KIDNEY Flashcards
Give two general signs/symptoms of AKI
Raised blood levels of creatinine and reduced urine output
Intravascular fluid overload can be managed in AKI by restricting NaCl intake to ___to___g/day if not hyponatraemic
1 to 2 g/day
What 4 serum electrolyte parameters should be monitored daily?
Acid base balance, Bicarbonate, Calcium, Phosphate, Potassium
List 3 drugs that can cause pre renal AKI…
Diuretics, NSAID’s and ACE inhibitors
Patients taking NSAID’s, ACEI or ARB’s need to be adequately _____
Hydrated
SICK DAY RULE: Consider stopping ____ and ____ in those with diarrhoea, vomiting or sepsis until clinical condition improved and stabilised
ACE inhibitors or ARB’s
CKD may lead to anaemia due to a fall in haemoglobin levels. This is due to damage of peritubular cells leading to inadequate secretion of …..
Erythropoietin - main regulator of RBC proliferation and differentiation in bone marrow
The hydroxylation of cholecalciferol takes place in the kidneys to produce active ______
Vitamin D (Calcitriol)
What can be used to treat anaemia in CKD caused by low EPO levels?
Erythropoiesis stimulating agents (ESA’s SC or IV) and iron (IV weekly darbepoietin)
In CKD Hb should be between 10-12g/dL TRUE or FALSE?
True as if treated to a higher level then hypertension may occur as blood thickens
High levels of phosphate can be managed using a phosphate binder such as…
Calcium acetate, calcium carbonate, Sevelamer
Low levels of calcium can lead to higher levels of…
PHOSPHATE
If the body is deficient in vitamin D and there is not an adequate supply of calcium to be absorbed in the gut then parathyroid hormone is produced to release calcium from _____ instead. This is known as WHAT?
Bones - secondary hyperthyroidism which leads to bone damage
To prevent secondary hyperparathyroidism a low dose of ______ can be given. Why is this vitamin D supplement a good choice?
Alfacalcidol - this is post renal vitamin D so is already active.
Name a drug that is useful in treating leg cramps
Quinine
Uraemia is…
Urea in the blood
Low levels of albumin can lead to…
Increased free drug in the body e.g phenytoin, sodium valproate, warfarin, diazepam, digoxin
Due to less binding
The MDRD takes WHAT into account? (4)
Is it useful for extremes in weight?
- Race
- Gender
- Serum creatinine
- Age
And NOT useful for extremes in weight
Stage 1 CKD = greater/equal to ___ GFR
90 GFR
Stage 2 CKD = ___ - 89 GFR
60
Stage 5 CKD =
15-29 GFR = Stage ?
4
Metabolic acidosis is due to what?
Reduced excretion of H+ ions by the kidneys
In the cockloft-gault formula F=? and M=?
F=1.04 and M=1.23
Dehydration can ____ urea levels
Elevate
Is urea a reliable measure of renal function?
No - but it can be used as an indicator of the patient’s general condition and state of hydration
Most patients with CKD will have ___tension and this may be a cause or a consequence of their kidney disease.
HYPERtension
Severe renal impairment leads to sodium _____, which in turn produces circulatory volume expansion with consequent hypertension
Retention
What are the symptoms of uraemia?
Anorexia, nausea, vomiting, constipation, foul taste and skin discolouration
Potassium levels of over __mmol/L are life threatening and should be treated as an emergency
7
High potassium levels can lead to ____ ____
Cardiac arrest
Name two drugs that are known to cause hyperkalaemia
ARBs and ACEIs
Name a sedating antihistamine used to treat pruritis
Chlorphenamine
Bendroflumethiazide may not be appropriate for management of hypertension in CKD, as it is ineffective once eGFR falls below 30 mL/minute/1.73 m2. The use of ______ may be preferred in such people.
Loop diuretics - E.G. Furosemide
If a patients pre treatment serum potassium levels are greater than 5.0 mmol/L what should NOT be used to treat hypertension?
ACE inhibitor
An increased ACR is associated with increase or decrease in adverse outcomes?
increase
What should be prescribed to all patients with CKD? (eGFR
Statin 20mg od Atorvastatin - Primary prevention
Accumulation of Metformin in those with stage 4 and 5 CKD can lead to…
Lactic Acidosis
What are the 4 symptoms of anaemia?
1) Tiredness
2) SOB
3) Lethargy
4) Palpitations
Calcium, phosphate and PTH should be measured in those with stage _ to _ CKD
4 to 5
How does Calcium Resonium work and what is it used for?
- Ion exchange resin
- Exchanges K+ for Ca2+ in GI tract
- Enhances potassium excretion
- TREAT OF HYPERKALAEMIA
How do Salbutamol nebs and insulin work in the treatment of hyperkalaemia?
- Stimulate Na-K pump to increase cellular uptake of potassium
- Decreases potassium levels in the blood
Is CKD a risk factor for CVD?
YES
What might an elderly person experience renal impairment but their serum creatinine levels might not reflect this?
- Because elderly people have reduced muscle mass so less creatinine breakdown product from muscle
What useful handbook can be referred to when dealing with a patient with impaired renal function?
Renal drug handbook
Why might itching occur in a patient with CKD?
- Due to build up of urea/waste products
- These cannot be excreted by kidneys as efficiently
When is bendroflurothiazide rendered ineffective at removing xs fluid in a patient with CKD?
- If their eGFR is below 30ml/min/1.73m2
What is a pre-renal cause of renal impairment?
- Reduction in renal blood flow
- Cardiac failure, vomiting and diarrhoea without fluid replacement
- Diuretics, NSAID’s, ACEI
- Increased production of waste products (urea) e.g infection, upper GI bleeding, steroid therapy
What are some post renal causes of reduced renal function?
- Obstruction of urinary tract
- Urinary stones
- Constipation
- BPHypertrophy
Cockroft gault formula should NOT be used for who?
- Children
- High muscle mass
- Elderly
- Pregnant
- Heart failure
What is ACR used to detect?
- Level of proteinuria
What is the role of Calcium gluconate in those with CKD?
- Protects the CV system from fatal arrhythmias in those with hyperkalaemia
What happens to bicarbonate levels in those with CKD and why?
- Kidney regenerates bicarbonate in the tubular cells and passes it back into the plasma
- This buffers H+ ions
- In RF there is reduced bicarb regen so reduced plasma levels of bicarb
Why does phosphate accumulate in those with RF?
What effect does this have?
- Reduced filtration and excretion of phosphate
- Causes reduction in levels of calcium as inversely linked
- Can lead to renal bone disease and secondary hyperparathyroidism
What happens if hypercalcaemia persists?
- Lead to formation of renal stones and cause more renal damage
What happens to the excretion of sodium if kidney damage?
- Ability to excrete excess sodium is lost
- Total ECF volume expansion occurs
- Fluid overload
What effect can uraemia have on drug binding?
- Urea can displace drug from protein binding sites
- Causing more free drug
- May be a need for therapeutic drug monitoring
- e.g digoxin, phenytoin, warfarin, sodium valproate
