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Renal Exam 2 > Lect 5 > Flashcards

Lect 5 Flashcards

1
Q

PTH effects on Ca and phos

A

increase in serum Ca

decrease in serum phos

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2
Q

Vit D effects on Ca and phos

A

increase in serum Ca

increase in serum phos

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3
Q

Calcitonin

A

decrease in serum Ca

decrease in serum phos

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4
Q

loss of nephrons

A

increased phos retention

decreased prod of 1,25 DH D3

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5
Q

secondary hyperparathyroidism

A

HD pts= PTH >495 pg/mL assoc w/ increased sudden death, increased morbidity and mortality

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6
Q

corrected Ca

A

Ca(corr)= [(4-albumin) x 0.8] + Ca(obs)

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7
Q

soft tissue calcification

A

rate is high when Ca x P >70 mg2/dL2
uncommon below 50 mg2/dL2
recommended to maintain below 55 mg2/dL2

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8
Q

elevated Ca x P assoc with ___

A

vascular calcification, CV disease, calciphylaxis, death

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9
Q

reference range of Ca

A

8.5-10.5

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10
Q

goal Ca for CKD stages

A

for all stages= w/in reference range

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11
Q

hypocalcemia

A

serum Ca less than 8.5

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12
Q

sx of hypocalcemia

A

depend on acuity of onset
acute= neuromuscular, CV
chronic= CNS, dermatologic

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13
Q

WHAT MEDS COMMONLY CAUSE HYPOCALCEMIA?

A

bisphosphonates, calcitonin, furosemide, oral phosphorus therapy

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14
Q

common causes of hypoCaemia

A

ICU, elderly, malnourished, pts who have received sodium phos as bowel prep, Vit D deficiency, parathyroidectomy or thyroidectomy, drugs

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15
Q

treatment for acute, symptomatic hypocalcemia

A

100-300 mg elemental Ca IV over 5-10 min (should not be infused faster than 60 mg/min due to cardiac dysfunction)

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16
Q

treatment for asymptomatic hypocalcemia

A

oral calcium 1-3 g/day

correct underlying cause if possible (replace Mg, replace Vit D)

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17
Q

treatment for acute, symptomatic hypocalcemia

A

100-300 mg elemental Ca IV over 5-10 min (should not be infused faster than 60 mg/min due to cardiac dysfunction)
continuous infusion 0.5-2 mg/kg/hr elemental Ca

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18
Q

treatment for asymptomatic hypocalcemia

A

oral calcium 1-3 g/day

correct underlying cause if possible (replace Mg, replace Vit D)

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19
Q

hypercalcemia

A

serum Ca >10.5 mg/dL

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20
Q

sx of hypercalcemia

A

Ca less than 13= asymptomatic
Ca >13= depends on acuity of onset
acute= anorexia, N/V, constipation, polyuria/dipsia; hypercalcemic crisis (acute elevation to >15 mg/dL)
chronic= metastatic calcification, nephrolithiasis, chronic renal insuffienciency

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21
Q

sx of hypercalcemia

A

Ca 13= depends on acuity of onset
acute= anorexia, N/V, constipation, polyuria/dipsia; hypercalcemic crisis (acute elevation to >15 mg/dL)
chronic= metastatic calcification, nephrolithiasis, chronic renal insuffienciency

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22
Q

common causes of hyperCaemia

A

malignancy, primary hyperparathyroidism, meds

23
Q

common drug causes of hyperCaemia

A

Vit D analogs, Ca supplements, lithium

24
Q

tx for hyperCaemia

A
  • rehydration with NS 200-300 mL/h
  • loop diuretics: furosemide 40-80 mg IV Q1-4h
  • calcitonin 4 units/kg SQ or IM Q12h (use when hydration is C/I)= use in hemodialysis or ESRD
  • bisphosphonates: zoledronate 4-8 mg IV given over 5 min
25
Q

hypophosphatemia causes

A

decreased GI absorption (phos binders, sucralafate)
increased urinary excretion
extracellular to intracellular redistribution (refeeding syndrome)

