Chronic kidney disease (CKD) is diagnosed based on evaluation of all available clinical and diagnostic information in a stable patient. The IRIS Board continues to recommend using creatinine, a widely available and well understood test, to diagnose and stage CKD. Symmetric dimethylarginine (SDMA), a new marker of kidney function, may be a useful adjunct for both diagnosis and staging of CKD.

Clinical presentation

Consider age, sex, breed predispositions, and relevant historical information, including medication history, toxin exposure, and diet.

Can be asymptomatic in early CKD. Signs may include polyuria, polydipsia, weight loss, decreased appetite, lethargy, dehydration, vomiting, and bad breath.

Physical examination findings

Can be normal in early CKD. Findings may include palpable kidney abnormalities, evidence of weight loss, dehydration, pale mucous membranes, uremic ulcers, evidence of hypertension, i.e., retinal hemorrhages/detachment.

Clinical signs and physical examination findings worsen with increasing severity of kidney disease

Diagnostic findings:

One or more
of the following findings
of the following findings
Investigate for and treat underlying disease

Treat hypertension if systolic blood pressure persistently >160 or evidence of end-organ damage

Treat persistent proteinuria (UPC >0.5) with kidney therapeutic diet and medication
Keep phosphorus <4.6 mg/dL
If required, use kidney diet +/– phosphate binder

Use with caution potentially nephrotoxic drugs

Correct prerenal and postrenal abnormalities

Fresh water available at all times
Same as Stage 1

Kidney therapeutic diet

Treat metabolic acidosis

If SDMA ≥ 25, consider treatment for Stage 3
Same as Stage 2

Keep phosphorus <5.0 mg/dL

Treat anemia if PCV <25%

Treat vomiting/appetite/ nausea

Consider subcutaneous and/or enteral fluids to
maintain hydration

Consider calcitriol therapy

If SDMA ≥45, consider treatment for Stage 4

Same as Stage 3

Keep phosphorus <6.0 mg/dL

Consider feeding tube for nutritional and hydration support and for ease of medicating

Learn more about IDEXX SDMA