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IPT: Renal > Block 3 > Flashcards

Block 3 Flashcards

1
Q

What are the vascular access types for hemodialysis?

A
  1. Fistula
  2. Graft
  3. Catheter
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2
Q

Which vascular access types of hemodialysis is preferred?

A

Fistula

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3
Q

Which vascular access types of hemodialysis is placed 6 months before dialysis?

A

Fistula

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4
Q

Which vascular access types of hemodialysis is placed about 3 months before dialysis?

A

Graft

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5
Q

Which vascular access types of hemodialysis does not require maturation?

A

Graft

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6
Q

Which vascular access types of hemodialysis does require maturation?

A

Fistula

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7
Q

Which vascular access types of hemodialysis is last line due to increased mortality and infection?

A

Catheter

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8
Q

Which vascular access types of hemodialysis is placed if emergency exists?

A

Catheter

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9
Q

A arteriovenous fistula consist of which artery/vein?

A

Radial artery + neighboring vein (usually cephalic)

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10
Q

When is an arteriovenous graft typically used?

A

If vein is small for a fistula or there is a blocked vein

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11
Q

An arteriovenous graft is placed where?

A

Between artery and vein w/ non-native vessel or artificial material

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12
Q

Where is a central venous catheter placed?

A

Usually in the internal jugular vein

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13
Q

Hemodialysis vs Peritoneal dialysis, which has more strict diet?

A

Hemodialysis

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14
Q

What kind of diet exists for hemodialysis?

A

Limit fluids, salt, potassium, phosphate

Increase protein

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15
Q

Advantage and Disadvantage of high flux hemodialysis

A

+ = large pores allow high clearance of middle-molecular weight molecules

  • = requireds ultrafiltration system
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16
Q

Advantage and Disadvantage of high efficiency hemodialysis

A

+ = better clearance of small solutes and better electrolyte control

  • = vascular access damage and hemodynamic instability
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17
Q

What are the main types of peritoneal dialysis?

A
  1. Automated PD

2. Continuous ambulatory PD

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18
Q

What is the “best” type of peritoneal dialysis?

A

NIPD; overnight exchanges and dry during daytime

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19
Q

What is the “worst” type of peritoneal dialysis?

A

CAPD; no machine needed, all physical exchange

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20
Q

When should you initiate dialysis?

A
  1. Serositis
  2. Acid-base disturbance
  3. Pruritis
  4. Uncontrolled volume or BP
  5. Malnutrition unresponsive to dietary interventions
  6. Cognitive impairment
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21
Q

When should you NOT initiate dialysis?

A

Dont base it off of GFR nor SCr!!!!

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22
Q

What does diffusion remove in dialysis?

A

Small solutes (uses concentration gradient)

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23
Q

What does convection remove in dialysis?

A

Excess body fluid + medium-sized solutes

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24
Q

What does ultrafiltration remove in dialysis?

A

Body fluid (uses hydrostatic/osmotic pressure)

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25
Q

What is an adequate urea reduction ratio goal?

A

≥ 65%

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26
Q

What is the equation of urea reduction ratio?

A

(U pre - U post) / U pre x 100

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27
Q

How often is urea reduction ratio calculated in dialysis patients?

A

Once per month

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28
Q

When assessing Kt/V in dialysis, what is the goal?

A

≥ 1.2 per treatment

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29
Q

What makes up Kt/V in dialysis dosing?

A 
K = dialyzer clearance
t = dialysis duration (min)
V = volume of water in body

V male = 50% TBW
V female = 60% TBW

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30
Q

Which is more accurate, URR or Kt/V in dialysis dosing and why?

A

Kt/V because it considers fluid removal

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31
Q

What are the indications for CRRT?

A
  1. AKI + life-threatening change in fluid, electrolyte, and acid-base balance
  2. Hemodynamic instability
  3. Acute brain injury or increased ICP or brain edema

AEIOU rule

Acidosis
Electrolyte disturbances
Intoxication
Overload
Uremia
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32
Q

KDIGO guidelines on CRRT access

A

Uncuffed non-tunneled dialysis catheter

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33
Q

What does slow continuous ultrafiltration CRRT remove?

A

Fluids only

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34
Q

What is the rate of a slow continuous ultrafiltration CRRT?

