Chapter 18: Renal Disease Flashcards
Most common causes of CKD?
HTN and diabetes
Which diuretic works at the loop of henle?
loop diuretics
Which diuretic works at the distal convoluted tubule?
thiazide diuretics
Loop diuretics block which pump & where?
Na-K pump in the ascending limb of the loop of Henle
Thiazide diuretics block which pump?
Na-Cl
Loop diuretics cause (increased/decreased) Ca reabsorption back into the blood
while thiazide diuretics cause (increased/decreased) Ca reabsorption
Decreased; increased
Long-term use of loop diuretics can (increase/decrease) bone density
whereas long-term use of thiazide diuretics can (increase/decrease) bone density
Decrease
increase
When aldosterone antagonists like spironolactone and eplerenone block aldosterone, more ___ and ___ are excreted in the urine and serum ___ increases
Na, water
K
What is the normal range for Scr?
0.6-1.3 mg/dL
CKD is generally defined as GFR ____ and/or _____
<60 ml/min
albuminuria
What drugs are first-line in preventing progression of disease in pts with CKD, diabetes and/or HTN if albuminuria is present?
ACE-I and ARB
When starting treatment with an ACEi or ARB, the baseline SCr can increase by up to ___%. This is normal and treatment should not be stopped
30%
What should you counsel a patient on when taking an ACE-I or ARB?
Avoid potassium supplements and salt substitutes
Patients with advanced kidney disease require monitoring of
PTH
phosphorous
Ca
Vitamin D levels
What is the MOA of phosphate binders?
Block absorption of dietary PO4 by binding to it in the intestine
When are phosphate binders taken? What is the frequency?
TID with meals or right before a meal
Which phosphate binders are first line?
Calcium-based (i.e. Ca acetate, Ca carbonate)
What is a side effect of calcium-based phosphate binders?
hypercalcemia
especially when used with vitamin D due to increased Ca absorption
Which phosphate binders are non-Ca and non-aluminum
Sevelamer carbonate
Sevelamer Hcl
What is unique about sevelamer?
Can lower total cholesterol and LDL by 15-30%
What are high levels of PTH treated with?
vitamin D
How does Vitamin D deficiency occur?
when the kidneys cannot hydroxylate vitamin D to the active form, 1,25-dihydroxy vitamin D
What is the difference between vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol)
D3 is synthesized in the skin after UV exposure
D2 is produced by plant sterols and is the primary source of dietary vitamin D
What is the MOA of vitamin D analogs?
increase intestinal absorption of Ca
raising serum calcium concentrations
inhibit PTH secretion
What is the MOA of calcimimetics?
increases sensitivity of Ca-sensing receptor on PT gland
causing decreased PTH
decreased Ca
decreased phosphate
What is an ADE of cinacalcet?
hypocalcemia
A sudden loss of kidney function due to a non-renal condition (e.g., drugs)
Acute Kidney Injury (AKI)
Common cause of AKI
dehydration
How can AKI present
BUN:SCr ratio > 20:1
plus decreased urine output
dry mucous membranes
tachycardia
What drug class works at the proximal tubule
SGLT2 inhibitors
Where does aldosterone work in the kidney
DCT and collecting duct
What does aldosterone do
Increases Na and water reabsorption
decrease K reabsorption
Which key drugs can cause kidney disease
Aminoglycosides Amphotericin B Cisplatin Cyclosporine Loop diuretics NSAIDs Polymyxins Radiographic contrast dye Tacrolimus Vancomycin
Besides renal impairment, what else can cause increased BUN
dehydration
Low muscle mass = ____ SCr
low