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MNT Prep > Renal/CKD > Flashcards

Renal/CKD Flashcards

1
Q

What is considered a good GFR? What does the GFR indicate?

A

125mL/min/1.73m2 (norm=120-200)

Renal function indicator

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2
Q

What is reabsorbed in the proximal tubule? (Right after the glomerulus)

A

Na, K, H2O, and aa

Uncontrolled, just happens

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3
Q

What is reabsorbed in the loop of henle and why? How/where is it absorbed?

A

Urine concentration control: Mostly water b/c of super salty medulla environment (passive)
Descending- Na reabsorbed (active)
Ascending- mostly water again

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4
Q

What is reabsorbed in the distal tubules? (After the loop of henle)

A

Na and H2O
Secreted= K and H
Variable and controlled based on concentration of urine (urine enters collecting duct from here)

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5
Q

How much blood does the kidney filter everyday? How much urine is produced?

A

900-1600L blood

1.5 L of urine

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6
Q

What happens at the juxtaglomerular apparatus?

A

The distal tubule touches the glomerulus and the concentration tells why her or not renin needs to be released
(High osmolality=secrete renin=up H2O)

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7
Q

What is renal function? Renal failure?

A

Kidneys ability to adequately eliminate N waste

Inability to secrete N waste.

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8
Q

What is azotemia? Oliguria?

A

High N waste products in blood (kidney not eliminating properly)

Excrete less that 500mL urine/day

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9
Q

What’s renal solute load? What’s it made of?

A

The amount of N waste and minerals that HAS to be excreted daily.
N (urea), Uric acid, Cr, NH4, K, Na, Cl

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10
Q

What is needed with a high RSL? What is possible range of urine concentration?

A

More fluid to excrete it.

Normal urine osmolality is from 50-1200 mOsm

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11
Q

What is obligatory urine loss?

A

Minimum fluid necessary to remove waste materials in urine (this will be higher if you eat a lot of protein)
Depends on how well the kidney can concentrate the urine

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12
Q

What is facultative urine loss?

A

Urine loss depends on tubular resorption rates and body needs

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13
Q

What is normal adult urine concentration (RSL)?

How do you calculate RSL?

A

1200-1400 mOsm/L

mOsm= (g Pro * 5.7) + mEq (Na+K+Cl)

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14
Q

What is the endocrine control of body water and how?

A

ADH/vasopressin (post pituitary gland)
It increases permeability of distal and collecting tubules when osmolality is high so increase H2O reabsorption.
ADH tries to decrease the osmolality

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15
Q

How are SGLT 2 inhibitor drugs (invokana) r/t the kidney?

A

SGLT is a transporter in the proximal tubule to bring glucose back into the blood.
The drug stops this transporter so glucose is excreted and lowers blood level (DM)

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16
Q

How are ACE inhibitors r/t kidney function?

A

ACE inhibitors block ADH to stop water reabsorption to keep BP low (CVD). Sometimes we don’t want that because we want urine to be the correct concentration.

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17
Q

Describe the renin-angiotensin? What does it control?

A

Controls BP
BV is low, kidney secrete renin to make angio into aldosterone (adrenal glands) which reabsorbs Na. Higher osmolality will increase water reabsorption and up BV and BP.

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18
Q

How is RBC production controlled?

A

Kidney producing EPO

Deficiency common with chronic renal anemia

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19
Q

Where does aldosterone act?

A

On the distal tubule to controllably increase Na reabsorption. (Active)

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20
Q

What are the 3 main hormone/Vit and 3 main areas of calcium-phosphorus homeostasis?

A

PTH, calcitonin, and vitamin D

In the kidneys, bones, and intestine

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21
Q

How is PTH triggered and what are its 3 main effects?

A

Low Ca=high PTH

  • kidney increases Ca reabsorption
  • osteoclasts break bone to release Ca and phosphorus
  • kidneys convert Vit D to active form (calcitonin increases Ca absorption in gut)
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22
Q

What are the 4 classic renal indicators?

A

High BUN
High creatinine
High phosphorus
High potassium

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23
Q

Normal and CKD range of BUN?

A

10-20mg/dL

CKD: 60-80 mg/dL (dialysis and eating protein)

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24
Q

Normal and CKD range for creatinine?

A

M: .5-1.1 mg/dL
F: .6-1.2

CKD: 2-15 mg/dL (muscle mass, GFR, and dialysis clearance)

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25
Q

Normal and CKD values for phosphorus?

A

3.0-4.5 mg/dL

CKD: 3.5-5.5 mg/dL (towards normal)

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26
Q

Normal and CKD values for potassium?

A

3.5-5.0 mEq/L (or mmol/L)

CKD: 3.5-6.0 mEq/L

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27
Q

Albumin normal and CKD values? Issues with albumin?

A

3.5-5.0 g/dL
CKD: >4 g/dL

Albuminuria- marker
Protein is lost with dialysis so if alb

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28
Q

Normal and CKD Prealbumin levels? Why is it typically elevated with CKD? What are its disadvantages?

