Chronic Kidney Disease Flashcards
What is ACR ratio?
Albumin to creatinine ratio
What ACR do non-diabetics have?
2 mg/mmol
What are some potential causes for transient albuminuria?
- recent major exercise
- urinary tract infection
- febrile illness
- decompensated congestive HR
- menstruation
- acute severe elevation in BG (ex. DKA)
- acute severe elevation in BP
What is the definition of microalbuminuria?
ACR > or equal to 2 mg/mmol
2-20 = microalbuminuria
BP target for diabetics
140/90
What is normal K+ range?
3.5-5.2 mmol/L
Normal albumin level?
40 g/L
If albumin decreases, what does calcium do?
begins to behave like it is higher
For every 10 g/L drop in albumin, calcium behaves as ____ higher
0.2
How does kidney disease affect phosphorus levels?
- Our kidneys filter phosphate easily
- When kidneys aren’t working 100%, it is not filtering phosphates
- Phosphates increased in blood and interact with Ca2+
- This can cause calcium-phosphate deposition in the body in tissues or heart and cause cause itchy skin
- Bad for heart and skin
What happens if Ca binds with phosphates ?
-Ca concentration in blood decreases
-
What happens if Ca binds with phosphates ?
- Ca concentration in blood decreases
- Parathyroid senses that
- Wants to find calcium (FROM YOUR BONES)
- Calcium is taken out of your bones
- Bones are getting weaker and tries to repair them, lays down fibrous tissue instead of normal bone layer
- Causes hyperparathyroidism
How do you treat this?
- Have to limit phosphate intake or use phosphate binders (binds in the stomach, doesn’t affect Ca2+)
- We use calcium carbonate (Apo-Cal 250 TID with meals) - as a phosphate binder
- If you use more and more Apo-Cal to bind phosphate, some of the Ca2+ gets absorbed and can cause high ca2+ levels
What do you want phosphate levels to be?
around 1.8 mmol/L
go over cases
okay
Low phosphate foods
- soda crackers
- popcorn
- vegetables
High phosphate foods
- pizza
- chocolate
- cheese
What are phosphate binders used for?
to treat high blood phosphorus levels
List examples of phosphate binders that bind dietary phosphate
- calcium acetate
- calcium carbonate
- calcium liquid
- aluminum hydroxide
- lanthanum and sevelamer bind dietary phosphate
Why are phosphate binders used?
Phosphate binders are used to lower the amount of phosphorus absorbed from food to limit development of bone and blood vessel disease
Aluminum hydroxide and calcium carbonate may also be prescribed as ______
antacids
Calcium preparations may also be prescribed as ?
calcium supplements
When these medications are prescribed as calcium supplements or antacids, how should you take them in relation to meals?
take between meals
Phosphate binders cause phosphate to be removed in the ____ rather than being absorbed into the blood.
stool
How do you take these meds as phosphate binders in relation to meals?
Take it just before eating so that it can bind to the phosphorous in the food.
If you forget to take it with a meal, it is still helpful to take it up to 30 mins after a meal
Special considerations for Lanthanum (Fosrenol) ?
Should be taken during or immediately after a meal. Taking a dose on an empty stomach can cause nausea and vomiting. Chew the tablet completely before swallowing. Do not swallow tablets whole.
Special considerations for Sevelamer (Renagel) ?
Sevelamer should be taken just before eating.
Swallow the tablet whole.
Renagel should not be cut or chewed. The contents of Sevelamer tablets expand in water and could cause choking if cut, chewed, or crushed.
Phosphate binders may interfere with the absorption of which drugs?
- iron supplements
- antibiotics
- digoxin
- ranitidine
- antiseizure meds
- antiarrhythmic meds
Take them at least 1 hour before or 3 hours after your phosphate binder
What do you do if you miss a dose of your phosphate binder?
If you forget to take your phosphorus binder and it is within 30 minutes of eating, take your usual dose. If it is more than 30 minutes since you ate then skip the dose. DO NOT DOUBLE YOUR NEXT DOSE
What are some possible side effects of phosphate binders?
Constipation, diarrhea, intestinal gas and/or stomach discomfort may occur. If you have problems with constipation, contact your doctor regarding a stool softener or other laxative. Contact your doctor if you experience mood or mental changes, bone pain, muscle weakness, tiredness or weight loss.
Counselling points for diet for people on phosphate binders
Avoid or limit high-phosphorous foods as advised by your doctor and dietician. High-phosphorous foods include dairy products, chocolate, nuts, bran muffins, etc.
