CNYACE In-Person CE Event: Topics in Nephrology/Urology

Topics in Nephrology/Urology:

Approach to AKI: Spot It, Stop It, Support It 

The Age-Old Battle of Nephrology and Cardiology 

Barrier Breach: Why Proteinuria Happens and What to Do 

Presented by: Joanna Finstad, DVM, MS, DACVECC

Approach to AKI: Spot It, Stop It, Support It  

This session offers a practical approach to recognizing, stabilizing, and initiating early treatment for dogs and cats with suspected AKI, including when referral is appropriate. We will review essential renal pathophysiology, outline effective early therapeutic strategies, and take a focused look at leptospirosis-associated AKI—highlighting key diagnostic pitfalls and the treatment decisions that most impact survival. Brief guidance on when renal replacement therapy is indicated will also be included. Attendees leave with an actionable approach to “spotting” AKI early, “stopping” progression with evidence-based therapy, and “supporting” patients through the critical pre-referral period.

Learning Objectives:

1. Define acute kidney injury (AKI) and recognize early clinical and laboratory indicators of renal dysfunction
2. Develop a systematic, stepwise approach to the diagnosis of AKI, including laboratory testing, urinalysis, and imaging
3. Apply a stepwise diagnostic and treatment approach for suspected leptospirosis, including appropriate sample collection, interpretation of antibody and PCR testing, vaccination considerations, and early antimicrobial therapy
4. Implement early interventions to halt ongoing renal injury, including discontinuation of nephrotoxic medications and treatment of underlying causes
5. Formulate initial treatment plans to support renal recovery, including fluid therapy, electrolyte management, and blood pressure control
6. Recognize indications for renal replacement therapy and appropriate timing for referral
7. Communicate prognosis and treatment expectations to pet owners based on severity and clinical progression

The Age-Old Battle of Nephrology and Cardiology

In this session, we will explore the intricate and often conflicting relationship between nephrology and cardiology in critically ill patients. As both the heart and kidneys play pivotal roles in maintaining homeostasis, their dysfunction can lead to complex clinical scenarios. We will discuss current strategies for managing patients with concurrent cardiac and renal disease, focusing on the latest advancements in diagnostics, therapeutic approaches, and case-based insights. Attendees will leave equipped with practical tools to better balance treatments, avoid common pitfalls, and improve outcomes in this delicate and dynamic balancing act.

Learning Objectives:

1. Describe the pathophysiology and classification of cardiorenal syndrome and its clinical relevance in veterinary patients  
2. Explain the concepts of fluid responsiveness and fluid tolerance and how they influence clinical decision-making  
3. Assess volume status in patients with concurrent cardiac and renal disease using practical clinical and diagnostic tools  
4. Develop individualized fluid therapy plans that balance renal perfusion with the risk of fluid overload  
5. Apply strategies to safely manage fluid therapy, diuretics, and adjunctive treatments in complex cardiorenal patients  
6. Communicate prognosis and treatment expectations effectively to pet owner

Barrier Breach: Why Proteinuria Happens and What to Do

Proteinuria is a common clinical finding in small animal practice, but its significance—and the appropriate response—can be challenging to determine. This lecture uses the concept of a “barrier breach” to provide a practical, clinically relevant framework for understanding why proteinuria occurs and how to manage it effectively in everyday practice. 
Participants will begin by reviewing the pathophysiology of proteinuria, with emphasis on differentiating glomerular and tubular disease and understanding how disruption of the glomerular filtration barrier leads to protein loss. The session will then focus on a stepwise approach to identifying underlying causes, including appropriate screening for systemic diseases and guidance on when further diagnostics are warranted. 
Using clear clinical thresholds, attendees will learn when proteinuria requires intervention and how to implement a structured, multimodal treatment strategy. Key topics will include dietary therapy, blood pressure control, antiproteinuric medications and anticoagulants. Treatment goals, monitoring strategies, and preventing common complications will also be addressed.

Learning Objectives:

1. Describe the structure and function of the glomerular filtration barrier and differentiate glomerular from tubular causes of proteinuria
2. Explain the key pathophysiologic mechanisms leading to proteinuria, including glomerular barrier disruption and tubular dysfunction
3. Develop a practical, stepwise approach to identifying underlying causes of proteinuria, including appropriate screening for infectious, inflammatory, endocrine, and neoplastic diseases
4. Differentiate clinically insignificant from clinically relevant proteinuria using urine protein:creatinine (UPC) thresholds
5. Formulate a structured, multimodal treatment plan, including management of underlying disease, dietary therapy, blood pressure control, and anti-proteinuric therapy