Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacy 302 > CKD > Flashcards

CKD Flashcards

1
Q

What happens to nephrons in chronic kidney disease (CKD)? What characterises abnormal kidney function in CKD?

A

Irreversible loss
Leaking protein or blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is CKD often unrecognised? What are the causes of CKD?

A

No specific symptoms or asymptomatic
Inherited or acquired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What conditions often coexist with CKD? What can treatment do for CKD?

A

CVD and diabetes
Prevent or delay progression, reduce complications, reduce CVD risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens to coexisting conditions as kidney dysfunction progresses? What can CKD progress to in a small percentage of people?

A

Become more common and increase in severity
End-stage kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens when kidneys don’t work properly?

A

Fluid retained, BP rises, waste builds up, electrolytes deranged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What do uraemic toxins accumulating lead to?

A

Fatigue, nausea, anorexia, lethargy, weight loss, pruritus, frothy urine, taste disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In CKD stages 4 & 5, what conditions are present?

A

Hyperkalaemia, uraemia, anaemia, impaired vitamin D metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does impaired vitamin D metabolism lead to?

A

Hyperparathyroidism, hypocalcaemia, hyperphosphataemia, affecting bone turnover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Approximately what percentage of the UK population has some degree of chronic kidney disease?

A

Approx. 13%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What percentage of patients present late with ESRD? Late presentation with ESRD causes what?

A

Approx. 19%
Significant individual, societal and NHS costs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CKD increases the risk of what?

A

Stroke and CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the KDIGO 2012 classification? What does the suffix ‘P’ denote in the KDIGO classification?

A
  1. Risk of CKD
    Low risk to very high risk
  2. Significant proteinuria at any stage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How should eGFR be estimated? What correction factor should be applied to GFR values for people of African-Caribbean or African family origin?

A

Using the GFR-EPI creatinine equation
Multiply eGFR by 1.159

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does reduced/increased muscle mass affect GFR? How long should meat consumption be avoided before eGFR test? How long should a blood sample be processed in for an eGFR test?

A

Overestimation/underestimation
12 hours
12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the advantage of the eGFRcysC test? What is the eGFRcysC test based on?

A

More sensitive
Cystatin C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is cystatin C handled by the kidneys? What is the impact of uncontrolled thyroid disease on eGFRcystatinC values?
Which proteinuria test should be used?

A

Filtered by glomerulus, completely reabsorbed by tubules, and catabolised
Falsely elevated in hypothyroidism, reduced in hyperthyroidism
ACR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

With the KDIGO classification, going from green to red, there is an increased risk of what?

A

ESRD, worsening eGFR, increased all-cause mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why is early diagnosis and investigation important in those with CVD? How often should eGFR be measured in at risk groups?

A

They have higher CVD risk, and may progress to ESRD
Annually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When should eGFR be tested in chronic kidney disease patients? When can the frequency of eGFR testing be reduced?

A

During intercurrent illness and perioperatively
eGFR levels remain very stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How should eGFR progression be monitored?

A

Measuring 3 eGFRs spread over at least 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is progressive CKD defined?

A

Fall in eGFR of 25% and change in eGFR category within a year or Sustained fall in eGFR of 15ml/min/1.73m2 per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the risks of progressive CKD compared to stable eGFR? What ethnicities are risk factors for progression of CKD?

A

4 – 5 times more likely to develop ESRD, 1.5 – 2 times increased risk of dying
African, African-Caribbean or Asian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What lifestyle factors are risk factors for progression of CKD? What are other factors?

A

Smoking
Hypertension, CVD, diabetes, proteinuria, AKI, untreated urinary outflow obstruction, long term use of NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How many eGFR tests are needed to diagnose CKD? How can you slow the progression of CKD?

A

At least 2 eGFR tests taken 3 months apart
Controlling BMs, BP, and reducing proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the target BP for CKD alone? What is the target BP for CKD + diabetes?

A

<140/90mmHg
<130/80mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When should you offer a low-cost renin–angiotensin system antagonist to people with CKD?

