- IRIS Staging of CKD
- IRIS Treatment Recommendations for CKD
- IRIS Grading of AKI
- IRIS Canine Proteinuria Consensus Project
The IRIS Board made three significant changes to CKD Guidelines during 2014 and 2015. A summary of these new recommendations is presented here. The full version of 2015 Guidelines will be uploaded during our website relaunch by the end of 2015.
Substaging by Arterial Blood Pressure
We recommend replacement of the existing abbreviations for blood pressure substages (AP0-AP1) with descriptive terms as follows:
|Systolic blood pressure |
|Diastolic blood pressure |
|Risk of future target organ |
|150 - 159||95 - 99||Mild||AP1||Borderline hypertension|
|160 - 179||100 - 119||Moderate||AP2||Hypertension|
Treatment of Proteinuria
We recommend that IRIS CKD Stage 1 patients with persistent proteinuria (UPC ≥ 0.5 for dogs or 0.4 for cats) are not only monitored and thoroughly investigated but also receive standard treatment for proteinuria as currently recommended for IRIS CKD Stages 2 to 4. This parallels the IRIS consensus statement on standard treatment for glomerulonephritis (J Vet Intern Med 2013;27:S27–S43).
Interpreting Blood Concentrations of Symmetric Dimethylarginine (SDMA) in CKD
SDMA concentrations in blood (plasma or serum) may be a more sensitive biomarker of renal function than blood creatinine concentrations. A persistent increase in SDMA above 14 µg/dl suggests reduced renal function and may be a reason to consider a dog or cat with creatinine values <1.4 or <1.6 mg/dl, respectively, as IRIS CKD Stage 1.
In IRIS CKD Stage 2 patients with low body condition scores, SDMA ≥25 µg/dl may indicate the degree of renal dysfunction has been underestimated. Consider treatment recommendations listed under IRIS CKD Stage 3 for this patient.
In IRIS CKD Stage 3 patients with low body condition scores, SDMA ≥45 µg/dl may indicate the degree of renal dysfunction has been underestimated. Consider treatment recommendations listed under IRIS CKD Stage 4 for this patient.
These comments are preliminary and based on early data from the use of SDMA in veterinary patients. We expect them to be updated as the veterinary profession gains further experience using SDMA alongside creatinine, the long-established marker in diagnosis and monitoring of canine and feline CKD.
The mission of IRIS is to help veterinary practitioners better diagnose, understand and treat renal disease in cats and dogs.
One of the organization's primary objectives is to establish an internationally recognized set of guidelines on the diagnosis and assessment of renal disease in small animals (IRIS Staging of Chronic Kidney Disease, CKD). In conjunction with these the board has also developed guidelines on the management of cases of CKD (IRIS Treatment Recommendations). Recently we have added guidelines on Grading Acute Kidney Injury (AKI) and the results of the IRIS Canine Proteinuria Consensus Project have been published online. The IRIS AKI Grading system and the IRIS CKD Staging and Treatment guidelines are works in progress that will be amended and updated as further information becomes available.
These guidelines are reviewed and updated by the IRIS Board regularly and you will find the most recent version on the website.