A

500mL/hr

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35
Q

Who would be eligible for slow continuous ultrafiltration CRRT?

A

Volume overload WITHOUT electrolyte or acid/base abnormalities or uremia

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36
Q

What does a continuous venovenous hemofiltration CRRT remove?

A

Larger solutes and fluid volume

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37
Q

While slow continuous ultrafiltration CRRT is done via ultrafiltration, how does continuous venovenous hemofiltration CRRT work?

A

Ultrafiltration + convection

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38
Q

Who would be eligible for continuous venovenous hemofiltration CRRT?

A

Moderate electrolyte imbalances or uremia

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39
Q

What does continuous venovenous hemodialysis CRRT remove?

A

Small to medium-sized solute, some fluid by diffusion

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40
Q

How does a continuous venovenous hemodialysis CRRT work?

A

Diffusion

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41
Q

Who would need a continuous venovenous hemodialysis CRRT?

A

Electrolyte abnormalities, uremia, azotemia, acidosis volume overload

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42
Q

How does a continuous venovenous hemodiafiltration CRRT work?

A

Diffusion + convection

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43
Q

What does a continuous venovenous hemodiafiltration CRRT remove?

A

Small-large sized solutes + fluid

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44
Q

Who would be eligible for a continuous venovenous hemodiafiltration CRRT?

A

Electrolyte abnormalities, fluid overload or SEVERE azotemia

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45
Q

What are some complications of CRRT?

A

Circuit clotting, hypotension, and medication clearance

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46
Q

What is the 1st line anticoagulant therapy for patients without increased bleeding risk on CRRT?

A

Regional citrate anticoagulation

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47
Q

When should argatroban be used for CRRT?

A

Heparin-induced thrombocytopenia

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48
Q

What is the 2nd line anticoagulant therapy for patients without increased bleeding risk on CRRT?

A

Unfractionated heparin or low molecular weight heparin

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49
Q

What should/shouldn’t you use for patients with increased bleeding risk or impaired coagulation on CRRT?

A

Use = regional citrate anticoagulation

Do NOT use = Unfractionated heparin or low molecular weight heparin

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50
Q

MOA of regional citrate anticoagulation?

A

Binds w/ ionized calcium forming a complex that reduces number of ionized calcium available to clot blood

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51
Q

When should you worry about giving regional citrate anticoagulation?

A

Patients on calcium-containing dialysis solution (can clot circuit)

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52
Q

AE of regional citrate anticoagulation?

A

Metabolic alkalosis, hypocalcemia, hypomagnesemia

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53
Q

MOA of heparin?

A

Inhibits factor Xa and Ila

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54
Q

What is argatroban indicated for?

A

Heparin induced thrombocytopenia AND pt who does not have an increased bleeding risk

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55
Q

What are some advantages of CRRT?

A
  • Safer in hemodynamically unstable pt
  • provides nutritional support
  • increased renal recovery
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56
Q

What are some disadvantages of CRRT?

A
  • Hypothermia

- need continuous anticoagulation

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57
Q

What are some complications of hemodialysis?

A

Infection, intradialytic hypotension, muscle cramps, and thrombosis

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58
Q

How do you prevent infection on catheters?

A
  1. Antiseptic wash
  2. Mupirocin 2% or topical triple ointment
  3. Caregivers wear mask, limit catheter manipulation
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59
Q

If infection occurs in AV fistulas, how long should you treat it for?

A

6 weeks

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60
Q

If infection occurs in grafts, how long should you treat it for?

A

2 to 4 weeks

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61
Q

When should you remove a catheter in hemodialysis?

A

S. aureus
Pseudomonas
Candida

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62
Q

Which AB treats MRSA for hemodialysis infections?

A

Vanco

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63
Q

To treat with empric therapy for hemodialysis infections, what must you give?

A

Cover both gram + and -

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64
Q

Which AB treats Pseudomonas or G- bugs for hemodialysis infections?

A

Aminoglycosides, Zosyn, 3rd or 4th gen cephalosporin, carbapenem

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65
Q

Intradialytic hypotension exists below what range?

A

BP <90/60

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66
Q

What are some causes of intradialytic hypotension?

A

Excessive ultrafiltration, antihypertensives before dialysis, rise in body temp and maybe serotonin surge

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67
Q

Repeated intradialytic hypotension can cause what?

