texas Heart Institute Journal, 33(1), 40. /pmc/articles/PMC1413606/

Plumb, D. C. (2011). Plumb’s Veterinary Drug Handbook (7th ed.). PharmaVet Inc.

Polzin, D. J. (2011). Chronic Kidney Disease in Small Animals. Veterinary Clinics of North America - Small Animal Practice, 41(1), 15–30. https://doi.org/10.1016/j.cvsm.2010.09.004 DOI: https://doi.org/10.1016/j.cvsm.2010.09.004

Putra, W. G., Widyastuti, S. K., & Batan, I. W. (2019). Laporan Kasus : Anaplasmosis dan Ehrlichiosis pada Anjing Kampung di Denpasar , Bali. Indonesia Medicus Veterinus, 8(4), 502–512. https://doi.org/10.19087/imv.2019.8.4.502

Ross, L. (2011). Acute Kidney Injury in Dogs and Cats. Veterinary

Clinics of North America - Small Animal Practice, 41(1), 1–14. https://doi.org/10.1016/j.cvsm.2010.09.003 DOI: https://doi.org/10.1016/j.cvsm.2010.09.003

Santacoloma Osorio, M., Giraldo, G. C., Santacoloma Osorio, M., & Giraldo, G. C. (2017). Gastrointestinal manifestations of chronic kidney disease. Revista Colombiana de Nefrología, 4(1), 17–26. https://doi.org/10.22265/ACNEF.4.1.266 DOI: https://doi.org/10.22265/acnef.4.1.266

Sargent, H. J., Elliott, J., & Jepson, R. E. (2021). The new age of renal biomarkers: does SDMA solve all of our problems? Journal of Small Animal Practice, 62(2), 71–81. https://doi.org/ 10.1111/jsap.13236 DOI: https://doi.org/10.1111/jsap.13236

Segev, G., Bandt, C., Francey, T., & Cowgill, L. D. (2008). Aluminum toxicity following administration of aluminum-based phosphate binders in 2 dogs with renal failure. Journal of Veterinary Internal Medicine, 22(6), 1432–1435. https://doi.org/10.1111/j.1939-1676.2008.0206.x DOI: https://doi.org/10.1111/j.1939-1676.2008.0206.x

Stillion, J. R., & Ritt, M. G. (2009). Renal Secondary Hyperparathyroidism in Dogs. Compendium, E1–E11. http://vetfolio-vetstreet.s3.amazonaws.com/mmah/79/c1332da0b 74423883f86f1d932c022/filePV0709_Stillion_0.pdf

Wilson, D. N. (2019). Prostaglandins and Kidney Function : A Comparison Between the Cortical and Inner Medullary Collecting Duct on Prostaglandin Production PROSTAGLANDINS AND KIDNEY FUNCTION : A COMPARISON BETWEEN THE CORTICAL AND INNER MEDULLARY COLLECT. University of Nebraska Medical Center.

Yilmaz, S., Kaya, E., Karaca, A., & Karatas, O. (2018). Aflatoxin B 1 induced renal and cardiac damage in rats: Protective effect of lycopene. Research in Veterinary Science, 119, 268–275. https://doi.org/10.1016/J.RVSC.2018.07.007 DOI: https://doi.org/10.1016/j.rvsc.2018.07.007

Zatelli, A., Pierantozzi, M., D’Ippolito, P., Bigliati, M., & Zini, E. (2012). Effect of dietary supplements in reducing probability of death for uremic crises in dogs affected by chronic kidney disease (Masked RCCT). The Scientific World Journal, 2012. https://doi.org/10.1100/2012/219082 DOI: https://doi.org/10.1100/2012/219082

Zatelli, A., Roura, X., D’Ippolito, P., Berlanda, M., & Zini, E. (2016). The effect of renal diet in association with enalapril or benazepril on proteinuria in dogs with proteinuric chronic kidney disease. Open Veterinary Journal, 6(2), 121–127. https://doi.org/10.4314/ovj.v6i2.8 DOI: https://doi.org/10.4314/ovj.v6i2.8

Zatelli, A., D'Ippolito, P., Roura, X., &Zini, E. (2017). Short-term effects of dietary supplementation with amino acids in dogs with proteinuric chronic kidney disease. The Canadian veterinary journal = La revue veterinairecanadienne, 58(12), 1287–1293.