kidneyflashcards

Question

# kidney flashcards What are the two mechanisms for acute pyelonephritis?

Answer 1

Hematogenous (from blood) or ascending (due to bladder infection, vesicoureteral reflux, and internal reflux)

Answer 2

Adult Polycystic Kidney Disease (APKD) Eventually destroys structure of kidney and leads to intermittent gross hematuria

Answer 3

Childhood Polycystic Kidney DiseaseSerious symptoms usually present at birthInfants may die from pulmonary or renal failure, if survive develop liver cirrhosis

Answer 4

an increase in urine volume

Answer 5

an increase in renal sodium excretion

Answer 6

Chronic glomerulonephritisUsually associated with systemic chronic diseases like HTN, DM, SLE

Answer 7

No, simple cysts seem to randomly happen and are more common

Answer 8

The cells in the macula densa

Answer 9

The distal convoluted tubule and the glomerulus (sense from DCT, signal to juxtaglomerular cells)

Answer 10

The juxtaglomerular cells

Answer 11

Water is more permeable in the thin limb.

Answer 12

Parathyroid hormone

Answer 13

The thick ascending limb

Answer 14

The thin descending limb

Answer 15

The distal convoluted tubule

Answer 16

The collecting duct

Answer 17

The proximal tubule

Answer 18

Loop diuretics

Answer 19

Carbonic anhydrase inhibitors

Answer 20

Potassium-sparing diuretics

Answer 21

Osmotic diuretics

Answer 22

Carbonic anhydrase inhibitor

Answer 23

They block carbonic anhydrase, which makes sodium and bicarbonate stay in the urine, so water stays with them.

Answer 24

1. The kidney accommodates relatively quickly2. They are not as effective3. They cause loss of bicarbonate, risk of acidosis4. They destroy the proton gradient in the proximal tubule... less H+ secreted in exchange for sodium

Answer 25

Metabolic alkalosis, altitude sickness (think respiratory alkalosis), glaucoma, and urinary alkalization to trap acidic drugs

Answer 26

Hyperchloremic metabolic acidosis, renal stones, potassium wasting, drowsiness/paresthesia

Answer 27

Hepatic cirrhosis (CA inhibitor increases ammonium retention), sulfa allergies

Answer 28

Loop diuretics

Answer 29

Loop diuretics block the NKCC transporter, which results in increased levels of Na, K, Cl, Mg, and Ca in the urine. Water follows.

Answer 30

An unsubstituted sulfamoyl group (H2NO2S)

Answer 31

Increases natriuretic activity but decreases CA inhibitor activity

Answer 32

An electrophilic group (aka carboxyl, etc.)

Answer 33

High ceiling diuretics

Answer 34

A sulfamoyl and a carboxyl on 1 and 5 respectivelyA secondary amine must be in the 2 or 3 position

Answer 35

It is a prodrug, becomes attached to either cysteine or glutathione in the body. Safe for those with sulfa allergies.

Answer 36

Dehydration, hypokalemic metabolic alkalosis, ototoxicity, hyperuricemia (gout concern), hypomagnesemia

Answer 37

sulfa allergies

Answer 38

Edema, acute hypercalcemia, hyperkalemia, acute renal failure, anion overdose

Answer 39

The Na Cl symporter

Answer 40

Thiazide diuretics

Answer 41

A thiazide-like diuretic

Answer 42

The decrease sodium and chloride absorption, leaving them in the urine, and increase calcium reabsorption due to the presence of a Ca/Na antiporter

Answer 43

HTN, CHF, kidney stones from idiopathic hypercalcuria, and nephrogenic diabetes insipidus

Answer 44

Hypokalemic metabolic alkalosis, hyperuricemia, impaired carbohydrate tolerance, hyperlipidemia, hyponatremia

Answer 45

Patients with sulfa allergies

Answer 46

They block sodium reabsorption channels in the collecting duct

Answer 47

When they block sodium reabsorption, potassium is no longer excreted in exchange for sodium.

Answer 48

False. Often used in combination.

Answer 49

CHR or hypertension in combination with a thiazide or loop diuretic.

