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My MNTII Test 2 > From Review: Kidney Disease > Flashcards

From Review: Kidney Disease Flashcards

1
Q

oliguria

A

low urine output of <400 mL/day.

a sign/cause of CKD.

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2
Q

anuria

A

very low urine output of <75-100 mL/day

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3
Q

What should be in a renal vitamin supplement

A

w/o vitamin A (retinol).

serum vit D is often low so many ppl need sup.

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4
Q

renal MVTs

A

renax, dialyvite 800, dialyvite 800 +zinc, nephrocaps, nephrovit, renal tabs, diatx (lowers tHcy as it has more folate, B12, B6)

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5
Q

K mg to mEq

A

39 mg K = 1 mEq

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6
Q

Na mg to mEq

A

23 mg Na = 1 mEq

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7
Q

decreaased carnitine levels caused by kidney failure: s/s

A

muscular weak, arrhythmias, high plasma triglycerides

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8
Q

carnitine recommendation

A

max 2g/day. neg results w/higher dose.

oral dose = 2g/day or less
IV = 1.4g/day (20 mg/kg)

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9
Q

control high iPTH meds

A

hectoral (doxercalcipherol)
zemplar (paricalcitol)
sensipar (cinacalcet) - not vit D

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10
Q

vit D3 therapy will

A

suppress iPTH and help normalize serum Ca

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11
Q

vit D3 therapy meds

A

calcitriol intravenous (Calcijex®), calcitriol oral (Rocaltrol®)- 1, 25 dihydroxy D3 .

doxercalciferol intravenous (Hectorol®), or doxercalciferol oral (Hectorol®)-1-alpha-hydroxy-vitamin D2.

paricalcitol (Zemplar®)- 19-nor-1-alpha-25 dihydroxy D2).

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12
Q

Sensipar® (cinacalcet) control

A

hyperparathyroidism associated w/bone disease, vascular calcification and parathyroid hyperplasia

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13
Q

Sensipar® (cinacalcet) more effective at

A

lowering iPTH than vit D is

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14
Q

Sensipar® binds to the

A

calcium-sensing Receptor (CaR) increasing its sensitivity to extracellular Ca. when Ca binds to and activates the CaR, PTH release is inhibited.

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15
Q

severe hyperphosphatemia level

A

7 - 15 mg/dL

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16
Q

meds to lower phos

A

renagel or renvela (less toxic, more expensive).
fosrenal.
less common - aluminum actacids: amphogel, Alu-tabs, alu-caps to bind phos in gut and increase excretion in stool.

must be taken w/each meal and snack. only give Ca sup if phos is below 7

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17
Q

causes for poor EPO response

A

infection/inflam, chronic blood loss, osteitis fibrosa, aluminum toxicity, hemoglobinopathies, folate or B12 def, multiple myeloma, malnutrition, hemodialysis.

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18
Q

high BUN indicate that

A

too high protein intake

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19
Q

predialysis enteral formula names

A

Suplena

RenalCal

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20
Q

PreD enteral: Suplena kcal

A

1800 Kcal/L calorically dense for fluid restriction

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21
Q

PreD enteral: Suplena low in

A

protein (44.7g/L) but HBV
electrolytes
phosphorus
vit A & D

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22
Q

PreD enteral: Suplena high in

A

calcium

folic acid

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23
Q

PreD enteral: Suplena has

A

carb stead and FOS

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24
Q

PreD enteral: RenalCal kcal

A

2.0 kcal/L

negligible electrolytes

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25
Q

PreD enteral: RenalCal AAs

A

67% essential and 33% non-essential L-AAs and histidine for + N balance and minimizing uremic symptoms

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26
Q

PreD enteral: RenalCal meets or exceeds

A

100% of RDI for water-sol vits in 1000 mL (2000 kcal)

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27
Q

PreD enteral: RenalCal fat source

A

contains 70% MCT LCT for improved tolerance

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28
Q

PreD parenteral nutrition

A

more essential AAs and less non-essential.

Aminosyn RF, Nephramine, RenAmine, Aminess

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29
Q

dialysis enteral formula names

A

Nepro
Novasource Renal
Nutren Renal

30
Q

dialysis enteral: Nepro kcal

A

1.8 cal/mL, 425 cal/8 fl oz, moderate protein content 81 g/L.

31
Q

dialysis enteral: Nepro low in

A

electrolytes & fluid

32
Q

dialysis enteral: Nepro vits

A

moderate in vit A and D.
high in folic acid and B6.

2:1 Ca/P ratio to help optimize Ca and P balance

33
Q

dialysis enteral: Nepro contains

A

carb steady and

FOS - indigestible carbs that ferment in the colon to produce short-chain fatty acids

34
Q

dialysis enteral: Novasource Renal kcal and pro

A

2 kcal/mL

74 g pro/1000 mL

35
Q

dialysis enteral: Novasource Renal low

A

fluid and electrolytes.

oral or TF

36
Q

dialysis enteral: Nutren Renal kcal

A

2.0 kcal/mL

37
Q

IDPN - Intradialytic Parenteral Nutrition

A

PN during dialysis for pts not tolerating PO sups (not covered by medicare or insurance companies). pts don’t want NG tube. most centers use standard PN formulas w/AAs, lipid, & glucose. Add insulin to PN for DM.

