Kidney Flashcards
What is the functions of the kidney?
REEM
Regulatory: fluid volume and composition, bp and pH
Endocrine: Erythropoietin production, renin production, prostaglandin production
Excretory: Excrete waste products and drugs
Need to assess impairment, adjust doses, hold/stop nephrotoxic
Metabolism: Vitamin D metabolism
In renal impairment what happens to Creatinine?
Creatinine will increase as there is a build up in the body, due to lack of kidneys excreting this.
eGFR of 90, what stage of renal impairment is this?
Stage 1 (G1) - Normal GFR
eGFR of 60-89, what stage of renal impairment is this?
Stage 2 (G2) - Mild impairment
eGFR of 45-59, what stage of renal impairment is this?
Stage 3 (G3a) -Mild to moderate
eGFR of 30-44, what stage of renal impairment is this?
Stage 3B (G3b)- Moderate to severe
eGFR of 15-29, what stage of renal impairment is this?
Stage 4 (G4) - Severe impairment
An eGFR of less than 15, what stage of renal impairment is this?
Stage 5 (G5) - Established / End stage
Where should Urea be?
Should be in the URINE and NOT blood
What can increase urea?
Dehydration, muscle injury, infection, haemorrhage, excess protein intake
What does an increased urea indicate?
Kidneys are not flushing the urea out, therefore indicates renal impairment
What is proteinuria / ACR a predictor of?
Predictor of renal disease development and adverse outcomes
Where should Albumin be found?
Albumin is protein bound and should be in the BLOOD and NOT in the Urine!
How do you work out the ACR ratio?
Albumin (mg) / Creatinine (g)
What is the ACR range for a diabetic F and M?
M - 2.5mg/mmol
F - 3.5mg/mmol
Non-diabetics = 70mg/mmol
As ACR increases and GFR decreases, this increases the risk of adverse outcomes, True or False?
True
A patient with diabetes are at an increased risk of issues with the kidneys, what drug should they be put on?
ACEi
How does Uraemia in kidney impairment affect drug absorption?
-Reduce drug absorption due to diarrhoea and vomiting, and gastrointestinal oedema. -Reduce calcium absorption can lead to less vitamin D activation.
How does a kidney impairment alter protein and tissue binding?
Less protein and tissue binding
-Protein - Phenytoin
-Tissue - Digoxin
= Accumulation (Toxicity)
How does kidney impairment affect drug metabolism?
-Less vitamin D metabolism = less calcium absorption from the gut and kidneys.
-Less insulin metabolism in Type 1 Diabetes Mellitus.
-Less elimination of pharmacologically active metabolites
As there is less drug excretion in a kidney impairment and doses of drugs need to be adjusted, does this apply to loading doses?
NO
When a patient is in end-stage renal failure, can we use nephrotoxic drugs?
Yes - Monitor for SIDE EFFECTS
What are the three types of renal failure?
Pre-renal, intrinsic and post-renal
What are the causes of pre-renal failure?
-Hypovolemia
-Reduced cardiac output
-Infection
-Liver disease
-Heart failure
-Lisinopril
-NSAIDS
-Lactulose overdose