Answer 50

Hyperkalemia, hyperchloremic metabolic acidosis

Answer 51

With potassium supplements or ACE inhibitors (which also retain potassium)

Answer 52

Edema associated with CHF, hepatic cirrhosis, nephrotic syndrome, or hyperaldosteronism

Answer 53

Kidney stones, with potassium supplements, or with ace inhibitors

Answer 54

On nuclear receptors in the collecting duct cells

Answer 55

Decreased number of sodium channels, enhanced channel removal, inhibited transport of sodium to the blood

Answer 56

Inhibition of 5a-reductase, stopping metabolization of aldosterone to active metabolites

Answer 57

HTN or CHF in combination with other diuretics, mineralocorticoid excess, aldosteronism (primary or secondary resulting from CHR, cirrhosis, or nephrotic syndrome)

Answer 58

Hyperkalemia, hyperchloremic metabolic acidosis, gynecomastia, impotence, BPH --> steroid!

Answer 59

If chronic renal insufficiency or at the same time as potassium supplements, ACE inhibitors, or potassium sparing diuretics.

Answer 60

Eplerenone (Inspra) -- selective to receptors in kidney, heart, bv, brain

Answer 61

HTN. Will reach full effect in 4 weeks.

Answer 62

Hyperkalemia, hypertriglyceridemia

Answer 63

With potassium supplementation, potassium sparing diuretics, ACE inhibitors, or CYP 3A4 inhibitors, chronic renal insufficiency, diabetes with microalbuminuria

Answer 64

This sugar is excreted but cannot be reabsorbed, so it increases the osmotic pressure of the urine which draws more water into the urine to be excreted. Limits water reabsorption in the proximal tubule and descending limb

Answer 65

Little to none. Mannitol causes diuresis without naturesis.

Answer 66

To increase urine volume or to reduce intracranial or intraocular pressure

Answer 67

Extracellular volume expansion (peripheral swelling due to mannitol other tissues), dehydration, hypernatremia

Answer 68

Demeclocycline (Declomycin)

Answer 69

It inhibits the effects of ADH at the collecting duct, stopping insertion of H20 channels and therefore reducing water reabsorption

Answer 70

SIADH, elevated ADH

Answer 71

Nephrogenic diabetes insipidus, renal failure

Answer 72

End stage renal disease--the point where the kidney function is so impaired that the patient must either get a transplant or go on dialysis

Answer 73

Diabetes mellitus, hypertension, and glomerulonephritis

Answer 74

MDRD equation

Answer 75

30-300mg/g

Answer 76

Stages 3a-5; Less than 60 mL/min/1.73m^2

Answer 77

90, 60, 45, 30, 15

Answer 78

CrCl = (140-age)(IBW)/(SCr*72) x 0.85 if female

Answer 79

Adjusted body weight (=0.3(actual-ideal)+ideal)

Answer 80

Buildup of waste products in blood, fluid overload, metabolic acidosis, anemia, and mineral and bone disorder

Answer 81

Uremic fetor, uremic frost, metallic taste, encephalopathy

Answer 82

DCT cells. Counteract by adding thiazides.

Answer 83

Potassium sparing diuretics

Answer 84

Trick question -- fluid restriction not generally necessary if sodium intake controlled although free water intake should be avoided.

Answer 85

Ethacrinic acid, potassium sparing diuretics, aldosterone antagonists, ADH antagonists, mannitol

Answer 86

Potassium -- limit to 3 gm/day

Answer 87

Hyperkalemia -- aim for 4.5 - 5.5 pre-dialysis

Answer 88

Hyperphosphatemia, hypocalcemia, and decreased vitamin D

Answer 89

Increased serum intact PTH (iPTH)

Answer 90

They bind dietary phosphate ingested with food (so must be taken with food) and allow them to be eliminated in the feces

Answer 91

Calcium carbonate (Tums)

Answer 92

Possible absorption of calcium, which could cause more soft tissue calcification

Answer 93

Calcium acetate -- binds twice as much phosphate, fewer hypercalcemic events

Answer 94

Sevelamer carbonate (Renvela)

Answer 95

Sucroferric oxyhydroxide (Velphoro)

Answer 96

Calcium containing binders are almost 0% effective at low pH (such as the stomach)

Answer 97

It decreases LDL by 15-30% and decreases uric acid in the blood.

Answer 98

They may darken or discolor stool.

