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International Renal Interest Society: Feline Guidelines & Emerging Themes

The mission of Dr. Rosie DVM is to enhance the capabilities of pet owners and veterinary practitioners in diagnosing, understanding, and treating renal disease in cats and dogs.

One of our main goals is to educate individuals on IRIS recognized guidelines for diagnosing and treating renal disease in small animals. IRIS is the International Renal Interest Society.

Kidney disease can be sudden onset (Acute Kidney Injury or AKI) or it can be chronic (Chronic Kidney Disease or CKD). Additionally, we explain guidelines for managing CKD cases and Treatment Recommendations.

Furthermore, IRIS have recently added guidelines for Grading Acute Kidney Injury (AKI), and the results of the IRIS Canine Proteinuria Consensus Project are now available online. Both the AKI Grading system and the CKD Staging and Treatment guidelines are continually evolving works that will be revised and updated as new information becomes available.

These guidelines undergo regular review and updates by the IRIS Board, and the most recent versions can be found on our Dr. Rosie DVM website.

IRIS Staging of CKD

As the leader in veterinary nephrology, IRIS is committed to providing practicing veterinarians with evidence-based guidance for diagnosing, treating, and managing kidney disease. This commitment includes offering valuable insights into interpreting diagnostic information effectively.

The inclusion of SDMA values in the IRIS CKD Staging Guidelines represents a significant advancement in not only the early diagnosis of CKD but also the customization of CKD treatment for individual patients. The IRIS Board recommends using both serum creatinine and SDMA to improve our ability to assess renal excretory function, as these two surrogate markers complement each other.

Furthermore, the IRIS Board has recently revised the staging criteria, expanding Stage 2 for dogs while reducing the size of Stage 3. This adjustment aims to reduce the significant variability in clinical signs and treatment needs observed in dogs previously categorized under the larger IRIS Stage 3 classification.

Staging chronic kidney disease (CKD) is essential for determining appropriate treatment and monitoring strategies. Initially, staging is based on fasting blood creatinine levels, evaluated on at least two occasions in a stable patient. Subsequent sub-staging involves assessing proteinuria and systemic blood pressure.

These staging categories allow for the formulation of empirical treatment recommendations and predictions regarding the likely response to treatment based on clinical experience.

IRIS Staging of CKD (Updated 2023)

IRIS Treatment Recommendations for CKD

Individualized treatment is crucial for managing chronic kidney disease (CKD). The recommendations provided serve as valuable starting points for most animals at each stage of the disease. Regular monitoring of these patients is essential, and treatment should be adjusted based on their response.

It's important to note that some suggested treatments are not approved for use in dogs and/or cats, and the recommended dosage rates are therefore based on experience rather than official authorization. Veterinarians must conduct a risk-benefit assessment for each patient before administering any treatment.

IRIS Treatment Recommendations - Dogs (Updated 2023)
IRIS Treatment Recommendations - Cats (Updated 2023)

IRIS Grading of Acute Kidney Injury (AKI)

Acute kidney injury (AKI) encompasses a spectrum of renal damage, ranging from mild, clinically undetectable nephron loss to severe acute renal failure. IRIS recommends grading AKI to accurately assess the disorder's severity, emphasizing its continuum nature. The IRIS AKI Grading scale (I-V) for dogs and cats relies on fasting blood creatinine levels and clinical parameters, including urinary flow rate.

This grading system was developed under the leadership of Dr. Larry Cowgill of the IRIS Board and was provisionally adopted in 2012, with final adoption in 2013. The IRIS Board is currently seeking feedback and suggestions for modifications from the American and European Societies of Veterinary Nephrology and Urology (ASVNU and ESVNU) as well as the broader veterinary community.

The IRIS AKI Grading scheme aims to assist in establishing appropriate prognoses for AKI patients. Future plans include expanding these guidelines to encompass recommendations for diagnostic testing, treatment, and monitoring of AKI, aligning with the widely accepted IRIS guidelines for Staging and Treatment of Chronic Kidney Disease (CKD).

IRIS Guideline Recommendations for Grading of AKI in Dogs & Cats

Treatment of Canine Proteinuric Kidney Disease

IRIS Consensus Recommendations for the Treatment of Canine Proteinuric Kidney Disease:
During its 2011 meeting in Denver, the IRIS Board sanctioned the establishment of a study group tasked with creating a consensus report titled "Best Clinical Practices for Proteinuric Kidney Disease in Dogs." Dr. David Polzin and Dr. Larry Cowgill, both Board members, were appointed as co-Chairs of this group. The primary goal of this initiative was to utilize existing evidence and group consensus to formulate a set of practical recommendations for the diagnosis and management of these patients.

To address the diverse range of patient presentations and geographic variations, the study group developed focused topics covering the following areas:

  1. Diagnostic Investigation of Dogs with Suspected Glomerular Disease
  2. Standard Therapy for Dogs with Suspected Glomerular Disease
  3. Immunosuppressive Treatment for Dogs with Glomerular Disease Based on Established Pathology
  4. Immunosuppressive Treatment for Dogs with Proteinuric Kidney Diseases in the Absence of Histopathologic Diagnosis
  5. Immunosuppressive Treatment for Dogs with Suspected Glomerular Disease and Serologic Evidence of a Possible Causative Agent

Additional information regarding this project can be found in the IRIS Newsletter. The outcomes of this work have been published as a supplement to the Journal of Veterinary Internal Medicine and are accessible online. The Board anticipates that this project will serve as a template for the development of future recommendations in nephrology and other fields within veterinary medicine. The production of this report, along with its publication as a journal supplement, was generously supported by Novartis Animal Health, now a part of Elanco Animal Health, a division of Eli Lilly and Company.

Journal of Veterinary Internal Medicine

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