Renal Flashcards
Chronic Kidney Disease (CKD) (Also known as Chronic Renal Failure)
Often un-recognized
until the most advanced stages
CKD Dx determined by
by lab studies and/or a reduction in the glomerular filtration rate for more than 3 months duration
Most common causes of CKD
diabetes and hypertension
Less frequent causes of CKD
cystic disorders of the kidney, obstructive uropathy, glomerular nephrotic and nephrotic syndromes
This is key in slowing the progression of CKD
Glycemic control for diabetic kidney disease and optimization of blood pressure
CKD is a risk factor for
cardiovascular disease, independent of comorbidities such as diabetes, hypertension and dyslipidemia
Classes of Diuretics
Loop Diuretics
Potassium Sparing Diuretics
Thiazide and Thiazide-like Diuretics
Miscellaneous Diuretics
CMP includes
kidney function (GFR)
GFR should be greater than
60
With chronic disease what is important
lifestyle management. Diet exercise etc.
Loop diuretics: potential for
cross-sensitivity with sulfa
Loop examples
Furosemide, bumetanide, torsemide
Potassium sparing often used
in combination with thiazide to reverse low potassium effect
Potassium sparing examples
Triamterene
Spironolactone
Eplerenone (Inspra)
Diuretics are used
because they reduce ECF
Loop MOA
Inhibits sodium reabsorption at the ascending loop of Henley.
Cause a large amount of sodium loss through the urine. Water follows salt.
Potassium sparing MOA
Inhibit potassium excretion distally. A little weaker. Keep K present by their function. Goal is to reduce potassium loss. This is why they are usually used in conjunction with thiazide.
weakest of all diuretics
Thiazide MOA
Act on the distal renal tubule to prevent sodium reabsorption. Generally longer lasting. Used in less severe cases. Outpatient setting.
Thiazide examples
HCTZ, chlorthalidone, indapamide, metolozone
High-dose therapy (HCTZ greater than 50) has increased
risk of hypokalemia, increase in uric acid levels, and serious CV outcomes; use in combination vs pushing high doses
Thiazide watch with
patients with hyperlipidemia
Diuretics ADR
hypotension, decreased GFR, hypokalemia/hyperkalemia, electrolyte abnormalities, metabolic alkalosis, hyponatremia
Eplerenone (Inspra)
next-generation aldosterone agent
Potassium sparing, selective aldosterone blocker
Note on diuretics from text
Initially diruetics promote loss of sodium through the urine and reduce cardiac output. Overtime peripheral vascular resistance is reduced. This is believed to be the result of sodium in the vessel walls themselves.. Sodium could cause vessel walls to constrict. The loss of sodium decreases vascular resistance, reducing afterload, and reducing blood pressure.
Diuretics Decreased effect with
NSAID
Diuretics drug effects increased wtih
with grapefruit juice, azoles, CCBs
Diuretics increased effects OF
ACEI, ARB, BB, potassium replacement
Diuretics cost
approximately $110 to $125/month without superior outcomes
Diuretics Monitoring
BP, HR, edema, weight gain, dyspnea, cough, urine output
Diuretics Prior to Initiating therapy
BUN, creatinine, electrolytes (sodium, potassium, calcium, and magnesium), uric acid, and glucose levels
Diuretics Ongoing monitoring
of electrolytes
Diuretics take as
directed early in the day if there are urination issues
Diuretics do not take
double dose
Diuretics monitor
weight
Diuretics Must
drink fluid
Maintaining a balance of electrolytes is essential to
the body’s homeostasis. When an electrolyte imbalance occurs, the cause must be promptly identified and treated.
Electrolytes affect multiple functions of the body. What are they.
functions in the body, including: Muscle function Neurologic activity Water balance regulation Bone formation
When do you run lab like the CMP for an otherwise healthy individual on a diuretic?
every 3 to 6 months
When electrolytes are lost, they can normally be replaced by
drinking fluids; this is the preferred treatment approach. However, if fluid loss is substantial, then fluids must be replaced by the intravenous route.
Common electrolytes
Sodium Potassium Calcium Chloride Magnesium Phosphate
This is how you rehydrate
70 to 80 ounces of water a day or one or two servings of electrolyte replacement. An example would be 8 to 16 oz of Gatorade
