Chronic Kidney disease Flashcards
What is the most common reason for dialysis/transplant?
diabetic nephropathy
What is the major mortality risk with CKD?
cardiac disease
What are the criteria of the warning drugs that may cause renal impairment?
HIGH renal excretion, LOW TI
What CV risk factors are important in CKD pt?
hypertension, diabetes, menopause, dyslipidaemia, prothrombotic factors, anaemia, malnutrition, inflammation, fluid overload
How can high PTH lead to CKD worsening?
because PTH helps the flux of phosphate and calcium in and out of the bones so when there is high PTH, calcium is drained out of the bone to the blood, calcifying the vessels
Signs of kidney disease are?
hypertension, OEDEMA, hyperkalaemia, metabolic acidosis, anaemia, metabolic bone disease
At what number should we reduce the dose of renally excreted drugs?
when GFR is less than 60mL/min
What are the examples of renally cleared drugs?
antiviral, BZD, dabigatran, digoxin, fenofibrate, gabapentin, insulin, lithium, metforim, opoiod, sotalol, sprinolactone, vitamin C
Why is meformin bad for CKD?
Because it increases the production of lactate and decreases the clearance of lactate which leads to acidosis
When should we cease metformin?
if GFR is less than 30mL/min (EXTREME CAUTION in patient between 30-60mL/min)
Where can you find information about dosing?
on PI (by TGA)
What can we use instead of enoxaparin that is renally cleared?
we can use unfractionated heparin in pt with eGFR less than 30
What can benzylpenicillin cause if used too much?
it can increase the risk of seizures
What are the benefits of ACEI and SARTAN in diabetic nephropathy (type 1 and 2)
Type 1: it decreases the risk of death, dialysis, transplant and nephropathy
Type 2: it decreases the risk of doubling of serum Cr, kidney failure or death
What happens to the efferent arteriole in diabetics?
VERY constricted efferent arteriole leads to loss of protein and then eventually cell death due to high pressure
