From Review: Kidney Disease Flashcards
oliguria
low urine output of <400 mL/day.
a sign/cause of CKD.
anuria
very low urine output of <75-100 mL/day
What should be in a renal vitamin supplement
w/o vitamin A (retinol).
serum vit D is often low so many ppl need sup.
renal MVTs
renax, dialyvite 800, dialyvite 800 +zinc, nephrocaps, nephrovit, renal tabs, diatx (lowers tHcy as it has more folate, B12, B6)
K mg to mEq
39 mg K = 1 mEq
Na mg to mEq
23 mg Na = 1 mEq
decreaased carnitine levels caused by kidney failure: s/s
muscular weak, arrhythmias, high plasma triglycerides
carnitine recommendation
max 2g/day. neg results w/higher dose.
oral dose = 2g/day or less
IV = 1.4g/day (20 mg/kg)
control high iPTH meds
hectoral (doxercalcipherol)
zemplar (paricalcitol)
sensipar (cinacalcet) - not vit D
vit D3 therapy will
suppress iPTH and help normalize serum Ca
vit D3 therapy meds
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).
Sensipar® (cinacalcet) control
hyperparathyroidism associated w/bone disease, vascular calcification and parathyroid hyperplasia
Sensipar® (cinacalcet) more effective at
lowering iPTH than vit D is
Sensipar® binds to the
calcium-sensing Receptor (CaR) increasing its sensitivity to extracellular Ca. when Ca binds to and activates the CaR, PTH release is inhibited.
severe hyperphosphatemia level
7 - 15 mg/dL
meds to lower phos
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
causes for poor EPO response
infection/inflam, chronic blood loss, osteitis fibrosa, aluminum toxicity, hemoglobinopathies, folate or B12 def, multiple myeloma, malnutrition, hemodialysis.
high BUN indicate that
too high protein intake
predialysis enteral formula names
Suplena
RenalCal
PreD enteral: Suplena kcal
1800 Kcal/L calorically dense for fluid restriction
PreD enteral: Suplena low in
protein (44.7g/L) but HBV
electrolytes
phosphorus
vit A & D
PreD enteral: Suplena high in
calcium
folic acid
PreD enteral: Suplena has
carb stead and FOS
PreD enteral: RenalCal kcal
2.0 kcal/L
negligible electrolytes
PreD enteral: RenalCal AAs
67% essential and 33% non-essential L-AAs and histidine for + N balance and minimizing uremic symptoms
PreD enteral: RenalCal meets or exceeds
100% of RDI for water-sol vits in 1000 mL (2000 kcal)
PreD enteral: RenalCal fat source
contains 70% MCT LCT for improved tolerance
PreD parenteral nutrition
more essential AAs and less non-essential.
Aminosyn RF, Nephramine, RenAmine, Aminess
dialysis enteral formula names
Nepro
Novasource Renal
Nutren Renal
dialysis enteral: Nepro kcal
1.8 cal/mL, 425 cal/8 fl oz, moderate protein content 81 g/L.
dialysis enteral: Nepro low in
electrolytes & fluid
dialysis enteral: Nepro vits
moderate in vit A and D.
high in folic acid and B6.
2:1 Ca/P ratio to help optimize Ca and P balance
dialysis enteral: Nepro contains
carb steady and
FOS - indigestible carbs that ferment in the colon to produce short-chain fatty acids
dialysis enteral: Novasource Renal kcal and pro
2 kcal/mL
74 g pro/1000 mL
dialysis enteral: Novasource Renal low
fluid and electrolytes.
oral or TF
dialysis enteral: Nutren Renal kcal
2.0 kcal/mL
IDPN - Intradialytic Parenteral Nutrition
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.
(PDK) Polycystic Kidney Disease: onset
hereditary, mostly 30-40 yrs.
usually produce enough erythropoietin, not anemic
PKD: s/s & mgmt
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.
(AGN) Acute Glomerulonephritis: onset
rapid, children 3-21 yrs who had a beta hemolytic group A strep infection
AGN: s/s
hematuria, albuminuria, oliguria, azotemia, hypertension, edema
AGN: mgmt
bed rest, antibiotics, Na & fluid restrict if severe edema & HTN, diuretics, BP meds
Glomerulonephritis
many types, chronic/acute. diffuse inflammatory changes in glomerulus in nephron (glomerulus is where urine production begins)
(CGN) Chronic Glomerulonephritis
glomeruli and tubules are progressively destroyed
CGN: possible causes
diseases such as sickle cell, AGN, lupus, nephrosis, diabetic nephropathy, idiosyncratic
CGN: detection
may be asymptomatic and detected d/t proteinuria/albuminuria
CGN: progress to
nephrotic syndrome, CKD, ESRD.
progress may be slowed by anti inflammatory meds, BG & BP control in DM, low protein diet
nephrotic syndrome: cause
idiopathic or as a phase of CGN/CKD
nephrotic syndrome: s/s
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.
nephrotic syndrome: meds
control edema & hypertension w/loop diuretics like lasix (furosemide), antihypertensives like ACE inhibitors (benazepril (lotensin), ramipril (altace))
also restriction fluid and sodium.
nephrotic syndrome: mgmt
monitor plasma electrolytes.
restrict sat fat and may need a statin med.
some pts respond to steroid therapy, immunosuppressants.
nephrotic syndrome: protein
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.
Alport’s syndrome
hereditary, damages kidneys and eyes, may cause deafness
BUN dialysis target value
60-90 mg/dL is acceptable for dialysis pt, 40-85 mg/dL
normal person <20
CKD stages BUN
1: 10-26 mg/dL
4: 30-60 mg/dL
5: 60-100 mg/dL
creatinine normal value
0.2-1.2
target < 1.2 mg/dL
CKD stages creatinine
1: < 1.2 mg/dL
4: 2-6 mg/dL
5: 6-10 mg/dL
creatine levels vs. kidney damage
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)
when is dialysis needed
BUN > 80 mg/dL
creatinine > 8.0 mg/dL
iPTH target range
150-300 pg/mL, 150-650 pg/dL
high iPTH will
promote bone turnover and osteodystrophy
low iPTH may be present in
adynamic bone disease (lowering of vit D & Ca therapy will be needed)
K/DOQI corrected total serum Ca
parameter target range
8.4-9.4 mg/dL
K/DOQI Ca x P
< 55
K/DOQI serum Phosphorus
3.5-5.5 mg/dL
K/DOQI serum HCO3
> 22 mEq/L
corrected Ca
.8 * (4 - pt alb) + serum Ca = corrected Ca
Ca x P
corrected Ca * Phos = product
should not > 55
volume conversions
1 c = 8 oz = 240 ml = 240 cc
1 oz = 30 ml
absorption of glucose from dialysate (peritoneal glucose absorption)
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
peritoneal dialysis protein req
1.2 - 1.5 g/kg dry wt/day
DOQI = 1.3 g/kg/day peritonitis = 2g/kg/day
HD protein req
1.0-1.5 g/kg dry wt/day
DOQI = 1.2 g/kg/day
acutely ill = 1.2-1.3
