Acierno MJ, Senior DF Urinary Disorders. In: Schaer M London: Manson; 2011

Al-Bard W, Martin KJ Vitamin D and Kidney Disease. Clinical Journal of the American Society of Nephrology. 2008; 3:(5)1555-60

Barber P Diagnosis and management of chronic renal failure in the cat. In Practice. 2003; 25:(6)306-13

Bartges JW Chronic kidney disease in dogs and cats. Vet Clin North Am Small Anim Pract. 2012; 42:(4)669-92

Breton A Pathophysiology and treatment of kidney disease in cats. The Veterinary Nurse. 2013; 3:(10)600-7

Brown SA Management of chronic kidney disease.Gloucester: BSAVA; 2007

Caney SMA Long-term care of cats with renal disease. Veterinary Nursing Journal. 2010; 25:(9)39-41

Cherry H Assessing pain and emotional wellbeing in feline patients with chronic kidney disease’. The Veterinary Nurse. 2014; 5:(7)390-6

Chew DJ, DiBartola SP, Schenck PA Canine and Feline Nephrology and Urology.Ohio: Elsevier; 2011

Forster-Van Hijfte M Feline hypertension: pathophysiology, clinical signs and treatment options. In Practice. 2002; 24:590-4

International Renal Interest Society. 2016. (accessed 13th November, 2017)

Korman RM, White JD Feline CKD – Current therapies – what is achievable?. J Feline Med Surg. 2013; 15:(1)29-44

Lewis R Understanding Chronic Kidney Disease a guide for the nonspecialist.Cumbria: M&K Publishing; 2012

Maltman M Disorders of calcium and the parathyroid glands. Veterinary Nursing Journal. 2011; 26:(7)229-32

Mardell E Evaluation, significance and treatment of feline proteinuria. In Practice. 2009; 31:512-16

Mayer-Roenne B, Goldstein RE, Erb HN Urinary tract infections in cats with hyperthyroidism, diabetes mellitus and chronic kidney disease. J Feline Med Surg. 2007; 9:(2)124-32

Polzin DJ Chronic Kidney Disease in Small Animals. Vet Clin North Am Small Anim Pract. 2011; 41:(1)15-30

Plantinga EA, Everts H, Kastelein AMC, Beynen AC Retrospective study of the survival of cats with acquired chronic renal insufficiency offered different commercial diets. Vet Rec. 2005; 157:185-7

Ross SJ, Osborne CA, Kirk CA, Lowry SR, Koehler LA, Polzin DJ Clinical evaluation of dietary modification for treatment of spontaneous chronic kidney disease in cats. J Am Vet Med Assoc. 2006; 229:(6)949-57

Somvanshi S, Khan NZ, Ahmed M Anemia in chronic kidney disease patients. Clinical Queries: Nephrology. 2012; 1:(3)198-204

Feline kidney disease: its symptoms and management’. 2009. (accessed 15th December, 2014)

Practical tips for managing the feline renal disease patient. 2010. (accessed 15th December, 2014)

Chronic kidney disease. 2012. (accessed 9th October, 2014)

Pathophysiology of chronic kidney disease and the nursing care of cats

02 November 2017
9 mins read
Volume 8 · Issue 9


Chronic kidney disease due to a progressive loss of kidney function is a condition regularly seen in the veterinary hospital with signs not only being polyuria and polydipsia, but anorexia, mucosal ulcers and dehydration. Understanding the pathophysiology of chronic kidney disease allows nursing care to be tailored not only for the condition, but to the individual patient encouraging a holistic approach and quality client care.

Kidneys play an important role in maintaining homeostasis (Lewis, 2012) being involved in the regulation of blood volume, pH, osmolarity, blood pressure and release of hormones (Breton, 2013). When kidneys start to fail this can lead to chronic kidney disease (CKD) where the kidneys irreversibly deteriorate (Somvanshi et al, 2012). CKD is a progressive loss of renal function due to nephron damage; these are the functional units of the kidneys where many homeostatic processes occur (Bartges, 2012). Signs of CKD include polyuria, polydipsia, vomiting and diarrhoea, anorexia and weight loss, dehydration, mucosal ulcers and uraemic breath.

One symptom of CKD is a rise in levels of blood urea nitrogen (BUN; normal reference range 17–29 mg/dl) (Brown, 2007) and creatinine (azotaemia being identified once the blood creatinine concentration >1.6 mg/dl) (Brown, 2007; Polzin, 2011). In healthy patients, urea is excreted in the urine but once kidneys begin to fail they are unable to remove the urea resulting in raised levels of BUN. Creatinine should be constantly filtered out through the kidneys but again when the kidneys begin to fail these levels also rise. These complications may show as typical gastrointestinal signs such as nausea, vomiting and diarrhoea (occasionally haemorrhagic) due to an increase in gastric acid where gastrin is not being metabolised within the kidneys as it once was. Mouth ulcers and a distinctive smell of ammonia on the breath occur due to nitrogenous waste such as ammonia and urea accumulating in the blood from the breakdown of proteins. Anorexia and subsequent weight loss and dehydration may then also be seen due to the build up of toxins in the blood combined with irritation and ulceration of the gastrointestinal tract making the patient feel unwell and painful (Acierno and Senior, 2011).

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