A

Diabetes and an ACR of 3 mg/mmol or more; Hypertension and an ACR of 30 mg/mmol or more; An ACR of 70 mg/mmol or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How do ACEi or ARBs reduce rate of progression?

A

Preferentially reducing intraglomerular pressure, and lower proteinurea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What should you do with the dose of renin–angiotensin system antagonists if the GFR decrease from pretreatment baseline is less than 25%?

A

Do not modify the dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What should you do with the dose of renin–angiotensin system antagonists if the serum creatinine increase from baseline is less than 30%?

A

Do not modify the dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What should you do if there is a decrease in eGFR or increase in serum creatinine after starting or increasing the dose of renin–angiotensin system antagonists, but it is less than 25% (eGFR) or 30% (serum creatinine) of baseline?

A

Repeat the test in 1–2 weeks. Do not modify the dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What should you do if the eGFR change is 25% or more, or the change in serum creatinine is 30% or more?

A

Investigate other causes, and stop or reduce the dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What does good glycaemic control reduce the development of?

A

Microalbuminuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When can bisphosphonates be used? What drugs should be offered to people with CKD for the secondary prevention of cardiovascular disease?

A

eGFR ≥ 30
Antiplatelet drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What drugs should you offer to people with CKD? What supplements should you offer if vitamin D deficient?

A

Statins
Colecalciferol or ergocalciferol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When should you consider alfacalcidol or calcitriol in CKD? When should you consider oral sodium bicarbonate supplementation?

A

If eGFR <30 ml/min/1.73m2
GFR less than 30 ml/min/1.73 m2 and a serum bicarbonate concentration of less than 20 mmol/litre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When should you consider apixaban in preference to warfarin in CKD? What are some risk factors for apixaban use?

A
  1. Confirmed eGFR of 30–50 ml/min/1.73 m2 and non-valvular atrial fibrillation with 1 or more of the risk factors
  2. Prior stroke or transient ischaemic attack, age 75 years or older, hypertension, diabetes mellitus, symptomatic heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the main complications of CKD?

A

CVD, anaemia, bone and mineral disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

In CKD, when is Hb < 110 g/L primarily due to?

A

EPO deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is EPO responsible for?

A

Proliferation and differentiation of erythroid progenitor cells in the bone marrow, which in turn is responsible for the production of RBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are potential causes of anaemia? What are the symptoms of anaemia?

A
  1. Blood loss during dialysis, shortened life span of RBC, impaired iron haemostasis, inflammation, secondary hyperparathyroidism
  2. Tiredness, shortness of breath, lethargy and palpitations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What can anaemia impair? How should iron deficiency be managed?

A

QoL and increasing risk of CV complications
As per normal to a max ferritin level of < 800 micrograms/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How is iron administered during dialysis? What do iron and ESA treatment do?

A

IV
Decreases patient fatigue, and has also been found to reduce hospitalisation and the need for blood transfusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are Erythropoiesis stimulating agents (ESAs)? What do ESAs improve?

A

Biological that stimulate EPO
Survival, reduces CV morbidity, enhance QoL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How are ESAs administered? What happens to some patients when given ESAs? When do ESAs not work?

A
  1. EPO IV for HD during dialysis, SC for PD
  2. Some patients are resistant to ESA treatment, and they have to depend on blood transfusions
  3. For patients with high CRP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What should be the Hb aim in CKD?

A

Between 100 – 120 g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is an ADR of pure red cell aplasia?

A

Reported leaving patients dependent on blood transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are some ADRs of ESAs?

A

HTN, seizures, allergic reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Extraskeletal calcification occurs when? Mineral and bone disorders can begin to appear from what stage? What do mineral and bone disorders manifest in?

A

Increasing risk of CVD
Stage 3 onwards
Abnormalities in Ca, PO4, PTH, vitamin D metabolism, bone turnover, mineralisation, volume, growth and strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Early CKD, PO4 excretion is what? As CKD progresses, what happens to PTH’s ability to excrete PO4?

A

Reduced
Diminishes and PO4 levels rise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What does reduced PO4 trigger?

A

Compensatory increase in PTH secretion stimulating kidneys to excrete more PO4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Renal hydroxylation of inactive calcidiol to the active form of vitamin D (calcitriol) is what?

