CKD Flashcards
Cockroft and Gault (CrCl) =
(140-age) * (weight)
______________________ * (0.85 for females)
SCr * 72
normal TSAT values
20-50%
Major causes of CKD
- diabetes
- HTN
- glomerulonephritis
- polycystic kidney disease
- HIV nephropathy
What eGFR value indicates kidney failure/end stage kidney disease?
<15
normal BUN levels
~ 6-20 mg/dL
What are three causes of increased parathyroid hormone in ESRD patients?
- hyperphosphatemia
- hypocalcemia
- decreased vitamin D
Why are phosphate binders taken with food?
They bind the phosphorous in the food we eat to block it from getting absorbed
What are two other benefits patients may get from taking sevelamer carbonate (besides decreased phosphate levels)?
- decreases uric acid
- decreases LDL levels
normal phosphate levels
2.5 - 4.5 mg/dL
Two forms of UNACTIVATED vitamin D
- cholecalciferol (D3)
- Ergocalciferol (D2)
Three forms of ACTIVATED vitamin D
- Calcitriol
- Paricalcitol
- Doxercalciferol
What is the main cause of anemia in ESRD patients?
decreased production of erythropoietin
What is the best assessment parameter for anemia?
Hemoglobin
When is it suggested to start an ESA for CKD 3-5ND?
- Hb < 10g/dL
- Hb falling at a rapid rate
- needed to avoid blood transfusion
When is it suggested to start an ESA for CKD 5D?
when Hb is between 9-10 g/dL
Do NOT use ESA to push Hb > ____________
11.5 g/dL
What are two adverse effects of ESA?
- PRCA: antibodies develop to erythropoietin
- increased BP
What is one major cause of ESA therapy failure?
Lack of vitamins/IRON
Which IV iron product requires a test dose the first time it’s administered?
Iron dextran (InFed, Dexferrum)
Which ESA has the shortest half-life and which one has the longest half-life?
shortest = recombinant human erythropoietin (epoetin alfa, Epogen)
longest = methoxy polyethylene glycol-epoetin beta (Mircera)
For which stage of CKD is IV the preferred route for iron?
CKD 5D
What are two causes of microcytic anemia?
- Iron deficiency
- Aluminum toxicity
What are two causes of macrocytic anemia?
- Folate deficiency
- Vitamin B12 deficiency
3 types of acute kidney injury
- pre-renal
- intrinsic
- post-renal
3 major causes of intrinsic AKI
- ischemia
- sepsis
- nephrotoxins
Drugs associated with impaired renal autoregulation
- NSAIDS
- ACEi/ARBs
- cyclosporine
Three criteria for acute kidney failure
- increase in SCr > 0.3mg/dL within 48 hours
OR - increase in SCr > 50% within last 7 days
OR - reduction in urine output (<0.5mL/kg/h for 6 hours)
Serum Osmolality (Osm) =
(Na*2) + (BUN/2.8) + (glucose/18)
