AKI + CKD Flashcards
what are the systemic illness that can cause AIN
SLE, sarcoid, sjogren, IgG4
how to ensure euvolemia in contrast induced nephropathy ?
(3 ml/hg/hr 1 hour before procedure, 1ml/kg/hr 6 hours after procedure for
CKD
c3/c4 - high or low with cholesterol emboli syndrome/atheroembolic disease ? other cutaenous presentation
c3c4 low
livedo reticularis and blue toes
if have calcium oxalate stones, should you limit calcium ntake ?
no
uric acidd nephrolithiasis seen when ?
heme disorders
ADPKD
treatment of uric acid
urine alkalization ( give K citrate)
allopurinol
struvite stones seen with ?
- uti ( proteus, klebsiella)
etiology cystine stone and tx ?
congenital ( autosomal recessive) urine alklaization
continue rasi even if gfr <30?
yes
what if hyperK on rasi, what to do ?
give K binders
SGLT2 recommendations in CKD
- egfr > 20
- ACR > 20 mg/mmol and or CHF/DM
benefits of SGLT2i in CKD ?
Prevent composite of decline in eGFR, progression to ESRD, kidney death, all cause mortality, nonfatal MI, hosp for HF
if still have proteinuria , what can you add to ckd patients
NS MRA ( fineronone)
if still have proteinuria , what can you add to ckd patients with CHF, Conn’s , refractory htn, what can you add ?
steroidal MRA ( aldosterone, eplerenone)
benefits of finerenone in CKD ?
- decrease progession CKD
- decrease CV and renal death
- Decrease afib ( CKD w/ T2DM)
benefits of spironolactone on CHF ?
↓↓↓
Less mortality any cause w HFrEF (RALES)
↓ HF hospitalization w HFpEF (TOPCAT)
benefit of eplrenone in CKD ? benefit in egfr
- decrease ACR and BP . other risk of high k
- no benefit egfr
effect of eplerenone on CHF ?
↓↓↓
Less cardiac mortality and hospitalization w HFrEF (EMPHASIS-HF)
per finearts study , impact of finerenone
↓↓↓
HF hospitalization w HFpEF, non sig trend to ↓ mortality
PTH target for dialysis patients ?
2-9 times ULN
hgb target and tsat target in CKD
100-110
tsat >30%
target hgb on ESA ? if more what ahppens ?
115
stroke-CAD-HTN
who to be cautious with regarding EPO
- previous stroke
- active cancer
- Uncontrolled BP
example of meds to avoid in hyperK ( not Kdur ..)
nsaids
when do start bicarb in CKD ?
when metab acidosis with bicarb < 18
can you use vit D if hyperphosphatemic and hypocalcemic
no
reasonbs to have hypocalcemia in ckd
- hyperpo4 –> hypocal
- low 1-alpha-hydroxylase –> low vit d –> low calcium absp
tx for high PTH in CKD pts
- Vit D to suppress pth if not hypercacelmic , high phosphate
- Cinecalcet to activate Ca sensing receptor to shut OFF pth secretion
- surgical in some cases
risk of what with biphosphonates or denosumab in CKD patients
severe hypocalcemia
for symptomatic gout, what to use
- low dose colchicine / steroids
what are non urgent/outpatient initiation of dialysis
- uremic : nauseous, fatigue, metallic tastE
- QOL
uremic pericarditis - does it show with classic ddiffuse ST elevation ?
- no
at what egfr do you initiate metformin at half dose
gfr 30-44
lowest gfr for mtf in ckd
30
flow trial states what
kidney protection of glp1 ( with MACE ) w/ liraglutide and semaglutide
max creat rise whgen starting acei/arb for dm2 + ckd + albumineria. if above that threshold, think what ?
30%
volume depletion
nsaids
AKI
RAS
inidication for finerenone in context of dm + ckd
ForDM2,gfr>25ml/min,
normal K
albuminuria>3mg/mmol
despite max RASi (ACEi or ARB)
in dm + ckd, if had to pick between sglt2 and finerone, would pick which ?
SGLT2i better at reducing HHF and progression of CKD
over nephropathy
- urine ACR and 24H urine
- > 20mg/mmol and 24H >300 mg/day
Overflow- overwhelmed resorption capacity of filtered protein ( <3.5)
MM
rhabdo
hemolysis
Glomerular- increased filtration of protein ( nephrotic range)
t2dm
SLE
Amyloid
IgA
primary cause
Tubulo-interstitial- impaired resorption of filtered protein ( <2g )
Sarcoid
Sjogren
heavy metals
Nsaids ( and AIN causing meds)
Post-renal proteinuria <1g/day
Stones
Genitourinary tumours
UTIs
tamm horsfal , what does it mean ?
it’s normal
hyalin cast seen in ?
ckd
wbc cast seen n
ain
infection
rbc cast seen in
GN
granular cast seen in
ATN
best to see kidney stone ?
nobn contrast ct
bosniak 1-2 , need f/u ?
no
renal mass size worried to be cancer? imaging ?
> 1 cm. ct/mri
if infected cysts, how long duration of atb ?
4 weeks !
most common cardiac abN in ADPKD?
mitral valve prolapse
Aortic insufficiency
extra renal manifestations ADPKD
- cebral aneurysm
- pancreatic cyst
- liver cysts
- diverticuli
number of cysts to dx ?
15-39 : >3cysts/ kidney
40-59 : >2 cysts /kidney
adpkd bp target ?
<110/75