A

Nephron ischemia

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68
Q

When should you take antihypertensives if youre on dialysis?

A

After dialysis, can cause hypotension if taken before

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69
Q

What are some common medications to manage intradialytic hypotension?

A

MIDODRINE
Sertraline
Levocarnitine
Fludricortisone

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70
Q

What is the first line Tx for managing intradialytic hypotension?

A

Midodrine

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71
Q

What is the typical dose of Midodrine?

A

2.5 to 10mg PO before dialysis OR 5mg 3 times / week on non-dialysis days

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72
Q

What kind of class does Midodrine belong to?

A

Selective alpha 1 agonist

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73
Q

What are some immediate Tx plans for managing intradialytic hypotension?

A
  1. Trendelenburg position
  2. 100cc of NS or hypertonic solution
  3. Decrease ultrafiltration rate
  4. Lower dialysate temperature
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74
Q

What causes muscle cramps?

A
  1. Hypoperfusion due to excessive ultrafiltration

2. Hypotension

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75
Q

How can you prevent muscle cramps?

A
  1. Vit. E 400U nightly
  2. Vit. C. 250mg daily
  3. Quinine 324mg daily (last line)
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76
Q

How can you treat muscle cramps?

A
  1. NS or hypertonic saline bolus

2. 50mL IV glucose

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77
Q

What is the definition of a thrombosis?

A

Blood flow <300mL/min thru catheter

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78
Q

Which Tx can prevent thrombosis?

A
  1. Ticlopidine
  2. Clopidogrel
  3. Aspirin
  4. Aspirin w/ Dipyridamole
  5. Fish Oil
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79
Q

How does Ticlopidine prevent thrombosis?

A

Decreases fistula thrombosis

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80
Q

How does Clopidogrel prevent thrombosis?

A

Decreases graft thrombosis after surgery

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81
Q

How does Aspirin prevent thrombosis?

A

??Mixed data?? 500>325

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82
Q

How does Aspirin w/ Dipyridamole prevent thrombosis?

A

Significant reduction at average of 4.5 years

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83
Q

How does Fish Oil prevent thrombosis?

A

Reduces graft thrombosis at 1 year **trial

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84
Q

Which Tx can manage thrombosis?

A
  1. Unfractionated heparin
  2. T-PA
  3. Sodium citrate
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85
Q

Which Tx for managing thrombosis is more efficacious?

A

Sodium citrate = UFH < T-PA

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86
Q

Which Tx for managing thrombosis is more safe?

A

Sodium citrate > UFH

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87
Q

Before giving a thrombolytic to treat a thrombosis, what must you do first?

A

Clear catheter with saline flush

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88
Q

What are some thrombolytics to treat thrombosis?

A
  1. Alteplase
  2. Tenecteplase
  3. Reteplase
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89
Q

What are some complications of peritoneal dialysis?

A
  1. Hyperglycemia
  2. Weight gain
  3. Peritonitis
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90
Q

Why do pt undergoing peritoneal dialysis suffer from hyperglycemia and weight gain?

A

Dialysate contains dextrose

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91
Q

What are the common bugs that cause peritonitis?

A

S. aureus and epidermidis

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92
Q

If a G+ bug exist in periotnitis, what can you use to treat it?

A

Vanco or cephalosporin (vanco for just hemodialysis infection)

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93
Q

Staphylococcus is catalase (positive/negative)

A

Negative

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94
Q

Anemia in males is considered:

A

Hb < 13

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95
Q

Anemia in females is considered:

A

Hb < 12

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96
Q

What is the formation of all cell lines called?

A

Hematopoeisis

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97
Q

Formation of blood cells occurs where?

A

Red bone marrow

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98
Q

Maturation of blood cells occurs where?

A

Red bone marrow

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99
Q

Erythropoiesis occurs where?

A

90% produced via kidneys

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100
Q

What conditions can stimulate EPO production?

A

Hypoxia and ischemia

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101
Q

What co-factors are required to form erythrocytes?

A
  1. Iron
  2. Folate
  3. Vit. B12
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102
Q

How many iron atoms are in each Hb molecule?

A

4

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103
Q

How many oxygen atoms are found in each Hb molecule?

A

1 for every iron, so 4

104
Q

What is the most clinically useful RBC index?

