Enfermedad renal

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Clinical epidemiology of kidney diseases in the cat

Thierry Francey, DVM, Dipl. ACVIM
Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Berne, Switzerland
Thierry Francey graduated from the University of Berne, Switzerland in 1988 and undertook aResidency in Small Animal Internal Medicine in a joint program between the University of Berne and the Louisiana State University. Between 2000 and 2005, he was a Fellow in Renal Medicine and Hemodialysis and a Lecturer in Internal Medicine at the University of California, Davis. Since 2005 he has been an Assistant Professor of Internal Medicine at the University of Berne, with his main interestin nephrology and renal replacement therapies.

Ariane Schweighauser, DVM
Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Berne, Switzerland
Ariane Schweighauser graduated from the University of Berne, Switzerland in 1997. She performed an Internship (2001-2002) and a Residency in Small Animal Internal Medicine (2002-2005) at the sameinstitution and in collaboration with the Louisiana State University. Since 2005 she has been a Clinical Instructor and in 2007 she also started a Clinical Fellowship in the Small Animal Nephrology and Hemodialysis Program of the University of Berne.

KEY POINTS
± Renal diseases are common in cats and they include acute kidney injuries (AKI), chronic kidney diseases (CKD) and hybrid forms ±Acute kidney injuries often result from bacterial infections (pyelonephritis), but also from toxicoses, ischemic damage or neoplastic infiltration ± Awareness of newer causes of renal diseases is essential for early recognition and selection of appropriate diagnostic tests ± Ureteral obstruction can lead to the emerging “big kidney – little kidney” syndrome with an acute uremic manifestation ± Somecommonly used therapeutics (e.g. ACEI, NSAID) have a significant nephrotoxic potential and their use must be monitored accordingly

Introduction
Kidney diseases are very common in cats and for this reason, they sometimes tend to be considered as almost normal in older felines. However, cats can suffer from a wide spectrum of renal injuries (Table 1), some of them acute and potentiallyreversible if treated appropriately; others are chronic and may need specific management for optimal outcome. It is therefore essential for the veterinarian to know the major renal diseases encountered in the cat, including some of the newer high-profile ones.

Chronic kidney disease
Chronic kidney disease (CKD) is a diagnosis cat owners all over the world are confronted with every day. Its prevalencehas been estimated to range between 1.6 (1) and 20% (2) in this species.

2 / / Veterinary Focus / / Vol 18 No 2 / / 2008

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Table 1. Differential diagnoses for renal diseases in the cat
Chronic kidney disease (CKD) Common Idiopathic chronic interstitial nephritis, polycystic kidney disease Less commonAmyloidosis, glomerulonephritis, slow-growing tumors

Acute kidney injury (AKI) Common Pyelonephritis Less common Infections (FIP), nephrotoxicoses (lillies, ethylene glycol, NSAIDS, aminoglycosides, melamine/ cyanuric acid), ischemia (systemic hypotension, severe systemic disease), neoplasia (renal lymphoma and other rapidly growing tumors)

Acute on chronic kidney disease Common Pyelonephritisdue to ascending infection in CKD, “big kidney little kidney syndrome” (ureteral obstruction), anti-thyroid therapy Less common Treatment with ACEI

CKD represents a progressive, irreversible loss of kidney function with subsequent terminal renal failure. Even though the clinical picture of uremia is fairly uniform in cats, many different inciting causes of CKD must be considered. The most...