38
Q

(PDK) Polycystic Kidney Disease: onset

A

hereditary, mostly 30-40 yrs.

usually produce enough erythropoietin, not anemic

39
Q

PKD: s/s & mgmt

A

hematuria, proteinuria, infection, flank pain

mgmt: nephrectomy, no salt/fluid restriction (may need salt w/high urine output).

meds: SAMSCA (tolvaptan) - Tx hyponatremia & slows progression.
Naringenin may slow progress.

40
Q

(AGN) Acute Glomerulonephritis: onset

A

rapid, children 3-21 yrs who had a beta hemolytic group A strep infection

41
Q

AGN: s/s

A

hematuria, albuminuria, oliguria, azotemia, hypertension, edema

42
Q

AGN: mgmt

A

bed rest, antibiotics, Na & fluid restrict if severe edema & HTN, diuretics, BP meds

43
Q

Glomerulonephritis

A

many types, chronic/acute. diffuse inflammatory changes in glomerulus in nephron (glomerulus is where urine production begins)

44
Q

(CGN) Chronic Glomerulonephritis

A

glomeruli and tubules are progressively destroyed

45
Q

CGN: possible causes

A

diseases such as sickle cell, AGN, lupus, nephrosis, diabetic nephropathy, idiosyncratic

46
Q

CGN: detection

A

may be asymptomatic and detected d/t proteinuria/albuminuria

47
Q

CGN: progress to

A

nephrotic syndrome, CKD, ESRD.

progress may be slowed by anti inflammatory meds, BG & BP control in DM, low protein diet

48
Q

nephrotic syndrome: cause

A

idiopathic or as a phase of CGN/CKD

49
Q

nephrotic syndrome: s/s

A 
proteinuria w/ 3.5-30g protein/day in urine. 
hyperlipidemia and lipiduria.
polyuria/polydipsia/oliguria.
low plasma albumin.
hypertension, edema.
weakness/lethargy/muscle wasting.
hypercoagulopathy.
50
Q

nephrotic syndrome: meds

A

control edema & hypertension w/loop diuretics like lasix (furosemide), antihypertensives like ACE inhibitors (benazepril (lotensin), ramipril (altace))

also restriction fluid and sodium.

51
Q

nephrotic syndrome: mgmt

A

monitor plasma electrolytes.
restrict sat fat and may need a statin med.
some pts respond to steroid therapy, immunosuppressants.

52
Q

nephrotic syndrome: protein

A

0.7-0.8g pro/kg IBW/day + 1g pro/g urinary protein.

high protein diet will not affect low albumin and too much pro increases proteinuria.

53
Q

Alport’s syndrome

A

hereditary, damages kidneys and eyes, may cause deafness

54
Q

BUN dialysis target value

A

60-90 mg/dL is acceptable for dialysis pt, 40-85 mg/dL

normal person <20

55
Q

CKD stages BUN

A

1: 10-26 mg/dL
4: 30-60 mg/dL
5: 60-100 mg/dL

56
Q

creatinine normal value

A

0.2-1.2

target < 1.2 mg/dL

57
Q

CKD stages creatinine

A

1: < 1.2 mg/dL
4: 2-6 mg/dL
5: 6-10 mg/dL

58
Q

creatine levels vs. kidney damage

A

0.6-1.5 mg = up to 50% nephron loss
1.6-4.6 mg = over 50%
4.7-9.9 mg = up to 75%
> 10 mg = 90% (ESRD)

59
Q

when is dialysis needed

A

BUN > 80 mg/dL

creatinine > 8.0 mg/dL

60
Q

iPTH target range

A

150-300 pg/mL, 150-650 pg/dL

61
Q

high iPTH will

A

promote bone turnover and osteodystrophy

62
Q

low iPTH may be present in

A

adynamic bone disease (lowering of vit D & Ca therapy will be needed)

63
Q

K/DOQI corrected total serum Ca

A

parameter target range

8.4-9.4 mg/dL

64
Q

K/DOQI Ca x P

A

< 55

65
Q

K/DOQI serum Phosphorus

A

3.5-5.5 mg/dL

66
Q

K/DOQI serum HCO3

A

> 22 mEq/L

67
Q

corrected Ca

A

.8 * (4 - pt alb) + serum Ca = corrected Ca

68
Q

Ca x P

A

corrected Ca * Phos = product

should not > 55

69
Q

volume conversions

A

1 c = 8 oz = 240 ml = 240 cc

1 oz = 30 ml

70
Q

absorption of glucose from dialysate (peritoneal glucose absorption)

A

ex. rate 5 L of 3% glucose solution: 3% = 3g/100ml or 30 g/L

5L * 30 g/L = 150 g/day * 3.4 kcal/g (glucose monohydrate) * 80% (glucose absorbed in dialysate) = 408 kcal

71
Q

peritoneal dialysis protein req

A

1.2 - 1.5 g/kg dry wt/day

DOQI = 1.3 g/kg/day
peritonitis = 2g/kg/day
72
Q

HD protein req

A

1.0-1.5 g/kg dry wt/day

DOQI = 1.2 g/kg/day
acutely ill = 1.2-1.3

My MNTII Test 2 (7 decks)

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