A

Reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What does hyperphosphataemia, hypocalcaemia and low calcitriol trigger? How should hyperphosphataemia, hypocalcaemia and low calcitriol be treated?

A
  1. Stimulation of PTH synthesis and secretion [secondary hyperparathyroidism]
  2. By correcting calcium, phosphate and vitamin D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What does reduced hydroxylation lead to?

A

Reduced intestinal absorption of calcium and then hypocalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How can phosphate be removed from the body? How do phosphate binders work? When should phosphate binders be taken?

A

Dialysis
Reducing GI absorption of phosphate from food
Before, with or soon after food for maximum efficacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the dose frequency of Sevelamer? When should Sevelamer be taken? What does Sevelamer do to cholesterol levels?

A

3x800mg
With food
Lowers them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What condition’s progression is slowed by Sevelamer? What is a notable disadvantage of Sevelamer? Which of these is a side effect of Sevelamer? What condition is lessened by Sevelamer?

A

Extraskeletal calcification
High pill burden
Constipation
Hypercalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are important counselling points to consider with phosphate binders?

A
  • Take with food
  • Calcium carbonate and lanthanum must be chewed
  • Sachets of lanthanum can be sprinkled on food
  • Calcium acetate and sevelamer must be swallowed whole
  • Sevelamer sachets must be dispersed in 60ml of water
  • Patients may split their binders up based on phosphate in food
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What condition can vitamin D replacement help with secondarily?

A

Hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What does vitamin D replacement help correct? What is a risk of vitamin D replacement? What is a risk of over-supplementation of vitamin D?

A

Hypocalcaemia
Hyperphosphataemia
Oversuppression of parathyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What class of medication is Cinacalcet? What does Cinacalcet increase the sensitivity of?

A

Calcimimetic
Calcium-sensing receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Where are the calcium-sensing receptors that Cinacalcet acts on located? What deos Cinacalcet inhibit? What are the effects of Cinacalcet?

A

Parathyroid glands
PTH release
Reducing calcium and phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the two types of Parathyroidectomy?

A

Sub-total or total

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What does total parathyroidectomy require?

A

Lifelong calcium supplementation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

At what GFR level should a patient be referred to a low clearance clinic? When is Renal Replacement Therapy (RRT) considered?

A

20ml/min
GFR <10ml/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What are the two types of kidney transplant donors?

A

Living or deceased donor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What condition occurs with both acute and chronic renal failure?

A

Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What causes metabolic acidosis in renal failure? What is the typical plasma bicarbonate level in renal failure with acidosis? What is important in limiting the fall in bicarbonate during metabolic acidosis?

A

Failure of excretion of acid anions
12-20mmol/L
Intracellular and bone buffering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the name for loss of bone mineral due to bone buffering? What is a consequence of bone buffering?

A

Osteomalacia
Loss of bone mineral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How are medicines eliminated by the kidneys affected by CKD? How are medicines metabolised to inactive compounds affected by CKD?

A

Reduced clearance and prolonged half-life
Not affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What treatments are appropriate for Hypertension, and what target should be aimed for in CKD?

A

Offer ACEi or AT1RA
Target <140/90 mmHg
Target <130/80 mmHg + Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the target serum ferritin level when treating anaemia in CKD?

A

800mcg/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

How should hyperkalaemia be treated in CKD?

A

Withold ACEi, AT1RA, K+ sparing agents
ECG and treat as per protocol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What medication class is considered for anaemia when serum ferritin is at the target?

A

ESA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the target Hb range when using ESA to correct anaemia?

A

100-120g/L

75
Q

What medication is used to treat metabolic acidosis? What is the eGFR level for using this medication to treat metabolic acidosis? What is the serum HCO3- level for using this medication to treat metabolic acidosis?

A

Oral sodium bicarbonate
<30ml/min
<20mmol/L

76
Q

How is osteodystrophy managed in CKD?

A

Correct calcium, phosphate and vitamin D
Offer bisphosphonates (CI in eGFR <30ml/min)
Offer colecalciferol or ergocalciferol if eGFR >30ml/min
Offer alfacalcidol or calcitriol if eGFR <30ml/min

77
Q

How is hyperparathyroidism treated in CKD?