A

Mean corpuscular volume (MCV)

105
Q

What is considered normocytic?

A

80 to 96 fL/cell

106
Q

What is considered microcytic?

A

<80

107
Q

What is considered macrocytic?

A

> 96

108
Q

What is a hematocrit?

A

Amount of Hb per volume of whole blood (usually 3x the amount)

109
Q

What is a mean corpuscular hemoglobin?

A

Hb / RBC count

110
Q

When would mean corpuscular hemoglobin increase?

A

B12/Folate deficiency

111
Q

When would mean corpuscular hemoglobin decrease?

A

Iron deficiency

112
Q

What is a mean corpuscular hemoglobin concentration?

A

Hb / Hct

113
Q

When would mean corpuscular hemoglobin concentration increase?

A

Hyperlipidemia

114
Q

When would mean corpuscular hemoglobin concentration decrease?

A

Iron deficiency

115
Q

What is used to differentiate iron deficiency anemia from thalassemias?

A

RBC distribution width

116
Q

When would RBC distribution width increase?

A

Iron deficiency

117
Q

What are reticulocytes?

A

Immature RBC

118
Q

How long do reticulocytes take to mature?

A

1 - 2 days in circulate

119
Q

An increase of reticulocytes indicates what?

A

Anemia due to blood loss or hemolysis

120
Q

A decrease of reticulocytes indicates what?

A

Untreated iron, B12 or folate deficiency

121
Q

Increased RBC destruction is a result of what?

A
  1. Drug-induced (methotrexate)

2. G6PD deficinecy

122
Q

What are some genetic causes of anemias?

A
  1. Sickle cell
  2. Thallassemia
  3. Aplastic anemia
123
Q

What are some acute clinical presentations of anemia?

A
  1. Tachycardia
  2. Angina
  3. Dyspnea
  4. Hypotension
124
Q

What are some chronic clinical presentations of anemia?

A
  1. Headache
  2. Vertigo
  3. Pallor
125
Q

What is the first step in diagnosing anemia?

A

Determine if pt is bleeding

126
Q

Microcytic anemia is _____ related

A

Iron deficiency

127
Q

Macrocytic anemia is _____ related

A

B12 + folate

128
Q

What are some signs and symptoms of iron deficiency anemia?

A
  1. Glossal pain
  2. Smooth tongue
  3. Reduced salivation
  4. Pica
  5. Pagophagia
129
Q

Iron that is from diet is known as ______

A

Fe 3+

130
Q

Where does the dietary iron go to once ingested?

A

Small intestines (duodenum)

131
Q

What is special about the duodenum and iron?

A

It’s where Fe 3+ converts to Fe 2+ and enters enterocytes

132
Q

What is the fate of Fe 2+ once it enters enterocytes?

A
  1. Oxidized and stored as ferritin

OR

  1. Bound to transferrin and transported to bone marrow, liver, or spleen
133
Q

What happens if Fe 2+ if transported to bone marrow?

A

Converted to Hb

134
Q

What happens if Fe 2+ if transported to liver?

A

Converted to ferritin for storage

135
Q

What happens if Fe 2+ if transported to spleen?

A

Converted to ferritin for storage

136
Q

What is the purpose of transferrin saturation levels?

A

Tells you about amount of iron bound to transferrin

137
Q

What is the purpose of total iron-binding capacity levels?

A

Tells you the iron binding capacity of transferrin

138
Q

If iron deficient, what happens to serum iron?

A

Goes down

139
Q

If iron deficient, what happens to ferritin?

A

Goes down

140
Q

If iron deficient, what happens to transferrin?

A

Goes up

141
Q

If iron deficient, what happens to transferrin saturation?

A

Goes down

142
Q

If iron deficient, what happens to total iron-binding capacity?

A

Goes up

143
Q

Which iron panel group may falsely elevate in acute illnesses?

A

Ferritin

144
Q

What is the normal range of serum iron levels?

A

40 to 160

145
Q

What is the normal range of total iron-binding capacity?

A

250 to 410

146
Q

What is the normal range of transferrin saturation?

A

20 to 50%

147
Q

What is the normal range of serum ferritin?

A

40 to 200

148
Q

Which drug class can cause Vit. B12 deficiency?

A

PPIs or antacids

149
Q

PPIs or antacids can cause what kind of deficiency?

