Nurse-led renal clinics

In all animals, clinical symptoms of renal dysfunction are not evident until 65 to 75% of renal tissue has been destroyed (Lister and Rand, 2006), and many veterinary practices instigate renal screening for older patients as part of senior clinics and prior to the start of pharmaceutical regimens (normally osteoarthritis treatments). Nutritional management can affect many consequences of renal failure, and is the cornerstone of its management. Chronic renal failure (CRF) has many physiological effects, these include the decreased ability to excrete nitrogenous waste (and thus build up of azotaemia), sodium and phosphorus, and an increased loss of potassium. Other clinical symptoms may include systemic hypertension, secondary hyperparathyroidism and non-regenerative anaemia (Lane, 2005), and therefore these aspects should be monitored as part of the nursing clinic.

Attendance at nurse clinics for animals that have been newly diagnosed or with suspected renal disease should be instigated as soon as possible (Box 1). All patients should be referred to a veterinary nurse with appropriate knowledge, in order to discuss diet, medications (if required), compliance (McLeod, 2008) and any future requirements for diagnostics and reviews of the patient. The nurse is well placed to answer any questions that the owner may have. This is a role that should be performed by a veterinary nurse for a number of reasons: