Nephrology Topics Flashcards
How is CKD classified?
cause of disease
GFR
extent of proteinuria
Complications of advanced CKD
altered Na and H2O balance hyperkalemia metabolic acidosis anemia CKD related mineral and bone disorder cardiovascular disease
Etiology of CKD
- diabetes mellitus
- HTN
- glomerulonephritis
polycystic kidney dz
wegeners granulomatosis
vascular disease
HIV nephropathy
CKD pathophysiology: what is the final common pathway to renal parenchymal damage and ESRD?
is it reversible or irreversible?
loss of nephron mass
glomerular capillary HTN
proteinuria
irreversible
CKD: contributing concerns
smoking
- red GFR
- inc urinary albumin excretion
- HR, BP
magnitude of obesity
-remained even after adjustment for DM and HTN
What is the first line treatment for diabetes?
ACE-I or ARB
(if urine albumin excretion >30)
inc dose until:
- albuminuria red by 30-50%
- drop in eGFR
- hyperkalemia
Hypertension
ACE-I and ARB
- effect on renal hemodynamics
- red BP
(look at albuminuria, GFR and BP)
How do we manage anemia?
erythropoietic stimulating agents (ESAs)(epoetin alfa, darbepoetin alfa, methoxy PEG-epoetin beta)
AND
iron supplementation (oral, IV)
What indicates that the bone marrow is responding to anemic treatment?
inc in reticulocytes
When is ESA treatment for anemia in a ND-CKD pt contraindicated?
Hb >/= 10 (>11.5–> cardiovascular events)
Erythropoietin Stimulating Agents: MOI
stimulates division of differentiation of committed erythroid progenitor cells
induces release of reticulocytes from bone marrow into blood stream
Erythropoietin Stimulating Agents: indications
anemia due to:
- myelosuppression
- CKD
Erythropoietin Stimulating Agents: box warning, ADEs
box warning:
inc CV and CKD events w/ Hg >11g/dL
ADEs:
- cancer (shortened survival, progression, recurrence) (>/=12g/dL)
- inc risk of DVT
Chronic Kidney Disease - Mineral and Bone Disorder: abnormalities in
parathyroid hormone calcium, phosphorus the calcium–phosphorus product vitamin D bone turnover soft-tissue calcifications
What is the net effect of PTH on serum levels?
inc ser Ca
dec ser phosphate
What is the net effect of vitamin D on serum levels?
inc ser Ca and phosphate
What is the net effect of FGF 23 on serum levels?
dec ser phosphate
What hormones control serum calcium and phosphate levels? On what organs?
PTH, vitamin D, FGF23
kidney, gut, bone
CKD-MBD: management
dietary phosphate restriction
phosphate binding agents
vitamin D supplementation
calcimimetic therapy
**the problem is excess phosphate retention – be aware of dietary intake
What are high phosphorus foods?
Pumpkin seeds Ground mustard seeds Parmesan cheese Brazil nuts Cocoa powder Edamame Baker’s yeast Bacon Beef liver Canned sardines
What are the agents used for hyperphosphatemia in CKD?
Ca based binders: calcium acetate, calcium carbonate
Fe based binders: ferric citrate, sucroferric oxyhydroxide
Resin binders: sevelamer carbonate, sevelamer hydrochloride
lanthanum carbonate
aluminum hydroxide
What is an ADE for iron based binders?
discolored/dark stools
Calcium based phosphate binding agents: agents, clinical indication, ADEs
calcium acetate, calcium carbonate
CKD hyperphosphatemia
ADEs:
hypercalcemia
hypophosphatemia
milk alkali syndrome
Sevelamer Hydrochloride: category, indication, additional considerations, ADEs, drug interactions
resin binder
hyperphosphatemia
LOWERS LDL
consider in pts at risk for extraskeletal calcification
ADEs:
metabolic acidosis (greater in children)
N/V/D
dyspepsia
may interact w/ cirpofloxacin, mycophenolate mofetil