Answer 99

Amphojel (aluminum hydroxide) due to aluminum toxicity leading to anemia. Only for short term b/c cannot excrete aluminum.

Answer 100

Auryxia (ferric citrate).

Answer 101

Meat, dairy, beans, nuts, beer, pop

Answer 102

800-1000mg

Answer 103

If PTH > target range for stage 3, 4, or 5. ORPhos >4.6mg/dL for stage 3 and 4Phos >5.5mg/dL for stage 5

Answer 104

Calcitriol

Answer 105

Cholecalciferol (D3) and Ergocalciferol (D2) in the liver, 1,25-dihydroxyvitamin D in the kidney to active form

Answer 106

Ergocalciferol (Calciferol) and Cholecalciferol

Answer 107

Stage 3 and stage 4 or if iPTH is elevated but inactive vitamin D is normal or low.

Answer 108

Stage 5 or if both inactive vitamin D and iPTH are elevated (not being converted)

Answer 109

To decrease the amount of iPTH by increasing the amount of vitamin D that the parathyroid gland senses.

Answer 110

Elevation of blood calcium

Answer 111

It is a pro-hormone that becomes activated in the liver at a more natural rate, maintaining more even serum concentrations.

Answer 112

Paricalcitol (Zemplar) and doxercalciferol (Hectorol)

Answer 113

Paricalcitol is approved for pediatric patients and has the most favorable ADE profile

Answer 114

Doxercalciferol

Answer 115

Calcitriol is cheaper and approved for pediatrics

Answer 116

Calcitriol

Answer 117

Cinacalcet (Sensipar)

Answer 118

It mimics the action of calcium by binding the receptor and inducing conformational change, sending a signal to decrease iPTH secretion

Answer 119

Velphoro (sucroferric oxyhydroxide)

Answer 120

When all calcium receptors are bound with cinacalcet, the body cannot sense or respond to a dangerous drop in blood calcium.

Answer 121

The kidney will convert inactive vitamin D as needed, rather than dumping the activated form into the system.

Answer 122

Decreased erythropoietin, decreased RBC life from uremia, and vitamin/blood loss during dialysis

Answer 123

Iron deficiency (microcytic) anemia

Answer 124

80-96 um^3

Answer 125

11.5 - 14.5%

Answer 126

Hemoglobin (Hb)

Answer 127

Males -- <12g/dL

Answer 128

Annually in CKD 3, biannually in CKD 4-5ND, and q3mos in CKD 5DIf PMH anemia, monitor CKD 3-5ND q3mos and CKD 5D q month

Answer 129

Iron therapy and erythropoiesis stimulating agents

Answer 130

If TSAT <500ng/mLMonitor these every 3 months

Answer 131

CKD stage 3-4 or peritoneal dialysis patients. NOT enough for hemodialysis patients

Answer 132

At least 200mg

Answer 133

Stomach upset

Answer 134

Take with orange juice, separate from food, separate from Ca++ by 2hours, avoid meds that increase stomach pH

Answer 135

Heme iron is absorbed better and from a different site, so not subject to the 200mg daily iron rule.

Answer 136

Proferrin ES, proferrin Forte

Answer 137

CKD stage 5D

Answer 138

Feraheme (ferumoxytol)

Answer 139

Iron dextran (InFed/Dexferrum)

Answer 140

Iron sucrose (Venofer)

Answer 141

Flushing, dizziness, and hypotension

Answer 142

Every 1-3 months

Answer 143

Atherosclerosis, proteinuria, renal tubular damage

Answer 144

After all other correctable causes of anemia have been addressed due to high price. CKD 3-5ND -- if Hb <10g/dL, falling at rapid rate, needed to avoid transfusionCKD 5D -- when Hb between 9 and 10 g/dL

Answer 145

Although this would improve QOL, it also increases incidence of CVAs (strokes).

Answer 146

10 - 11 g/dL

Answer 147

They stimulate erythroid progenitor cells.

Answer 148

Recombinant human erythropoietin (Epogen, Procrit, EPO) and darbepoetin alfa (Aranesp)

Answer 149

Darbepoetin alfa (Aranesp)

Answer 150

Epogen -- because SC dose is 2/3 IV dose if target reached

Answer 151

Units: EpogenMcg: Aranesp

Answer 152

Pure red cell aplasia (PRCA) where antibodies develop to erythropoietin, HTN (23% patients) leading to increased cardiac arrest, seizure, stroke, exacerbations of HF, HTN, and MI

Answer 153

No more than every 4 weeks

Answer 154

1-2 g/dL increase per month

Answer 155

Metabolic acidosis because they cannot excrete H+ ions.