A

15-36mg/dL, CKD: >30 mg/dL
Higher because kidney can’t degrade it like normal
PAB= neg acute phase (so high with inflammation and dialysis), not nutritionally correlated, and high wth CKD

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29
Q

Normal and CKD serum creatinine values? Used to measure what? Controlled by what?

A

.5-1.2 and CKD= 2-15.0 mg/dL

Shows extent of failure at Dx and used to monitor Tx ( ms breakdown usually excreted in urine)

Controlled with dialysis

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30
Q

What does creatinine clearance measure? What does it indicate? Is it high or low with CKD?

A

Indicates GFR
Measures renal damage and used to stage CKD
Usually low with CKD

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31
Q

What does BUN indicate? What is it influenced by? Why is it higher with disease?

A

Extent of renal failure
Influenced by hydration, too much Pro, GI bleed, low kcals or hypercatabolism
Higher because N or urea aren’t excreted well

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32
Q

What is CRF and stage 4/5 CKD BUN:Cr ratio?

A

15 is pro intake high, catabolic, dehydration

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33
Q

What happens with high K levels? How is K managed? What is a risk of dialysis?

A

Over 7 mEq/L- cardiac arrhythmia

Diet, drugs, and dialysis

Dialysis can cause hypokalemia

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34
Q

What drugs should be avoided to help control K levels?

A

K sparing diuretics

Spironolactone and triamterene because they retain K and K is already being retained

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35
Q

Why are Ca levels usually low with CKD? What is a goal range for Ca with CKD?

A

High phosphate levels mean lower Ca levels
Lower Vit D metabolism by kidney means less absorption in the GI

9-10.5 mg/dL

36
Q

How are high levels of phosphate managed? What should the value always be under?

A

Diet and phosphate binders

Keep under 6 mg/dL

37
Q

How much Ca is bound to albumin?

What calculation do you need to use for corrected serum Ca when albumin is low?

A

60% Ca is bound to alb

[(4 g/dL - reported albumin)*0.8] + reported calcium

38
Q

What is calciphlaxis? What measurement (and its value) is used to find higher risk for it?

A

Disease- calcium and phosphorus deposition in soft tissues
Calcium- Phosphorus Product:
>55. (-75) is increased calcification risk
NO Ca SUPPLeMENTS.

39
Q

What blood and lipid values could be off and why?

A

TG and cholesterol high due to high meat diet. Keep it below 200mg/dL with CKD

Hct and Hb levels slightly lower if controlled

40
Q

Sodium goal and reasons for fluctuations.

A

136-145 mEq/L

If wt stable- urine Na from intake
If wt changing- Na retention and fluid fluctuations.

41
Q

What is dry weight?

A

Edema free body weight
Wt with normal hydration, normal BP and no edema (WNL Na)

With dialysis pt- dry weight is after dialysis

42
Q

What does standard body weight indicate?

How do you find %SBW?

A

Nutritional status

(Actual BW/SBW)*100

43
Q

What are obese and malnutrition classifications with SBW?

A

Over 115% and under 90%

44
Q

What is the calculation for adjusted BW?

A

BW ef + [(SBW- BW ef) * 0.25]

Use when less than 95% and > 115 %

45
Q

Define CKD.

A

Irreversible nephron damage

46
Q

How is the severity of CKD measured?

A

Low creatinine and urea clearance
(Shows high serum Cr and Urea)
EsRD= ClCr less than 10

47
Q

Stage 1 CKD

A

GFR- 90 or above
No Sx
No special diet

48
Q

Stage 2 CKD

A

GFR 60-89
Mild azotemia
High BUN and Cr
No diet

49
Q

Stage 3 CKD

A

GFR 30-59
Moderate azotemia
High BUN and Cr
Phosphorus restriction and emphasize B and C vits (maybe D Zn and Fe)

50
Q

Stage 4 CKD

A 
GFR 15-29 
Restrict protein (0.6g/kg) 
30-35 kcal 
Phosphorus restriction
Ca- stay under 2000mg/day
51
Q

Stage 5 CKD

A 
Permanent 
Oliguria or anuria 
GFR less than 15 
Need dialysis 
Protein .6-.75g/d (without dialysis)
52
Q

Leading cause and some others of CKD.

A

DM
Low PTH
High Ca and high K
Vascular disease

53
Q

3 stages of Tx profession for CKD

A

Diet and drugs (conservative management)
Dialysis
Transplant

54
Q

Adjusted ef BW formula and when to use it.

A

Use if SBW over 115 or under 95.

BWef + [(SBW-BWef) * 0.25]

55
Q

Dry weight (or edema free) is when (4 things)

A

Normal BP
Normal serum Na
No edema
Normal hydration

(Or right after dialysis)

56
Q

Name a drug to control hyperkalemia and some of its dietary SA.