A

Treat as per protocol
Consider cinacalcet
Consider parathyroidectomy

78
Q

How is hyperphosphataemia treated in CKD?

A

Limit dietary phosphate
Offer phosphate binders

79
Q

How is uraemia treated in CKD?

A

Dialysis & consideration of transplant
Loratadine, menthol & aqueous cream or e45 for itching

80
Q

What process is dialysis based on? What is the goal of dialysis?

A

Diffusion across a semi-permeable membrane
Restore intracellular and extracellular fluid environment

81
Q

What is the eGFR level where dialysis is usually started? What is a symptom of uraemia that indicate the need for dialysis?

A

<15ml/min
Anorexia

82
Q

What is a unique characteristic of dialysis patients regarding kidney function? What is not a valid measure in dialysis patients?

A

Little or no residual kidney function
GFR

83
Q

What dietary changes are required for Haemodialysis patients?

A

Less fluid intake
Low sodium
Low potassium
Low phosphate

84
Q

What type of access is required for haemodialysis? How is it created? How long does it take for this to be functional? What is another type of vascular access for haemodialysis?

A

Arteriovenous fistula
Surgically connecting an artery and vein (allows blood at arterial pressure into vein)
~2 months
Central venous access

85
Q

What is a disadvantage of central venous access? How many needles are placed into the vascular access during haemodialysis?

A

High infection rate
2

86
Q

What does ‘dry weight’ refer to in haemodialysis? Why is sodium bicarbonate usually not required orally for haemodialysis patients?

A

Target weight after fluid removal
Administered via dialysis

87
Q

What is added to the blood during dialysis?

A

Anticoagulant

88
Q

How often is unit based haemodialysis done? How long does unit based haemodialysis last?

A

3x a week
4 hours

89
Q

How often is home based haemodialysis done? When is home based haemodialysis done?

A

6x a week
Overnight

90
Q

What is a complication of haemodialysis vascular access? What is a complication of haemodialysis due to anticoagulation? What is a complication of haemodialysis in general?

A

Occluded access
Bleeding
Sepsis

91
Q

What medication can be used for restless legs? What medication can be used for itching? What topical treatments are used for itch relief?

A

Clonazepam
Loratadine
Menthol and aqueous cream

92
Q

Why do haemodialysis patients often have lower levels of iron? Why is oral iron therapy not effective for HD patients? What type of iron replacement is usually required for HD patients?

A

Due to blood loss and inflammation
Poor absorption due to high urea levels
IV

93
Q

When are blood samples taken for HD patients? How often should biochemical and haematological parameters be monitored for HD? How often should biochemical and haematological parameters be monitored for home HD?

A

During a midweek HD session
Every month in hospitals
At least every 3 months

94
Q

What is the pre-dialysis target blood pressure? What is the post-dialysis target blood pressure?

A

<140/90
<130/80

95
Q

What is a potential complication post-dialysis? What is the name of the syndrome that is a potential complication when starting HD? What is the cause of this?

A

Hypotension
Disequilibrium syndrome
Rapid changes in blood composition

96
Q

What is a common symptom of disequilibrium syndrome? How are dialysis sessions adjusted at the start of treatment to prevent disequilibrium syndrome?

A

Headache
Shorter and more frequent

97
Q

What part of the body acts as a semi-permeable membrane in peritoneal dialysis? Does peritoneal dialysis require fluid or dietary changes? What is the name of the permanent tunnelled catheter used in peritoneal dialysis?

A

Peritoneum
No fluid or dietary changes
Tenckhoff

98
Q

What does dialysate contain? What is the purpose of this? How long is dialysate left to dwell in the abdomen? How long does the dialysate exchange generally take?

A

Glucose
Provides osmotic gradient
4-6 hours
About 30 mins

99
Q

What does CAPD stand for? Who is CAPD suited for? How many exchanges are done every day with CAPD? Around how many litres are exchanged per day with CAPD?

