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BCPS > Nephrology > Flashcards

Nephrology Flashcards

1
Q

anuric

A

UOP less than 50 mL/24 hours

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2
Q

oliguric

A

UOP less than 0.5 mL/mkg/hr for 12 hours or more

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3
Q

nonoliguric

A

UOP more than 500 mL/24 hours

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4
Q

Stage I AKI

A

SCr >= 0.3 increase or 1.5-2x baseline

UOP < 0.5 ml/kg/hr for 6-12 hrs

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5
Q

Stage II AKI

A

SCr 2-3x baseline

UOP < 0.5 mL/kg/hr for >= 12 hrs

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6
Q

Stage III AKI

A

SCr >3x baseline or SCr >=4 or on RRT

UOP <0.3 mL/mkg/hr for >= 24 hours or anuria for >=12 hours

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7
Q

prerenal AKI

A

hypoperfusion

BUN/SCr > 20:1
Urinary Na <20
FENa <1% ( hold onto water, sodium)

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8
Q

functional AKI

A

AKA prerenal azotemia
Undamaged kidneys

BUN/SCr > 20:1
Urinary Na <20
FENa <1% (hold onto water, sodium)

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9
Q

intrinsic AKI

A

kidney damage

May have rash, fever, persistent hypotension

Positive urinary WBC, RBC, proteinuria
Muddy brown granular casts; tubular epithelial casts; hyaline casts

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10
Q

postrenal AKI

A

kidney stones, BPH

Normal UA

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11
Q

FENa calculation

A

(Urinary Na/Serum Na) / (Urinary Cr/SCr) * 100

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12
Q

Meds causing pseudo-nephrotoxicity

A

Alter serum creatinine without affecting GFR

trimethoprim, cimetidine, steroids, tetracycline, cefoxitin

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13
Q

Aminoglycosides

A

Cause ATN (intrinsic AKI)

Starts ~6-10 days after therapy
Nonoliguric (500ml/24hrs)
Hypokalemia, hypomagnesemia

Risk if trough >2

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14
Q

Contrast

A

Cause ATN (intrinsic AKI)

SCr rises within 24 hours and peaks 2-5 days after procedure
Risk of oliguria, dialysis

Give NS or NaBicarb 6-12 hrs prior to procedure, avoid diuretics, and hold metformin for 48 hours after

Contrast treated as drug by Joint Commission

Gadolinium-based agents at risk for nephrogenic systemic fibrosis

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15
Q

Cisplatin

A

Causes ATN (intrinsitc AKI) - potentially irreversible

SCr peaks 10-12 days after therapy
May have hypokalemia and hypocalcemia (due to renal magnesium wasting)

Aggressively hydrate prior to treatment

Amifostine: cisplatin-chelating agent

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16
Q

Amphotericin B

A

Causes ATN (intrinsic AKI) - vasoconstriction decreases blood flow to kidney

Damage occurs after 2-3 g (2-5 days post initiation)
Electrolyte wasting

Hydrate with 1L NS prior to each dose
Use liposomal product

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17
Q

ACE/ARB

A

Causes functional AKI

Expect to rise 30% within 2-5 days, stabilize in 2-3 weeks
Inc >30% harmful

Avoid with diuretics (during drug initiation), NSAIDs

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18
Q

NSAIDs

A

Cause functional AKI (low urinary volume, Na; Inc in BUN, SCr, K, edema, weight)

Occurs within days of starting therapy

Avoid with concomitant meds of RAAS

Rapid recovery

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19
Q

Cyclosporine, tacrolimus

A

Cause functional AKI

Occurs days after starting therapy, along w/ HTN, Hyperkalemia, hypomagnesemia

Dose related

Monitor levels, use with other non-nephrotoxic immunosuppressants (steroids, mycophenolate)

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20
Q

Acute allergic interstitial nephritis

A

Allergic hypersensitivity reaction affecting interstitium of kidney

Caused by penicillins, nsaids (prolonged use)

DC offending agent, start steroid

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21
Q

Chronic interstitial nephritis

A

Progressive, irreversible

Caused by lithium, tacrolimus, cyclosporine after longterm use

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22
Q

Stage 1/G1 CKD

A

Kidney damage, normal GFR

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23
Q

Stage 2/ G2 CKD

A

Kidney damage with mildly decreased GFR 60-89)

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24
Q

Stage 3 / G3a,b CKD

A

Moderate decrease in GFR (30-59)
G3a: 45-59
G3b: 30-44

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25
Q

Stage 4/ G4 CKD

A

Severe decrease in GFR 15-29

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26
Q

Stage 5/G5 CKD

A

Kidney failure <15

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27
Q

A1 albuminuria

A

Normal to mildly increased
ACR <30
<30mg/24hr

28
Q

A2 albuminuria

A

Moderately increased
ACR 30/300
30-300mg/24hr

29
Q

A3 albuminuria

A

Severely increased albuminuria
ACR > 300
>300mg/24hrs

Nephrotic-range proteinuria
>3000mg/24hrs

30
Q

T1D monitoring for albuminuria

A

5 years after diagnosis
Twice annually if ACR > 300mg/g and/or GFR 30-60

31
Q

T2D monitoring for albuminuria

A

Immediately
Twice annually if ACR > 300mg/g or GFR 30-60

32
Q

Goal BP via KDIGO

A

SBP 120

33
Q

BP management

A

Start ACE/ARB with any degree of proteinuria, even if normotensive. Monitor BP, SCr, K within 2-4 weeks
(Hold if K >5.6 or SCr increases by more than 30%)