26
Q

hypophosphatemia symptoms

A 
mild-mod= aysymptomatic
severe= arrhythmias, resp muscle fatigue/ failure, myalgias, weakness, coma
27
Q

treatment for severe symptomatic hypophosphatemia

A

phos 15-30 mmol IV over 3 hours

28
Q

causes of hyperPhosemia

A

renal failure

intracellular phos release (tumor lysis syndrome)

29
Q

sx of hyperphosphatemia

A

soft tissue calcification
N/V, diarrhea, lethargy, seizures
renal osteodystrophy

30
Q

phos restriction

A

restrict to 800-1000 mg/day when:
phos levels >4.7 mg/dL
plasma conc of PTH elevated above target

31
Q

reference range for phos

A

2.6-4.5

32
Q

calcium citrate

A

phos binder

not to be used concurrently w/ aluminum-based binders

33
Q

aluminum-based phos binders

A

slowly removed by dialysis so can accumulate in various tissues
toxicity treated with deferoxamine

34
Q

aluminum-based phos binders

A

slowly removed by dialysis so can accumulate in various tissues
toxicity treated with deferoxamine

35
Q

when are non-Ca, non-Mg, non-Al based binders first line?

A

when hypercalcemic, low PTH, or vascular calcification

36
Q

examples of non-Ca, non-Mg, non-Al based binders

A
  • sevelamer HCl (Renagel)= lowers LDL, increases HDL; should not be broken or chewed
  • lanthanum carbonate (Fosrenol)= chewable wafer
37
Q

when is it ok to use aluminum-based binders?

A

in pts with phos >7 mg/dL, they may be used for less than 4 weeks

38
Q

Stage 3 & 4 phos binders first line

A

calcium-based

39
Q

Stage 5 primary phos binder therapy

A

either calcium-based binders OR non-Ca, non-Mg, non-Al based binders
can use combo if monotherapy ineffective

40
Q

stage 5 use of calcium binders

A

total daily dose of elemental Ca should not exceed 2 g/day (1500 mg phos binder, 500 mg diet)

41
Q

when do you start a Vit D COMPOUND in CKD?

A

Stage 3 or 4

when serum conc of 25-hydroxyvitamin D is less than 30

42
Q

when do you start a Vit D STEROL in CKD?

A

serum conc of 25(OH)D less than 30 and PTH is above target range
when PTH is progressively increasing and remain persistently higher than the upper reference limit
only in pts with Ca and phos at goal
do not use in rapidly worsening kidney function or non-compliant

43
Q

when is it ok to use aluminum-based binders?

A

in pts with phos >7 mg/dL, they may be used for

44
Q

which Vit D therapies are compounds?

A

ergocalciferol and cholecalciferol

45
Q

which Vit D therapies are sterols?

A

calcitriol, paricalcitol, doxecalciferol

46
Q

ADR’s of Vit D tx

A

increased intestinal absorption of Ca and phos (can lead to hyperCaemia or aggravate hyperPhosemia)
decreased PTH –> adynamic dbone disease

47
Q

when do you start a Vit D COMPOUND in CKD?

A

Stage 3 or 4

when serum conc of 25-hydroxyvitamin D is

48
Q

when do you start a Vit D COMPOUND in CKD?

A

Stage 3 or 4

when serum conc of 25-hydroxyvitamin D is

49
Q

when do you start a Vit D STEROL in CKD?

A

serum conc of 25(OH)D target range
when PTH is progressively increasing and remain persistently higher than the upper reference limit
only in pts with Ca and phos at goal
do not use in rapidly worsening kidney function or non-compliant

50
Q

PTH reference ranges

A

Stage 3-5= 35-70

Stage 5 dialysis= 130-600

51
Q

calcimimetics (cinacalet HCl)

A

decrease PTH secretion and Ca x P

majority of pts receiving concurrent Vit D and phos binders

52
Q

ADR’s of calcimimetics

A

N/V, hypoCaemia
inhibitor of CYP2D6
take with meals

53
Q

calcimimetics place in therapy

A

alternative or adjunct to Vit D analogs

Renal Exam 2 (10 decks)

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