A

Vit. B12

150
Q

What are some signs and symptoms of Vit. B12 deficiency?

A

Neurological abnormalities

151
Q

In B12 deficiency, what happens to both homocysteine and methylmalonic acid levels?

A

Both rise

152
Q

In folic acid deficiency, what happens to both homocysteine and methylmalonic acid levels?

A

Only homocysteine levels rise

153
Q

How do B12 and folate work together?

A

B12 converts folate to its active form and folate would be needed for DNA synthesis

154
Q

What are the root causes of anemia of inflammation?

A

Inflammation occurs via IL-1, IL-6, and TNF.

Increases hepcidin which decreases iron uptake and iron storage release

155
Q

What are the iron panel abnormalities with anemia of inflammation?

A
  1. Decrease serum iron
  2. Increase serum ferritin
  3. Decrease transferrin
  4. Decrease TSAT
156
Q

What is thalassemia?

A

alpha or beta chain in Hb is malformed which hinders oxygen carry ability

157
Q

What is aplastic anemia?

A

Inability for stem cells to produce RBC, WBC, or PLT because of genetics, drugs, etc

158
Q

What is the most common enzyme defect in humans and what is the result of it? What RX can cause this?

A

G6PD deficiency; hemolysis due to oxidative stress to Hb

  1. Antimalarials
  2. Sulfonamides
  3. Nitrofurantoin
  4. ASA, Cipro, Vit. E, Metformin
159
Q

Folate and Vit. B12 are needed for what?

A

RBC maturation and DNA synthesis

160
Q

How does Vit. B12 cause neuropathies?

A

Methylmalonyl-CoA accumulates and form abnormal fatty acids

161
Q

What is the target goal for oral iron therapy?

A

150 to 200mg of elemental iron dalily

162
Q

What is the duration of therapy for oral iron therapy?

A

3 to 6 months after anemia has resolved

163
Q

What is the max absorption of elemental iron / day?

A

40 to 80mg

164
Q

How can you dose elemental PO iron to improve tolerability?

A

Dose every other day rather than TID dosing

165
Q

Which iron preparations have the highest elemental iron %?

A

Carbonyl iron and iron polysaccharide complex

166
Q

What are some things that decrease iron absorption?

A

Antacids, H2 blockers, PPIs, tetracyclines, coffee, tea, milk eggs

167
Q

What are some things that increase iron absorption?

A

Vitamin C

168
Q

How often should you monitor for iron efficacy?

A

Check CBC every 3 months for 1 year, then yearly if indication have improved

169
Q

What are some general AE of oral iron?

A

GI effects, dark stools

170
Q

What are some ways to improve tolerability of oral iron?

A
  1. Switch to delayed release
  2. Switch to less elemental iron
  3. Liquid
  4. Take with food
171
Q

When is parenteral iron given to CKD patients?

A

TSAT <30

Ferritin <500

172
Q

How do you dose parenteral iron?

A

HB x weight (lbs) = dose (mg)

173
Q

What would be the iron overload levels for IV iron?

A

TSAT >45

Ferritin >800

174
Q

What is the BBW of iron dextran?

A

Anaphylaxis even with the test dose + increased % of hypotension

175
Q

Which IV iron product is only used for patients receiving supplemental epoetin therapy?

A

Sodium ferric gluconate (Ferrlecit)

176
Q

Which IV iron products have a BBW of anaphylaxis?

A

Iron dextran + Ferumoxytol

177
Q

Which IV iron product cannot be used on dialysis patients?

A

Ferric carboxymaltose

178
Q

How is cyanocobalamin given for neurological manifestations?

A

IM daily for 1 week then weekly for 1 to 2 months, then monthly for life

179
Q

When are transfusions given?

A

Hb<7
Major bleed
Hemodynamically unstable`

180
Q

How much folic is given for patients?

A

1mg daily

Unless pregnant or a child, then 0.4mg

181
Q

How do you calculate mean corpuscular volume?

A

Hct / RBC count

182
Q

What are glomerulonephropathies?

A

Disorders that affect the structure and function of the glomerulus

183
Q

How are glomerulonephropathies classified?

A
  1. Asymptomatic
  2. Nephritic
  3. Nephrotic

***based on lab and diagnostic findings, not cause of disease.

184
Q

What are some hallmark features of nephritic syndrome?