A

Continuous Ambulatory Peritoneal Dialysis
Low transporters
4 exchanges
Around 8-10L

100
Q

What does APD stand for? When is APD usually performed? Who is APD suited for?
How long does APD usually last?

A

Automated Peritoneal Dialysis
Overnight
Fast transporters
7-10 hours

101
Q

Why should PD bags always be checked? What affects the ability of PD fluid to remove water? What are the three different strengths of PD bags?

A

Differing strengths and volumes
Amount of glucose
Weak, medium, strong

102
Q

For a 72-year-old female (160cm, 45 kg) with a serum creatinine of 120 µmol/L, what is the next step regarding her Enalapril 5mg OD prescription?

A

Assess if a dose alteration is needed

103
Q

For a 48-year-old female (165cm, 95 kg, BMI: 35) with a serum creatinine of 100 µmol/L, what action should be taken?

A

Recommend an appropriate dose of dabigatran

104
Q

For a 55-year-old male (175cm, 70 kg) with a serum creatinine of 80 µmol/L, what is the next step when evaluating him for vancomycin?


A

Determine if any dose changes are required

105
Q

What formula is recommended for estimating GFR and calculating drug doses in most patients with renal impairment? What patient characteristics are utilized as variables in this formula?

A

CKD-EPI formula
Serum creatinine, age, sex

106
Q

In the CKD-EPI formula, what does SCr represent? In the CKD-EPI formula, what is the value of K for females? In the CKD-EPI formula, what is the value of K for males? In the CKD-EPI formula, what is the value of α for females? In the CKD-EPI formula, what is the value of α for males?

A

Serum creatinine in mg/dL
0.7
0.9
-0.329
-0.411

107
Q

What are the causes of CKD?

A
  • Hypertension
  • Diabetes Mellitus
  • Prolonged/Frequent AKI
  • CVD Medication
  • Structural defects
  • Congenital abnormalities
  • Autosomal Dominant Polycystic Kidney Disease (ADPKD)
  • Obstructive nephropathy
  • Multisystem Diseases
108
Q

How does diabetes contribute to the pathogenicity of CKD? How does hypertension contribute to the pathogenicity of CKD? How does glomerulonephritis contribute to CKD?

A

Damage to kidney infrastructure
Damages blood vessels in the kidney
Inflammation of the glomeruli

109
Q

Name one class of nephrotoxic drugs that may cause CKD.

110
Q

What are common signs and symptoms associated with an accumulation of toxins in CKD?

A

Fatigue
Nausea
Anorexia
Lethargy
Weight Loss
Pruritus

111
Q

What are common signs found in CKD stages 4 and 5?

A

Hyperkalaemia (impaired excretion)
Uraemia
Anaemia
Impaired Vitamin D Metabolism (reduced hydroxylation of cholecalciferol)
Hyperparathyroidism
Hypocalcaemia
Hyperphosphataemia (impaired excretion)

112
Q

What electrolyte disturbance results from impaired Vitamin D metabolism in CKD? How does CKD lead to metabolic acidosis?

A

Hypocalcaemia
Less nephron mass to produce bicarbonate

113
Q

At what creatinine clearance level does uraemia usually develop? What is a common cause of uraemia?

A

<10mL/min
Fluid overload

114
Q

What are the goals of therapy in CKD?

A
  • Prevent or delay the progression of CKD
  • Treat underlying causes and contributing factors
  • Prevent and/or effectively treat any complications of CKD
  • Reduce the patients associated cardiovascular risk
  • If needed replace lost kidney function via RRT/ - Transplantation
  • In end stage renal disease: Relieve symptoms and improve patients QoL and reduce hospital admissions
115
Q

What are symptoms of uraemia?

A
  • Nausea & Vomiting
  • Fatigue
  • Anorexia
  • Weight loss
  • Muscle cramps
  • Pruritus
  • Change in mental status
116
Q

What are severe complications of untreated uraemia?

A
  • Seizure
  • Coma
  • Cardiac arrest
  • Death
117
Q

Why can spontaneous bleeding occur with severe uraemia?

A

Due to platelet dysfunction

118
Q

Why are Potassium Sparing Diuretics usually inappropriate in CKD? Why are Thiazide diuretics ineffective at eGFR <30 mL/min?