Add thiazide if Stage 1-3; Loop if stage 4-5

CCB as second line to ACE/ARB

34
Q

A1c goal

A

<7%

35
Q

SGLT2i

A

Use if CKD & T2DM, with GFR >20 (can consider if no diabetes)

Can continue if GFR falls below 20

If still uncontrolled, add GLP1

36
Q

Finerenone

A

nonsteroidal MRA
Add if on max ACE/ARB, T2DM, normal potassium, GFR >25 and ACR >30

37
Q

When to NOT start a statin

A

dialysis-dependent CKD

If already on statin when start dialysis, can continue

38
Q

Indication for RRT

A

Acidosis (not responding to bicarb)
Electrolyte abnormality (hyperkalemia, hyperphosphatemia)
Intoxication (ethylene glycol, lithium, methanol, phenobarbital, salicylate, theophylline)
Overload (fluid)
Uremia

39
Q

Preferred access for HD

A

arteriovenous fistula

40
Q

Urea Reduction Ratio (URR)

A

URR = [(preBUN - postBUN)/preBUN] * 100%

Goal >65% with target of 70%

Demonstrates adequacy of dialysis

41
Q

Most common organism for HD infection

A

S. aureus

42
Q

Thrombosis of catheter

A

Alteplase or reteplase

43
Q

Sieving coefficient

A

SC = concentration of drug in ultrafiltrate / concentration of drug in blood

Predicts drug removal in continuous RRT

44
Q

Common pathogen for PD infection; Empiric regimen

A

S. epi, S. aureus, streptococci, E. coli, P. aeruginosa

Vanco OR first gen ceph
+
Third gen ceph or aminoglycoside

Cefepime monotherapy

Intraperitoneal administration preferred

45
Q

When to start anemia workup

A

CrCl <60
or
Hgb < 12

46
Q

Frequency of Hgb/Hct monitoring in CKD stages

A

Stage 3: annually
Stage 4: twice per year
Stage 5: every 3 months

47
Q

TSAT

A

(Serum iron / TICB) * 100

Assesses available iron

Goal between >20 - <30% depending on source

Monitor every 3 months

48
Q

Ferritin

A

measures stored iron

Goal varies between >100 and <500 depending on source

Monitor every 3 months

49
Q

ESAs

A

Start if Hgb <10 (in dialysis; or along w/ other factors in non-dialysis)

AVOID if hx of stroke or cancer
CI in uncontrolled HTN

Replace iron stores FIRST. Iron deficiency is most common cause of erythropoeitin resistance

Maz increase in Hgb is ~ 1 every 2-4 weeks; do not adjust dose more than every 4 weeks. Adjust in 25% increments

50
Q

Epoetin alfa

A

50-100 units/kg three times per week

Same molecular structure as human erythropoietin

51
Q

Darbepoetin alfa (Aranesp)

A

Non-dialysis: 0.45mcg/kg every 4 weeks
Dialysis: 0.45 mcg/kg weekly or 0.75mcg/kg every 2 weeks

Modified to be longer acting

52
Q

Mircera

A

methoxy polyethylene glycol-epoetin beta

0.6mcg/kg every 2 weeks

Modified for longer duration of action

Onset = 1-2 weeks

53
Q

Iron therapy in dialysis

A

Avoid PO replacement
Generally use standard 1000mg over 10 days

54
Q

Parenteral iron requiring test dose

A

iron dextran

55
Q

Corrected calcium

A

Serum Ca + 0.8 (4- albumin)

56
Q

Phosphate goal Stage 5 CKD

A

2-9x ULN

57
Q

First line phosphate binders in stage 3-4 CKD

A

Calcium carbonate
Calcium acetate (PhosLo, Phoslyra)

Limited by hypercalcemia

58
Q

Sevelamer (Renvela)

A

Nonabsorbable phosphate binder

Primary therapy in CKD Stage 5, especially if hypercalcemic

59
Q

Lanthanum carbonate

A

Not widely used; indication similar to sevelamer – if patient has hypercalcemia

60
Q

Ferric citrate

A

Iron based phosphate binder
Can be used for iron supplementation if not on dialysis

GI upset

61
Q

Sucroferric oxyhydroxyide

A

iron based phosphate binder
chew
GI upset

62
Q

Target vitamin d goal

A

> 30 ng/mL

63
Q

Calcitriol

A

FDA approved to manage hypocalcemia and preventing/treating secondary hyperparathyroid

High incidence of hypercalcemia

Not routinely used in CKD 3a-5

64
Q

Paricalcitol

A

vitamin D analog approved for treatment/prevention of secondary hyperparathyroidism

Lower incidence of hypercalcemia than calcitriol

65
Q

Doxercalciferol

A

vitamin D analog for treatment/prevention of secondary hyperparathyroidism

Lower risk of hypercalcemia than calcitriol

66
Q

Cinacalcet (sensipar)

A

Calcimimetic - indicated for secondary hyperparathyroidism
Increases sensitivity of receptors to serum calcium, thus reducing PTH

30mg daily

Caution in seizure disorder

CYP2D6 inhibitor, 3A4 substrate

BCPS (9 decks)

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