A

Inflammation, hematuria, edema, proteinuria, and HTN

185
Q

What are some hallmark features of nephrotic syndrome?

A

Profound proteinuria, edema, hypoproteinemia, and hyperlipidemia

186
Q

Neonates, infants, children, and adolescents are how old?

A

Neonates: Birth to 28 days
Infant: 28 days to 12 months
Child: 1 yr to 13 yrs
Adolescent: 13yrs to 18yrs

187
Q

Comparing preterm to term infants, who has a lower GFR and/or rate of improvement?

A

Preterm infants

188
Q

When do infants reach mature GFR?

A

2yrs old

189
Q

What is the most frequent cause of acute renal failure in children?

A

Hemolytic Uremic Syndrome

190
Q

What causes typical hemolytic uremic syndrome in children?

A

Shiga-like toxin (E.coli)

191
Q

How do you treat typical hemolytic uremic syndrome in children?

A

Dialysis

192
Q

R for pediatric

A

Decrease CrCl by 25% or less than 0.5ml/kg/h for 8 hrs

193
Q

I for pediatric

A

Decrease CrCl by 50% or less than 0.5ml/kg/h for 12 hrs

194
Q

F for pediatric

A

Decrease CrCl by 75% or <35ml/min/1.73 or less than 0.5ml/kg/h for 24 hrs or anuria for 12 hrs

195
Q

What is the gold standard biomarker for renal function of pediatrics?

A

SCr

196
Q

Stage I AKI + Pediatrics

A

Increase in SCr by 0.3 during 48hrs or 1.5 to 2 times increase or <0.5ml/kg/hr for 8 hrs

197
Q

Stage II AKI + Pediatrics

A

Increase in SCr by 2 to 3x or <0.5ml/kg/hr for 16hrs (12hrs for RIFLE criteria)

198
Q

Stage III AKI + Pediatrics

A

Increase in SCr by at least 3x, or if GFR is below 35 or <0.5ml/kg/hr for 24hrs or anuria for 12 hrs

199
Q

What are some complications with PD, IHD, or CRRT in infants?

A

Higher risk of hypothermia or hypotension due to smaller blood volume

200
Q

What are the two recent AKI prevention projects in pediatric patients?

A

NINJA + RAI

201
Q

What does a diffuse type damage look like?

A

All over the glomeruli

202
Q

What does a focal type damage look like?

A

Some of the glomeruli

203
Q

What does a segmental type damage look like?

A

Some of the glomerulus

204
Q

What does a global type damage look like?

A

Most of the glomerulus

205
Q

What are some ADR unique to cyclosporine?

A

Hypertrichosis + gingival hyperplasia

206
Q

Which RX should you not give to pregnant women for nephritic/nephrotic syndrome?

A

MMF

207
Q

Which RX to treat nephritic/nephrotic syndrome can cause cancer?

A

MMF, Azathioprine, Chlorambucil

208
Q

Which drug alone is specifically used for lupus nephritis?

A

Hydroxychloroquine

209
Q

Which RX to treat nephritic/nephrotic syndrome can cause retinal toxicity?

A

Hydroxychloroquine

210
Q

Which RX to treat nephritic/nephrotic syndrome can cause gonadal toxicity?

A

Cyclophosphamide

211
Q

Which RX to treat nephritic/nephrotic syndrome can cause hemorrhagic cystitis?

A

Cyclophosphamide

212
Q

Which population group is more likely to get kidney stones?

A

Caucasians

213
Q

What type of kidney stones are more prevalent?

A

Calcium stones

214
Q

What is the gold standard to diagnose kidney stones?

A

CT

215
Q

What is special about CT scans and diagnosing kidney stones?

A

Gold standard + no contrast required

216
Q

What is special about the renal ultrasound and diagnosing kidney stones?

A

Less expensive + sensitive

217
Q

What is special about the x-ray and diagnosing kidney stones?

A

Less expensive + can differentiate stone types

218
Q

Which pH causes calcium phosphate kidney stones?

A

Basic

219
Q

Which pH causes uric crystal kidney stones?

A

Acidic

220
Q

Which pH causes calcium oxalate stones?

A

Acidic

221
Q

What is the Dx of idiopathic hypercalciuria?