A

Increases K+ in CKD
Decreased drug delivery to the kidneys

119
Q

Why should ACE inhibitors be avoided in renal artery stenosis?

A

May worsen kidney function

120
Q

What is the target blood pressure for CKD patients with low proteinuria (ACR < 70)? What is the target blood pressure for CKD patients with high proteinuria (ACR > 70) or CKD and diabetes?

A

<140/90
<130/80

121
Q

According to the guidelines, when should an ACE inhibitor/ARB be considered as a first-line agent for hypertension in CKD? What is a suitable 2nd line anti-hypertensive agent if eGFR > 30?

A

Diabetes or proteinuria
Thiazide-like diuretic or loop diuretic

122
Q

What dose of Atorvastatin should be offered daily for CVD prevention in CKD Stage 3a and onwards?

123
Q

Why is it important to be aware of the increased risk of bleeding when offering antiplatelet drugs to people with CKD? Why is CKD one of the most common causes of anaemia?

A

Platelet dysfunction in CKD
Reduced erythropoietin production

124
Q

What are the symptoms of renal anaemia?

A

Fatigue
Lethargy
SOB
Reduced exercise tolerance

125
Q

Why might phosphate binders contribute to anaemia in CKD?

A

Reduce dietary iron absorption

126
Q

What investigations should be performed to investigate other causes of anaemia?

A
  1. FBC: WCC, platelets, MCV
  2. Haematinics: folate, Vitamin B12
  3. Iron studies: ferritin, transferrin, transferrin saturations (TSAT)
  4. Parathyroid function (PTH)
  5. Inflammatory markers (CRP)
127
Q

When should other causes of anaemia be considered in CKD patients? How do you manage renal anaemia?

A
  1. CrCl >60ml/min
  2. Replenish iron stores (oral or IV)
  3. Correct EPO deficiency (EPO stimulating agent (ESA))
128
Q

What Hb range should be maintained when managing renal anaemia?

A

10-12 g/dl

129
Q

What are the cautions with using ESAs? What monitoring is required when using ESAs? What are the MHRA guidelines for ESAs?

A

HTN, seizures, PRCA
BP, reticulocyte counts, Hb and electrolytes
Observe for severe skin reactions

130
Q

What are the 4 types of Renal Bone Disease - Osteodystrophy?

A
  1. Secondary to hyperparathyroidism
  2. Osteomalacia (reduced mineralisation)
  3. Mixed osteodystrophy
  4. Adynamic bone disease (reduced bone formation and reabsorption)
131
Q

What are the Manifestations of Renal Bone Disease - Osteodystrophy?

A

Defects of bone mineralization
Bone pain
Fractures
Structural deformities

132
Q

How does decreased GFR lead to hyperphosphatemia in renal bone disease? How does decreased GFR lead to low calcitriol in renal bone disease?

A

Phosphate retention
Reduced kidney activation of Vitamin D

133
Q

Which condition involves reduced bone mineralisation? Which type of renal bone disease is characterized by reduced bone formation and reabsorption?

A

Osteomalacia
Adynamic bone disease

134
Q

What are manifestations of renal bone disease?

A
  • Defects of bone mineralisation
  • Bone pain
  • Fractures
  • Structural deformities
135
Q

What happens to the Glomerular Filtration Rate in renal bone disease?

136
Q

What happens to phosphate levels in renal bone disease? What happens to calcitriol levels in renal bone disease? What happens to calcium levels in renal bone disease? What happens to phosphate levels in renal bone disease?

A

Phosphate retention occurs
Calcitriol levels decrease
Hypocalcaemia
Hyperphosphataemia

137
Q

What is skeletal resistance to PTH in renal bone disease?

A

Bones do not respond to PTH

138
Q

In what stages of CKD does hyperphosphatemia usually occur?

139
Q

What is the target phosphate level for adults with stage 4 or 5 CKD who are not on dialysis? What serum phosphate levels should be maintained for adults with stage 5 CKD who are on dialysis?

