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NEPHRO Flashcards

1
Q

What is the definition of Acute Kidney Injury (AKI)?

A

Acute (rapid) decrease in kidney function or GFR over hours, days, or even weeks.

Associated with an accumulation of waste products (BUN and Serum Creatinine) and (usually) volume. GFR normal values are 90-120 mL/min.

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2
Q

What are the KDIGO criteria for diagnosing AKI?

A
  • Increase in serum creatinine of at least 0.3 mg/dl within 48 hours
  • 50% increase in baseline creatinine within 7 days
  • Urine output of less than 0.5 ml/kg/hour for at least 6 hours

Only one criterion needs to be met for diagnosis of AKI.

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3
Q

What are the classifications of urine output in AKI?

A
  • Nonoliguric: >500 ml/24hr
  • Oliguric: <0.5 mL/kg/hour for 12 hours or more
  • Anuric: <50 ml/24hr

Anuric state indicates a worse outcome.

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4
Q

What are common complications of AKI?

A
  • Fluid overload
  • Acid-base abnormalities
  • Electrolyte abnormalities

These complications can significantly affect patient management and outcomes.

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5
Q

What are some risk factors associated with AKI?

A
  • Preexisting CKD (eGFR < 60mL/minute/1.73m2)
  • Volume depletion (e.g., vomiting, diarrhea)
  • Obstruction of urinary tract
  • Use of nephrotoxic agents/drugs (e.g., IV radiographic contrast, aminoglycosides)

Understanding these risk factors is crucial for prevention.

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6
Q

What are the main categories of the pathophysiology of AKI?

A
  • Prerenal
  • Intrinsic
  • Postrenal

Each category has distinct causes and treatment considerations.

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7
Q

What are the prevention strategies for AKI?

A
  • Avoid nephrotoxic drugs when possible
  • Ensure adequate hydration
  • Patient education
  • Drug therapies to decrease incidence of contrast-induced nephropathy

Prevention is key in at-risk populations.

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8
Q

What is the indication for renal replacement therapy (RRT)?

A
  • BUN greater than 100 mg/dL or signs of uremia
  • Volume overload unresponsive to diuretics
  • Life-threatening electrolyte imbalance
  • Refractory metabolic acidosis

RRT is a critical intervention in severe cases of AKI.

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9
Q

What is the definition of Chronic Kidney Disease (CKD)?

A

Kidney damage for more than 3 months, as defined by structural or functional abnormality of the kidney, with or without decreased GFR.

GFR < 60 mL/minute/1.73m2 for 3 months indicates CKD.

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10
Q

What is the significance of albuminuria/proteinuria in CKD?

A

Marker of kidney damage and a progression factor.

Albumin/Creatinine Ratio (ACR) is used for screening.

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11
Q

What are the management strategies for slowing the progression of CKD?

A
  • Aggressive BP management (Goal systolic BP < 130 mmHg)
  • Use of ACEIs and ARBs with any degree of proteinuria
  • Diuretics as needed
  • Dietary sodium restriction (< 2.4 g/day)

These strategies are essential to mitigate the effects of CKD.

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12
Q

What is the role of erythropoiesis-stimulating agents (ESAs) in CKD?

A
  • Hold or reduce dose when hemoglobin is >10 g/dL in nondialysis patients
  • Hold or reduce dose when hemoglobin is >11 g/dL in dialysis patients
  • Do not exceed a hemoglobin > 13 g/dL

Proper management of hemoglobin levels can reduce morbidity in CKD patients.

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13
Q

True or False: Intravenous fluids are the first-line treatment for prerenal azotemia.

A

True

Correcting primary hemodynamics is crucial in prerenal azotemia.

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14
Q

Fill in the blank: The most implicated medications in drug-induced kidney injury include ______.

A
  • Aminoglycosides
  • NSAIDs
  • ACEIs
  • IV contrast dye
  • Amphotericin
  • Piperacillin/tazobactam plus vancomycin

Awareness of these medications can help in preventing AKI.

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15
Q

What laboratory values indicate a patient’s kidney function has declined?

A
  • Increased BUN
  • Increased serum creatinine
  • Decreased urine output

Monitoring these values is critical in assessing kidney health.

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16
Q

What is the recommended hemoglobin level for patients with CKD?

A

Do not exceed a hemoglobin > 13 g/dL

17
Q

What is the first-line treatment for anemia in patients with stage 5 CKD on hemodialysis?

A

Increase epoetin

18
Q

What are the factors contributing to CKD-MBD and renal osteodystrophy?

A
  • Hyperphosphatemia
  • ↓↓ production of 1,25-dihydroxyvitamin D3
  • ↓↓ absorption of calcium in the gut
  • ↓↓ ionized (free) calcium concentrations
  • Direct stimulation of PTH secretion
19
Q

What are common signs and symptoms of CKD-MBD?

A
  • Insidious onset: fatigue and musculoskeletal and GI pain
  • Calcification visible on radiography
  • Bone pain and fractures can occur if progression is left untreated
20
Q

Which laboratory abnormalities are associated with CKD-MBD?

A
  • Phosphorus
  • Corrected calcium
  • Intact PTH
  • Alkaline phosphatase
  • 25-OH vitamin D3
21
Q

What are the nondrug therapy options for CKD-MBD?

A
  • Dietary phosphate restriction 800–1200 mg/day in stage 3 CKD or higher
  • Dialysis by itself is insufficient to maintain phosphorus balances in most patients
  • Parathyroidectomy
22
Q

What is the role of phosphate binders in CKD-MBD treatment?

A

↓ Phosphate

23
Q

What is the effect of vitamin D analogs in CKD-MBD treatment?

24
Q

What should be considered when choosing phosphate binders for CKD Stage 3,4 + hypocalcemia?

A

Ca carbonate, Ca acetate

25
Q

What phosphate binders are recommended for CKD Stage 5 + hypercalcemia?

A

Sevelamer, Lanthanum

26
Q

What are the products included in vitamin D analogs?

A
  • Ergocalciferol (vitamin D2)
  • Cholecalciferol (vitamin D3)
  • Calcifediol (25-hydroxyvitamin D3)
  • Calcitriol
  • Doxercalciferol
  • Paricalcitol
27
Q

True or False: Routine use of calcitriol and vitamin D analogs is suggested for all adults with CKD G3a–G5.

28
Q

Which vitamin D analogs do not require hepatic or renal activation?

A

Calcitriol, Paricalcitol

29
Q

What is the indication for calcimimetics in CKD-MBD?

A

Secondary hyperparathyroidism, especially in patients with high calcium and phosphate concentrations

30
Q

What is the mechanism of action of Cinacalcet HCl?

A

Increases the sensitivity of calcium receptors on the parathyroid gland to serum calcium concentrations, thus reducing PTH

31
Q

What are the adverse effects of Etelcalcetide?

A
  • Hypocalcemia
  • Diarrhea
  • QT prolongation
  • May worsen heart failure
32
Q

In a patient with ↑↑ PTH and risk of hypercalcemia, what treatment is indicated?

A

Calcimimetics

33
Q

In a patient with ↑↑ PTH and risk of hypocalcemia, what treatment is indicated?

A

Vitamin D analog

34
Q

What is the best approach to managing hyperparathyroidism and renal osteodystrophy in a patient with ↑ PTH, ↑ calcium, and ↑ phosphorus?

A

Change calcium acetate to sevelamer and add cinacalcet

PTH (17 decks)

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