A

High urine calcium

Normal serum calcium

222
Q

What is the Dx of primary hyperparathyroidism and calcium stones?

A

High urine calcium
High serum calcium
Low serum phosphate

223
Q

How do you treat calcium stones as a result of hyperparathyroidism?

A

Surgery

224
Q

How do you treat idiopathic hypercalciuria?

A

Use thiazide or thiazide like diuretics (chlorthalidone, HCTZ) or Indapamide (ACE + thiazide-like), reduce sodium and protein

225
Q

What is the Dx of hyperuricosuria?

A

High uric acid excretion

226
Q

How do you treat hyperuricosuria?

A

Allopurinol, thiazide, potassium citrate, reduce meat

227
Q

What pH level do you want to reach to treat uric acid stones?

A

6 to 6.5

228
Q

What is the SIG of potassium citrate + uric acid stones?

A

10 to 30 mEq BID; follow up in 6 wks

229
Q

What is the SIG of allopurinol + uric acid stones?

A

Only used for prevention, not treatment

230
Q

What medications should you use to treat cystine stones?

A

Potassium citrate, chelating agent, captopril

231
Q

What is the SIG of potassium citrate + cystine stones?

A

20 to 30 mEq BID

232
Q

What causes stuvite stones?

A

Bacteria during UTIs

233
Q

What does the prognosis look like for someone w/ ADPKD1?

A

Shorter life and faster progression

234
Q

What does the prognosis look like for someone w/ ADPKD2?

A

Longer life expectancy vs ADPKD1, and shorter progression

235
Q

How is PKD type 1 diagnosed?

A 
<30yo = 2+ cysts
30-59 = 2+ cysts in each kidney
60+ = 4+ cysts in each kidney
236
Q

Which abx can you use for PKD?

A

Must have good cyst penetration such as: fluroquinolones, SMX/TMP, or chloramphenicol

237
Q

What should the diet be for someone who has PKD?

A

No caffeine and low-protein

238
Q

Who is more likely to get diagnosed with atherosclerotic RAS?

A

Pts >50 yo

239
Q

Who is more likely to get diagnosed with fibromuscular dysplasia RAS?

A

Young women

240
Q

What labs should pop out when diagnosing RAS?

A

Elevated BUN and SCr

Proteinuria

241
Q

What are some diagnostic and screening tools to look for when looking at RAS?

A

> 60% reduction in RA diameter, HTN before 30, severe HTN after 55, malignant or resistant HTN, sudden pulmonary edema

242
Q

What are some non-pharmacological Tx for RAS?

A

Increased fruit and vegetables and low-fat dairy for calcium intake

243
Q

Which RX do not need to be adjusted?

A 
Azithromycin
Ceftriaxone
Metronidazole
Nafcillin
Abacavir
Tenofovir alafenamide
Aspirin 
Clopidogrel
Enalapril
HCTZ
Atorvastatin
Omeprazole
Glipizide
Glyburide
244
Q

Who is more likely to get diagnosed with fibromuscular dysplasia RAS?

A

Young women

245
Q

What labs should pop out when diagnosing RAS?

A

Elevated BUN and SCr

Proteinuria

246
Q

What are some diagnostic and screening tools to look for when looking at RAS?

A

> 60% reduction in RA diameter, HTN before 30, severe HTN after 55, malignant or resistant HTN, sudden pulmonary edema

247
Q

What are some non-pharmacological Tx for RAS?

A

Increased fruit and vegetables and low-fat dairy for calcium intake

248
Q

Which diuretic needs to be renally adjusted?

A

Spironolactone

249
Q

Which pH causes cystine kidney stones?

A

Acidic

250
Q

Which H2RA/PPI needs to be renally adjusted?

A

Famotidine

251
Q

Which chromosome is affected by ADPKD2?

A

4

252
Q

Which beta blocker needs to be renally adjusted?

A

Sotalol

253
Q

Which diuretic needs to be renally adjusted?

A

Spironolactone

254
Q

Which pH causes cystine kidney stones?

A

Acidic

255
Q

Which chromosome is affected by ADPKD1?

A

16

256
Q

Which chromosome is affected by ADPKD2?

A

4

257
Q

Which immunosuppressive agents for GN are most specific?

A

Cyclosporine + tacrolimus (reduces T-lymphocyte activity?)

IPT: Renal (3 decks)

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