A

0.9 and 1.5 mmol/l
1.1 and 1.7 mmol/l (improved removal of phosphate from blood)

140
Q

When should phosphate binders be initiated in CKD? What is the mechanism of action of phosphate binders? When should phosphate binders be taken for maximum efficacy?

A

Before dialysis, stage 4-5 CKD
Reduce GI absorption of phosphate
Before, with or soon after food

141
Q

What is the purpose of Vitamin D in treating renal bone disease? What does Vitamin D supplementation help to correct? What parameters should be monitored when giving Vitamin D supplements?

A

Promotes normal physiology and mineral metabolism
Hypocalcaemia and secondary hyperparathyroidism
Serum calcium and phosphate

142
Q

Which Vitamin D supplements are typically used for Stage 1-3 CKD? Which Vitamin D supplements are typically used for Stage 4-5 CKD?

A

Colecalciferol/Ergocalciferol with calcium
Alfacalcidol or Calcitriol

143
Q

What type of agent is Cinacalcet? For what condition is Cinacalcet licensed?

A

Calcimimetic agent
Secondary hyperparathyroidism

144
Q

How does Cinacalcet work? What is a significant disadvantage of Cinacalcet?

A

Suppresses PTH secretion without increasing calcium
Very expensive

145
Q

How long must kidney function or structural abnormality be present to define Chronic Kidney Disease? According to NICE, what two factors define CKD?

A

Over 3 months
Reduction in kidney function or structural damage

146
Q

According to NICE, what GFR value defines CKD? According to NICE, over what period must a GFR less than 60 ml/min/1.73 m2 be measured to define CKD?

A

Less than 60 ml/min/1.73 m2
At least 2 occasions, 90 days apart

147
Q

According to KDIGO, what is CKD based on?

A

Cause, GFR category, and Albuminuria category (CGA)

148
Q

What happens to ammonia synthesis in metabolic acidosis due to kidney disease? What happens to hydrogen ion excretion in metabolic acidosis due to kidney disease?

A

Kidneys lose the capacity to synthesise ammonia
Kidneys lose the capacity to excrete hydrogen ions

149
Q

What happens to bicarbonate regeneration in metabolic acidosis due to kidney disease?

A

Kidneys lose the capacity to regenerate bicarbonate

150
Q

What is the normal range of serum bicarbonate? What serum bicarbonate level indicates increased risk of metabolic acidosis?

A

22-29mmol/l
<21mmol/l

151
Q

When does metabolic acidosis worsen significantly in CKD?

A

GFR declines below 45 ml/min/1.73 m2

152
Q

In CKD, what blood gas should be checked?

A

Lactate, base excess, and pH

153
Q

When should oral sodium bicarbonate supplementation be considered?

A

GFR <30 and bicarbonate <20

154
Q

What are 2 therapies for electrolyte disturbance in CKD? What is a dietary recommendation for electrolyte disturbance in CKD?

A

Calcium Resonium and Dialysis
Low potassium diet

155
Q

What causes oedema in CKD? What therapies are there for oedema in CKD?

A

Salt and water retention
Diuretics, fluid restriction, low Na diet

156
Q

What is pruritus in CKD due to? What therapies are there for pruritus in CKD?

A

Increased phosphate and urea
Anti-histamines, creams, phosphate binders, dialysis

157
Q

Which type of antihistamines are more effective for pruritus?

A

Sedating antihistamines

158
Q

What therapies are there for leg cramps/restless legs in CKD?

A

Quinine sulphate, clonazepam

159
Q

What causes gout in CKD? What therapies are there for gout in CKD?

A

Decreases uric acid secretion
Low dose allopurinol, analgesics

160
Q

Why should metformin be avoided in renal failure with CI <30 mL/min?

A

Lactic acidosis

161
Q

What are symptoms of CKD?

A

Hypertension
GI symptoms

162
Q

What drug would you use to counter acidosis?

A

Sodium bicarbonate

163
Q

When should assessment for renal replacement therapy or conservative management begin? What should be offered to people starting dialysis or conservative management?

A

At least 1 year before needed
Full dietary assessment by specialist

164
Q

What does haemodialysis manage? How does haemofiltration remove waste? What does haemofiltration remove?

