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Notes > Nephrology > Flashcards

Nephrology Flashcards

1
Q

definition of AKI

A

increase in sCr > 0.3 or 1.5x baseline in last week

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2
Q

anuria definition

A

urine output <50ml/day

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3
Q

functional kidney injury causes

A

low blood flow
does not allow the kidneys to fxn as well

concentrated urine

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4
Q

intrinsic kidney injury

A

infections or physical injury

urine is NOT concentrated

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5
Q

drugs that hurt the kidneys

A

bactrim - inhibit tubular secretion of cr

cimetidine - inhibit tubular secretion of cr

corticosteroids - increase BUN

Tetracyclines - increase BUN

cephalosporins - interfere with cr assay

aminoglycosides - tubular necrosis

contrast dye - tubular necrosis

cisplatin - tubular necrosis

amphotericin B - tubular necrosis

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6
Q

risk factors for nephrotoxicity with contrast dye

A

> 75 yo, anemia, DM, hypovolemia, decreased blood flow to kidney, hypotension, nephrotoxins, >140ml of contrast, kidney disease

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7
Q

ACE/ARB effects on kidneys

A

dilates the efferent arteriole

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8
Q

NSAID effects on kidneys

A

constrict afferent arteriole and reduce glomerular blood flow,

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9
Q

cyclosporine and tacrolimus effect on kidneys

A

constrict afferent arterioles

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10
Q

drugs that may cause tubulostitial disease

A

PCN
NSAIDs
Lithium

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11
Q

drugs that cause postrenal (obstructive) nephropathy

A

sulfonamides, methotrexate, acyclovir, vitamin C

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12
Q

drugs that cause nephrolithiasis

A

triamterene, sulfadiazine, ephedrine

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13
Q

diabetic kidney disease

A

ACEi/ARB
Patiromer to bind K
HCTZ if stage 1-3, loop diuretic if stage 4-5
SGLT2 if DM, GFR>30, and ACR > 300

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14
Q

thrombosis tx w/hemodialysis

A

alteplase 2mg OR
reteplase 0.4 units

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15
Q

antibiotics to use for infected peritoneal cavity

A

vanc or 1st gen cephalosporin
PLUS
3rd gen cephalosporin, aminoglycoside, or aztreonam

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16
Q

what medical condition contraindicates ESA’s?

A

uncontrolled hypertension

17
Q

Procrit dose (epoetin-alfa)
Epogen

A

SC or IV
50-100units/kg TIW

18
Q

Darbepoetin alfa (Aranesp)

A

SC or IV
Non-Dialysis: 0.45mcg/kg q4w
Dialysis: 0.45mcg/kg qweekly or 0.75mcg/kg q2w

19
Q

Mircera (methoxy-polyethylene glycol-epoetin beta)

A

takes 7-15 days after initial dose to see effects
SC or IV
0.6 mcg/kg q2w

20
Q

when to use iron supplements

A

serum ferritin <500ng/mL
OR
serum transferrin sat <30%

21
Q

iron dextran dosing

A

25mg test dose then
1g at once
OR
100mg IV TIW x 10 doses

22
Q

sodium ferric gluconate complex

A

Ferrlecit
125mg IV TIW x 8 doses

23
Q

Iron Sucrose

A

100mg IV TIW x 10 doses in Hemodialysis

200mg IV daily x 5 doses in Non-HD patients

24
Q

Ferumoxytol

A

Feraheme
510mg x 2, 3-8 days apart

25
Q

Ferric Carboxymaltose

A

Injectafer
750mg x 2, 7 days apart

26
Q

what happens to phosphorous and calcium when CrCl <30ml/min

A

parathyroid hormone leeches calcium from the bones, decreases reabsorption of calcium from kidneys

27
Q

calcium supplements for CKD

A

calcium carbonate 1250mg TID
calcium acetate (Phoslo) 667mg tabs
may decrease metabolic acidosis

28
Q

Sevelamer dosing

A

Renvela and Fosrenol
decreases LDL and increases HDL
may worsen metabolic acidosis
may increase hypercalcemia

29
Q

Vit D Dosing

A

<5: weekly x 12, then monthly
5 - 15: weekly x 4, then monthly
16 - 30: monthly dosing

30
Q

Cacitriol

A

active Vitamin D3
PO or IV
0.25mcg daily for hypocalcemia and 2ndary hyperparathyroidism

MOA: increases calcium and phosphate absorption from the small intestine, increases bone mineralization indirectly by increasing ions from absorption, may also cause bone absorption in bone remodeling, in kidneys it causes more reabsorption of Ca and Phos

31
Q

Vitamin D 2 brand name

A

ergocalciferol
inactive

32
Q

Vitamin D 3 brand name

A

cholecalciferol
inactive

33
Q

vitamin d - calcium - phosphorous pathways

A

liver converts D3 to another form w/magnesium, then kidney converts to active vitamin d w/magnesium
D is made active if we need calcium absorption, if not it is made into an inactive form and excreted
this conversion is regulated by calcium, phosphate, and PTH

34
Q

calcium mimetics on the market for hyperparathyroidism

A

calcitriol - active vitamin D

paricalcitol - D analog, IV

Doxercalciferol - D analog IV, requires hepatic activation

analogs less hyper-Ca than calcitriol

35
Q

Cinacalcet (Sensipar) for secondary hyperparathyroidism

A

use for secondary high PTH if high calcium and phos and d cannot be increased

will attach to PTH gland and increase sensitivity to serum Ca to reduce PTH, decreases blood Ca via increased uptake

30mg daily

36
Q

cinacalcet drug interactions

A

2D6 inhibitor - increases TCA’s, flecainide, and thioridazine

3A - doubles [x] of ketoconazole

37
Q

etelcalcetide (parsabiv)

A

synthetic cinacalcet, same MOA

5mg IV TIW after HD

stays in blood for a month

Notes (14 decks)

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