Pathophysiological consequences of chronic renal failure in an adult cat

Condition
Dehydration (and hypovolaemia) Anasarca ( and hypervolaemia) Hypokalaemia Cardiotoxicity & cardiomyopathies

Causation
Impaired regulation of fluid volume Sodium and water retention, hypoalbuminaemia, vascular injury Impaired regulation of electrolyte balance Impaired regulation of electrolyte balance and uraemic toxicity, hypertension Impaired regulation of electrolyte balance Impaired regulation of electrolyte balance (calcium and phosphate) leading to activation of parathyroid hormones. Decreased ability to generate ammonium ions, increased retention of hydrogen ions and excessive loss of bicarbonate ions. Decreased EPO synthesis, uraemic toxicity, erythrocyte fragility, haemorrhage Failure of chemotaxis by leukocytes and cell-mediated response Glomerular fibrosis & increased vascular resistance, decreased production of renal vasodilators, sodium and water retention, decreased cleareance of aldosterone

Clinical signs
Skin tenting, dry mucous membranes, lethargy, thirst Generalised oedema

Laboratory testing indicators

Soft tissue mineralisation Osteoporosis/ osteodystophia fibrosa

Increased PCV, hyperalbuminaemia, hyponatraemia Hypoalbuminaemia, hypernatraemia, low total protein. Muscle weakness, lethargy, poor quality Hypokalaemia coat Abnormal heart sounds, lethargy, Hyperkalaemia, Hypoalbuminaemia, ascites, coughing/respiration difficulty, hyperuraemia, low total protein. oedema of the pericardial sac Abnormal mineralisation of tissue Abnormal mineralisation of tissue Softening and demineralisation of bone (osteomalacia), rarely in older animals ‘rubber jaw’. Hyperventilation High levels of parathormorne , low levels of Vit D possible.

Metabolic acidosis

Acidosis of the blood.

Anaemia

Jaundice, mucous membrane pallor, lethargy, weakness, anorexia Secondary infection – increased temperature, inflammation. High blood pressure, retinal haemorrhage or detachment and other ocular lesions, capillary bed haemorrhage

Hyperbilirubinaemia, low levels of EPO, hyperuraemia. High WCC and leukocyte counts (or normal if dysfunction is severe). Possible bacteraemia. Reduced PCV (anaemia due to haemorrhage)

Immune system dysfunction

Hypertension

weakness. Vomiting. mental dullness. vomiting. lipaemia Laboured respiration Hyperuraemia Neurological signs e. ulcerative and haemorrhagic gastritis Pancreatic necrosis Terminal pulmonary oedema (and pneumonia) Spongiform myelinopathy Anorexia. increased alveolar permeability due to uraemic toxicity. steatorrhoea. headpressing. stroke (rarely). twitching. Uraemic encephalopathy Weakness. ataxia.Cachexia Vascular lesions Ulcerative stomatitis. haemorrhage. diarrhoea leading to catabolic state Uraemic toxicity Uraemic toxicity leading to production of ammonia by bacteria Uraemic toxicity Immunosuppression. abdominal pain High pancreatic enzymes. agitation. poor body condition Oedema. aggression. foul smelling film in mouth cavity. aspiration of vomit. ascites Possible proteinuria Hyaline degeneration & fibrinoid change visible in histology Hyperuraemia Presence of ulcerative lesions along the GIT. coma. lethargy. malaena. vomition. seizure.g. drowsiness etc Hyperammonaemia .