KIDNEY Flashcards
common types of AKI
70% - hypo-perfusion of the kidneys
20% obstruction to urine flow
10% structural damaged due to ischemia, inflammation, toxins, necrosis
CKIDGO criteria for AKI
increased SCR >/ 26.5 mmol/L within 48 hrs or increased SCr >/1.5x baseline known/presumed to have occurred within prior 7days or
Urine volume < 0.5mL/kg/hr for 6 hrs
treatment for hyperkalemia
calcium gluconate, sodium bicarbonate, insulin, salbutamol, furosemide, sodium poystyrene sulfonate (exchanges sodium ions for potassium in intestinal cell) dialysis
know cockroft gault equation
CKIDGO definition of CKD
GFR <60 ml/min for>/3 months with or without signs of kidney damage
OR
presence of markers of kidney damage for >/3 months with or without decreased gfr
what factors doe KDIGO used to stage CKD
GFR and albuminuria
what stage is considered dialysis
G5
<15ml/min GFR
know staging of CKD
G1: >/ 90 GFR G2: 60-90 G3a and G3b: 30-59 G4: 15-29 G5: <15 or dialysis
which drug to use for albuminuria or proteinuria
ACEI or ARB
complications of CKD that we need to treat
anemia
hyperphosphatemia
secondary hyperparathyroidism ( HPT)
BP goal for CKD?
individualized.
<130/80 (BP)
<120 IF meets SPRINT criteria
SPRINT ( >50 years of age, elevated cardiovascular risk without diabetes
list the phosphate binder options
1st choice: calcium carbonate
2nd: lanthanum, sevelamer
which phosphate binder is preferred in stage 5 CKD
sevelamer
treatment for metabolic acidosis
sodium bicarb
important counselling points for calcium carb
Oral iron salts, fluoroquinolones, tetracyclines and levothyroxine: absorption reduced. Give 2 h before or 4 h after calcium.
unique side efffect of sevelamer
can lower LDL cholesterol by 30%
too much vitamin D such as using alfacalcidol can caused what?
hypercalcemia and hyperphosphatemia
where is Vitamin D metabolizes
kidney to become active Vitamin D ( calcitriol)
how does PTH regulates phosphate
stimulating reabsorption of P from bone
Decreased reabosption of P from the kidneys
what is the consequence of CKD on parathyroid hormone
INCREASE PO4, DECREASE CA sensing receptors( high results in higher serum calcium to suppress PTH) AND DECREASE ACTIVE VITAMIN D
Treatment of HPT
normalize Ca2+
prevent increased in PO4 ( diet, phosphate binder, dialysis
correct vitamin D deficiency
MOA of vitamin D analogues?
stimulate Ca absorption in the intestines
stimulates renal tubular Ca reabsorption
SUPPRESS PTH production
what can oversuppression of PTH caused
decreased osteoblast and osteoclast activity
Ca uptake by bone is reduced
INCREASE risk of fractures and calcification
indication for VITAMIN D analogues
to correct calcium level and manage hyperparthyroidism
what does HPT do the the bones
high turnover bone disease
PTH stimulates osteoclasts and osteoblasts
increase resorption and bone formation
results in abnormal unmineralized osteoid
MOA of cinacalcet
binds to Ca receptors to increase sensitivity to Ca and decrease PTH release
**not recommended as first line for HPT due to risk of hypocalcemia
where erythroietin produce
kidney
diagnosis of anemia
Hb < 130 in males
<120 in females
what is the target HB when using ESA
<115 g/L
ePrex usually initiate when Hb 90-100 g/L
what is the major concern with ESA
thromboembolism (with higher Hb targets)
hypertension
allergic reaction
when should we initiate iron supplementatio n
ferritin <500 ng/mL AND Tsat <30%
important counselling points of iron supplementation
take on empty stomach to increase absorption
take 1 hr before or 2-3 hrs after diary/ Ca supplements
warn about darkstools, constipatio, abdominial pian
sick day management for insulin
hold bolus
continue basal
Where in the nephron does active drug secretion most often occur?
proximal tubule
What is the best method for initial testing of proteinuria in a patient with chronic kidney disease risk factors?
Urine albumin : creatinine ratio