Answer 156

When bicarb <20mEq/L

Answer 157

Increased bicarbonate in dialysate, shohl's solution OR sodium bicarbonate tablets

Answer 158

CKD (stage 3-5ND): 0.8 g/kg/day if GFR <30ml/minESRD: 1.2 g/kg/day due to protein loss through dialysis

Answer 159

Water soluble vitamins -- B and C (Nephrocaps, Nephron FA)

Answer 160

60 yo: 30 - 35 kcal/kg/day

Answer 161

False because it may be changing rapidly and other waste products build up faster.

Answer 162

Prerenal azotemia (hypoperfusion) and postrenal obstruction (kidney stone)

Answer 163

Multiple organ failure, sepsis, bleeding, liver disease, mechanical ventilator

Answer 164

A decrease in glomerular hydrostatic pressure which leads to decreased GFR (often caused by NSAIDs, ACE inhibitors)

Answer 165

Urine output and FEna

Answer 166

<50mL / 24 hours

Answer 167

<400 ml / 24 hours

Answer 168

>400 mL / 24 hours

Answer 169

Prerenal or functional renal failure

Answer 170

Renal injury

Answer 171

Remove cause then supportive therapy

Answer 172

NSAIDs (and acetaminophen), ACE inhibitors, contrast media, and proton pump inhibitors

Answer 173

Acid/base balance, Electrolytes, Intoxication, Overload, Uremia

Answer 174

When BUN >100 and/or SCr >10. Look at S/Sx too.

Answer 175

BUN, creatinine, middle molecules like beta2microglobulin, uric acid

Answer 176

AV fistula

Answer 177

AV fistula

Answer 178

1. High Vd (volume of distribution) -- mostly in tissues2. High lipophilicity3. Large molecular weight4. Highly protein bound

Answer 179

Kt/V and URR

Answer 180

Measure of the fraction of total body water that is cleared of urea. K is clearance, t is time, V is Vd. Goal = 1.4

Answer 181

Measure of reduction of patient's BUN. Goal is >70% reduction.

Answer 182

Hypotension, pruritus, muscle cramps

Answer 183

Patients with bigger abdomens, residual kidney function, pediatric patients

Answer 184

False -- peritoneal dialysis is continuous

Answer 185

Dwell time

Answer 186

Different molecules take different times to equilibrate

Answer 187

Patient switches waste out and puts new dialysate in three times during the day and dwells overnight.

Answer 188

Patient dwells during the day and a cycler drains and refills throughout the night.

Answer 189

Patient is "empty" throughout the day and cycler runs throughout the night. Unfortunately, no long dwell.

Answer 190

Patient is "empty" throughout the day and cycler runs throughout the night, but does not fully drain the fluid, leaving a reserve volume in the entire time.

Answer 191

Cloudy effluent, abdominal pain, fever, N/V, chills, tenderness

Answer 192

Empiric therapy (covers gram + and -) before organism identified, then modify once cultures obtained.

Answer 193

Antibiotics can be administered intraperitoneally, directly to the infection site. Especially good when PO not an option or poor vascular access.

Answer 194

Acute renal failure, especially if pt critically ill or hemodynamically unstable.

Answer 195

Heparin. Because the heart is pumping the blood through at a slow rate that can lead to clotting.

Answer 196

Convection -- addition of ultrafiltrate fluid before dialyzer increases blood volume, which must be forced out through dialysis.

Answer 197

Slower -- they can work on the blood 24/7 but hemodialysis must happen over 4 hours per session.

Answer 198

Diffusion. In this method, dialysate is being run opposite the blood so substances can diffuse from the blood to dialysate just like regular hemodialysis except longer period of time/slower rate.

Answer 199

Convection AND diffusion. This is done by running the blood opposite dialysate just like hemodialysis, but there is also ultrafiltrate added to the blood before it reaches the dialyzer so that excess volume is also spilling over into the dialysate and waste.