Barrett D, Wilson B, Woollands A. Care Planning: A Guide for Nurses, 2nd ed. London: Taylor and Francis; 2012

Burnier M, Brunner HR. Angiotensin II receptor antagonists. Lancet.. 2000; 355:(9204)637-645

Elliott J, Rawlings JM, Markwell PJ, Barber PJ. Survival of cats with naturally occurring chronic renal failure: effect of dietary management. J Small Anim Pract.. 2000; 41:(6)235-242

Freeman L, Becvarova I, Cave N WSAVA Nutritional Assessment Guidelines. J Small Anim Pract.. 2011; 52:(7)385-396

Hall JA, Yerramilli M, Obare E, Jewell DE. Comparison of serum concentrations of symmetric dimethylarginine and creatinine as kidney function biomarkers in cats with chronic kidney disease. J Vet Intern Med.. 2014; 28:(6)1676-83

Hall JA, MacLeay J, Yerramilli M, Obare E, Schiefelbein H. Positive impact of nutritional interventions on serum symmetric dimethylarginine and creatinine concentrations in client-owned geriatric cats. PLOS ONE.. 2016; 11:(4)

International Renal Interest Society (IRIS). Diagnosing, Staging and Treating Chronic Renal Disease in Dogs and Cats. IRIS Pocket Guide to CKD. 2019.] (accessed 28 January 2020)

Lane IF. Nutritional management of urinary tract conditions, 6th Edition. In: Ettinger SJ, Feldman EC (eds). : Saunders Elsevier; 2005

Nelson D, Welsh P. Using the ability model to design and implement a patient care plan. The Veterinary Nurse.. 2015; 6:(3)141-149

Norman B. An Ounce of Prevention: Best Practice Bundles. Medico-surgical Matters.. 2010; 19:8-9

Orpet H, Jeffery A. Implementing the Ability Model November 2010 ed. 2007. [Graduate Diploma in Professional and Clinical Veterinary Nursing course notes].London: The Royal Veterinary College;

Orpet H, Welsh P. Handbook of Veterinary Nursing, 2nd ed. Oxford: Wiley-Blackwell; 2011

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:(7)185-187

Renal patients: IRIS scores, nursing care plans and care bundles

02 December 2020
9 mins read
Volume 11 · Issue 10
Box 1.


The role of a consulting nurse in chronic medical cases is very important in helping with compliance, client education and ultimately welfare and quality of life. In patients with chronic renal failure the use of the International Renal Interest Society (IRIS) score enables all veterinary professionals to be able to implement any guidelines or protocols (care bundles) in order to benefit the health of the animal and to have these incorporated into long-term care plans.

Clinical symptoms of renal dysfunction (polydipsia, polyuria) are not evident until a large portion of renal tissue has been destroyed, until then many cases can remain undiagnosed. 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 and water-soluble vitamins. Other clinical symptoms also include systemic hypertension, secondary hyperparathyroidism and non-regenerative anaemia (Lane, 2005), these aspects should therefore be monitored as part of the nursing clinic.

Most veterinary practices offer owners renal screening for older patients, as part of senior clinics, pre-anaesthetic screening or before the start of pharmaceutical regimens (such as osteoarthritis treatments).

Early identification of these CRF cases is required in order to establish management of the different stages of CRF. Guidelines set out by The International Renal Interest Society (IRIS) help to establish the types of management that are required at the different disease stages. These guidelines can be utilised as part of care bundles to formulate a nursing care plan (NCP) (Box 1).

Register now to continue reading

Thank you for visiting The Veterinary Nurse and reading some of our peer-reviewed content for veterinary professionals. To continue reading this article, please register today.