Renal 2 Flashcards
Where do Thiazides act in the kidney and what do they do?
Act on the distal tubule
Prevent uptake of Na and H20
What are the indications of Thiazides?
1) Cardiac Failure
2) CKD
3) Hypertension
4) Nephrotic syndrome
What is the possible side effect of Thiazides?
Hypovolaemia
Where does spiralactone act in the kidneys?
Inhibits aldosterone
Prevents the uptake of Na, Cl and H20 in exchange for K+
What are the indications for spiralactone?
Cardiac failure
Liver cirrhosis
What is the possible side effect of spiralactone?
Hyperkalaemia
How does amiloride act on the kidneys?
Inhibits sodium reabsorption in exchange for potassium
What are the indications of amiloride?
To prevent hypokalaemia
What is the possible side effect of amiloride?
Hyperkalaemia
What are the 6 types of drugs used in CKD?
1) Anti hypertensives
2) Diuretics
3) Sodium bicarbonate
4) Statins
5) Vitamin D analogues
6) Erythropoeitin
Alpha calcidol is an example of what kind of drug?
Vitamin D analogue
How do Vitamin D analogues work?
Hydroxylated in the liver to an active form
Increase uptake of phosphate and calcium from the gut
What are the 2 possible side effects of vit D analogues?
1) Hyperphosphataemia
2) Hypercalcaemia
What are the 2 possible side effects of the use of Epo?
Hypertension
Pure Red Cell aplasia
Why are NSAIDs potentially nephrotoxic?
Inhibit the formation of prostaglandins
Prostaglandins vasodilate the afferent arteriole
Why are ACEi and ARBs potentially nephrotoxic?
They inhibit Ang II which vasoconstricts the efferent arteriole to increase trans glomerular pressure
Penicillins are potentially nephrotoxic as they cause what kidney problem?
Acute interstital nephritis
What can accumulation of penicillins in CKD lead to?
Seizures
What can accumulation of opiods in CKD lead to and what kind of preparations should be avoided?
CNS side effects and respiratory depression
Slow release preparations should be avoided
Digoxin is excreted via the kidneys, what can its accumulation lead to?
Bradychardia
Visual disturbances
Mental confusion
Aggravate hyperkalaemia
Hypoglycaemic agents are also renally excreted what kind of agents should you avoid in CKD/AKI to avoid hypoglycaemia?
Long acting agents should be avoided
What can accumulation of metformin (which is renally excreted lead to)?
Lactic acidosis
Hypoglycaemia
What is herbal medicine Cat’s Claw indicated in causing?
AKI and hypotension with anti hypertensives
What is the primary determinant in water distribution in the body?
Osmotic pressure
What electrolyte mostly determines extracellular volume?
Na as its primarily extracellular
By how much does total body fluid fluctuate?
Less than 1%
Where is more than half of total body water contained?
Intracellulary
Where is K+ primarily in the body?
Intracellularly
What are routine maintenance fluids?
Fluids given by the IV route as the oral route is not possible
Essential electrolytes are also given to prevent depletion
What are your daily requirements of Na, K and H2O?
Sodium - 50-100mmol
Potassium - 40-80mmol
Water - 1.5-2.5L
What type of fluids are used for routine maintenance fluids?
Crystalloids
Dextrose/ NaCl
Why should electrolytes be monitored when a patient is receiving routine maintenance fluids?
Risk of hyponatraemia if give too much water
What are replacement fluids?
Assessmant of fluid loss is made and then IV fluids given to replace this loss eg. After diarrhoea/Vomiting/blood loss/burns
What 4 electrolytes can be added to replacement fluids?
1) Calcium
2) Magnesium
3) Potassium
4) Phosphate
What kind of fluids are used for replacement fluids?
Crystalloid fluids
When are resuscitation fluids used?
When hypovolaemia is insufficient to maintain tissue perfusion
What is the difference between true hypovolaemia and relative hypovolaemia?
True hypovolaemia - When there is actual fluid loss from the body - the rate of fluid loss from ECF exceeds net intake eg. Haemorrhage
Relative hypovolaemia - Decrease in effective circulating volume eg. Sepsis
What is the difference between NaCl and Hartmann’s solution used as resuscitation fluids and what are the risks with either?
Hartmann’s is more physiological as contains, Na, Cl, Calcium, Lactate and Potassium
NaCl - risk of hyperchloraemic (normal anion gap) metabollic acidosis
Hartmanns - risk of hyperkalaemia
Blood can also be used as a resuscitation fluid, after how many units of blood should clotting factors be administrated?>
After around 4 units
What is the difference between crystalloids and colloids?
Crystalloids = water to which electrolytes have been added, low sodium disperse through intracellular and extracellular compartments, high sodium disseminate into extracellular compartments Colloids = Fluids that contain large proteins or other similarly sized molecules, stay in intravascular space for a long period of time, used to increase intravascular volume, large volumes without free water can cause a hyperoncotic state
What does BUFALO stand for in the surviving SEPSIS campaign?
B - do blood cultures and septic screen U - assess urine output, UandE, Urine culture F - Fluid resuscitation A - Give IV Abx L - Measure lactate and Hb O - Give O2 to correct hypoxia
What is the difference between diffusion and convection?
Diffusion = movement of substances due to a diffusion gradient Convection = mass movement of solute owing to movement of fluid due to increased transmembrane pressure
What are the 2 types of peritoneal dialysis?
Automated PD - machine performs PD overnight
Continuous ambulatory PD (CAPD) - Manual changes 3-4 times a day
What is SEPSIS?
Systemic inflammatory response with an infective cause
What is the treatment for hyperkalaemia in an acute setting?
1) Calcium gluconarate (cardio protective as stabilises myocytes) 10ml , 10%
2) Salbutamol 5mg 4x day with a nebuliser
3) Insulin and glucose (insulin drives potassium into cells and you give glucose to prevent hypoglycaemia) 50ml 50% + 10 units insulin
What kind of hyperparathyroidism can occur in CKD?
Secondary