A

Metabolic disturbances
By convection
Larger solutes/molecules

165
Q

To what is the incidence and prevalence of CKD closely linked?

A

Ethnic group and socio-economic class

166
Q

What is the cleansing fluid used in peritoneal dialysis called?

167
Q

What dialysis choice should be considered as first choice for children 2 years or under?

A

Peritoneal dialysis

168
Q

Within what timeframe should adults with progressive deterioration in kidney function be placed on the national transplant list?

A

Within 6 months of dialysis start

169
Q

What are the benefits of renal transplants? What are the issues with renal transplants

A
  1. No longer need dialysis
    Less likely to be hospitalised
  2. Supply and “graft-versus” host rejection
170
Q

What are the main class of renal transplant drugs?

A

ANTI-rejection or immunosuppressive
Anti-infectives

171
Q

Why are anti-infectives normally given during induction of an organ during renal transplant? What antiviral protection is usually given during renal transplant? What anti-infective drug is usually given during induction of an organ in a renal transplant, unless the patient is allergic?

A

Decrease infection risk
Acyclovir
Co-trimoxazole

172
Q

Name an antifungal medication that a renal transplant patient might receive? What is induction therapy in the context of kidney transplantation? What does induction therapy typically include?

A

Nystatin
Short-term use of immunosuppressive agents
High doses of corticosteroids

173
Q

How can induction immunosuppressive medications be classified?

A

Depleting agents
Non-depleting agents

174
Q

What is the categorization of induction immunosuppressive medications based on? What is a characteristic of depleting agents?
When are depleting agents also used?

A

Ability to target specific antigens
Potent with potential for toxicity
Severe cases of acute rejection

175
Q

How is Rabbit anti-human thymocyte immunoglobulin (Thymoglobuline) made? What do the antibodies in r-ATG attach to? What is the typical dose of r-ATG administered after a kidney transplant?

A

Injecting human thymus cells into rabbits
Cells of the immune system
1 to 1.5 mg/kg/day

176
Q

What is the range of days that r-ATG is administered for after a kidney transplant? What is the cumulative dose of r-ATG that is administered after a kidney transplant? How many mg does r-ATG come in per vial?

A

3-9 days
3-13.5mg/kg
25mg

177
Q

What is a phenomenon associated with patients treated with rATG?

A

Cytokine release syndrome

178
Q

What type of antibody is basiliximab? What is the mechanism of action of basiliximab? What is basiliximab authorized for in the UK? What is the dosage of basiliximab administered? When are the doses of basiliximab administered?

A

Monoclonal
Interleukin-2 receptor antagonist
Prophylaxis of acute organ rejection
2 doses of 20mg dose
2 hours before, 4 days after surgery

179
Q

What is tacrolimus? Why is maintenance on one brand of tacrolimus paramount? What is belatacept? What does belatacept inhibit?

A

Calcineurin inhibitor
Differing bioavailability between formulations
Soluble fusion protein
CD28-mediated co-stimulation of T-cells

180
Q

What can Belatacept be used in combination with?

A

Mycophenolate and/or corticosteroids

181
Q

What is Mycophenolate mofetil used for? What forms does Mycophenolate mofetil come in?

A

Prophylaxis of acute transplant rejection
Capsules or an oral suspension

182
Q

What type of inhibitor is Mycophenolate sodium? What enzyme does Mycophenolate sodium inhibit? What pathway does Mycophenolate sodium inhibit?

A

Reversible inhibitor
Inosine monophosphate dehydrogenase
De novo pathway of guanosine nucleotide synthesis

183
Q

What is creatinine a by-product of?


A

Muscle breakdown

184
Q

What patient groups is the Cockcroft – Gault Equation commonly used for?

A
  • Direct-acting oral anticoagulants (DOACs)
  • Patients taking nephrotoxic drugs
  • Elderly patients (aged 75 years and older)
  • Patients at extremes of muscle mass (BMI <18 kg/m2 or >40 kg/m2)
  • Patients taking medicines that are largely renally excreted and have a narrow therapeutic index, such as digoxin and sotalol

Pharmacy 302 (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions