Nephrology

Question 1

What is the criteria for AKI?

Answer 1

One of the following:
- At least 0.3 mg/dL increase in Scr within a 48 hr period
-Increase in baseline SCr by at least 1.5x
-UOP < 0.5 mL/kg/hr for at least 6 hrs

Question 2

Which medications may cause acute tubular necrosis?

Answer 2

-Aminoglycosides
-Cisplatin/carboplatin
-Amp B

Question 3

Which medications may cause acute allergic interstitial nephritis?

Answer 3

-NSAIDs
-PPIs
-Beta-lactams

Question 4

What is the definition of CKD?

Answer 4

One of the following:
-Kidney damage for > 3 months
-GFR < 60 for 3 months

Question 5

What are the different stages of GFR (G-categories)

Answer 5

-G1: >/= 90
-G2: 60-89
-G3a: 45-59
-G3b: 30-44
-G4: 15-29
-G5 < 15 or treatment w/ dialysis

Question 6

What are the different staging categories for albuminuria?

Answer 6

-A1: < 30
-A2: 30-300
-A3: > 300

Question 7

What is the Cockcroft-Gault equation?

Answer 7

(140-age) x ABW/ SCr x 72

*Multiply by 0.85 in women

Question 8

What is a benefit for CKD-EPI over MDRD?

Answer 8

More accurate in those w/ eGFR > 60

Question 9

What is the goal BP for CKD patients per KDIGO?

Answer 9

SBP < 120 mmHg

Question 10

Which medication(s) are recommended in CKD patients w/ albuminuria?

Answer 10

ACE-I/ARB

*even if patient is normotensive

Question 11

What is the goal BP for CKD patients per ACC/AHA?

Answer 11

< 130/80

Question 12

Which class of antihypertensives are second-line for proteinuria?

Answer 12

Non-DHP CCBs

Question 13

What are the causes of anemia in CKD?

Answer 13

-Decreased EPO production
-Iron deficiency
-Shorter life span of RBC
-Blood loss during dialysis
-GI blood loss

Question 14

What are common symptoms of anemia?

Answer 14

-Fatigue
-Cold intolerance
-Depression
-Reduced exercise capacity
-SOB

Question 15

What hemoglobin values are consistent with a diagnosis of anemia?

Answer 15

Men: < 13 mg/dL

Women: < 12 mg/dL

Question 16

What is the place of therapy for oral iron in anemia on CKD?

Answer 16

-Consider 1-3 month trial
-Not recommended for HD patients
-If uses, 200 mg of elemental iron/day (divided doses)

Question 17

What is the place of therapy for IV iron in anemia on CKD?

Answer 17

-TSAT is 30% or less AND ferritin concentration is 500 ng/mL or less
-Empiric cumulative or total dose of 1000 mg is given

Question 18

Which IV iron formulation requires a test dose before starting therapy?

Answer 18

Iron dextran

Question 19

What is a benefit of darbepoetin alfa over epoetin alfa?

Answer 19

Less frequent dosing

Question 20

For which patient population are ESAs not recommended?

Answer 20

Hgb 10 g/dL or greater

Question 21

What is a major risk associated with ESA use?

Answer 21

Increased CV events/risk

Question 22

What are common phosphate binders?

Answer 22

-Calcium acetate
-Ferric citrate
-Sevelamer
-Sucroferric oxyhydroxide

Question 23

What medications can be used in the outpatient setting for hyperkalemia?

Answer 23

Sodium polystyrene sulfonate
-Oral or rectal administration
-High Na content

Patiromer
-Oral administration
-May cause hypo-Mg

Sodium zirconium cyclosilicate
-Oral administration
-May cause edema

Question 24

What are indicated for renal replacement therapy?

Answer 24

-A = acidosis (not responsive to bicarbonate)
-E = electrolyte abnormality (hyper-K, hyper-phos)
-I = intoxication (ethylene glycol, lithium, phenobarbital)
-O = fluid overload
-U = uremia (pericarditis and weight loss)