A

Kayexlate
Increase Mg and Ca losses, raises serum Na
Use with low K diet
(It’s a cation exchange resin)

57
Q

What is a V supp used for CKD

A

Nephrovite

High in water soluble vitamins and low in fat soluble vitamins

58
Q

What drug stimulates RBC production? What else is taken with it?

A

EPO
If iron stores low (need ferritin over 100 ng/mL), give Fe supplement
Do NOT take Ca supp at same time as Fe supp

59
Q

What drugs control hyperphosphatemia? What are the forms?

A

Phosphate binders bind phosphate in GI tract.
Take within 1/2 hour of eating.
Liquid, calcium based, or aluminum based (only use short term!)

60
Q

3 examples of Al phosphate binders and when are they used?

A

Basaljel, alternagel, amphojel

Use of phosphate over 6.0 and only use for 1 month

61
Q

3 examples of Ca phosphate binders and when should they be avoided?

A

Ca acetate, Phoslo, Tums

No if serum phosphate over 6.0 or if calcium phosphate product is over 60.

62
Q

What is Rocaltrol? What is the IV version?

A

Active Vit D supps
Help maintain serum Ca WNL and lower PTH levels

Calcijex (IV)

63
Q

When to not give active vitamin D?

A

Phosphate over 6.0 mg/dL
Calcium over 11.5 mg/dL
Calcium phosphate product over 60
Intact PTH less than 150

64
Q

3 common ACE inhibitors and action and SA?

A

Capoten, vasotec, altace, or “ril”
Stop aldosterone from being made so less Na reabsorption in distal tubule.
Can cause high K
Restrict diet K if on ACE and serum K over 5.6

65
Q

What are protein levels for the following GFR?

A

.6-.8 (adj if obese)
.6 (adj if obese)
.8
1.2

66
Q

What is a high Na food? What are Na recs based on fluid output?

A 
400mg/serving 
 Over 1 L output = 2-4g Na 
Less than 1L output= 2g Na 
Typical US diet= 4-8g 
General rule= less than 2.4 g/day
67
Q

When does K usually need restricted?

What are HD K guidelines?

A

If GFR under 15 or late CKD
If one ACE inhibitor

HD: 2-3g/day

68
Q

When is phosphate restricted and to what? When is Ca usually too low?

A

If GFR

69
Q

3 main groups high in phosphorus?

A

Meats, legumes, dairy

Phosphorus is controlled with DIET!!

70
Q

How do you limit interdialytic wt gain during HD? (Fluid intake)

A

> 1 L fluid output = 2L intake

71
Q

Fluid recs for edema on HD?

A

Fluid output + 500 mL

72
Q

What main nutrients are modified for pre-dialysis pt?

A

Protein (stage 4)
K (4 or 5)
Phosphorus (4)
Fluid (later CKD)

73
Q

What main groups are modified for dialysis pt?

A 
Kcals (35) 
Protein (1.2) 
Na (if low urinary output) 
K (2-3G/day)
Phosphorus (800-1000)
Fluid (based on urinary output) 
Vits- B, C, D 
Minerals- Fe, Ca (less than 2g/d) 
Fats- TLC??
74
Q

5 high K food sources and what’s high?

A

Over 200mg per serving

Avocado, cooked broccoli or mushrooms, Brussels sprouts, fresh apricot, dates

75
Q

5 foods low in K and what is low?

A

Less than 200 mg/serving.

Canned apricots, berries, apples, brassica family, fresh broccoli, zucchini cooked

76
Q

What are protein levels for the following GFR?

A

.6-.8 (adj if obese)
.6 (adj if obese)
.8
1.2

77
Q

What is a high Na food? What are Na recs based on fluid output?

A 
400mg/serving 
 Over 1 L output = 2-4g Na 
Less than 1L output= 2g Na 
Typical US diet= 4-8g 
General rule= less than 2.4 g/day
78
Q

When does K usually need restricted?

What are HD K guidelines?

A

If GFR under 15 or late CKD
If one ACE inhibitor

HD: 2-3g/day

79
Q

When is phosphate restricted and to what? When is Ca usually too low?

A

If GFR

80
Q

3 main groups high in phosphorus?

A

Meats, legumes, dairy

Phosphorus is controlled with DIET!!

81
Q

How do you limit interdialytic wt gain during HD? (Fluid intake)

A

> 1 L fluid output = 2L intake

82
Q

Fluid recs for edema on HD?

A

Fluid output + 500 mL

83
Q

What main nutrients are modified for pre-dialysis pt?

A

Protein (stage 4)
K (4 or 5)
Phosphorus (4)
Fluid (later CKD)

84
Q

What main groups are modified for dialysis pt?

A 
Kcals (35) 
Protein (1.2) 
Na (if low urinary output) 
K (2-3G/day)
Phosphorus (800-1000)
Fluid (based on urinary output) 
Vits- B, C, D 
Minerals- Fe, Ca (less than 2g/d) 
Fats- TLC??
85
Q

5 high K food sources and what’s high?

A

Over 200mg per serving

Avocado, cooked broccoli or mushrooms, Brussels sprouts, fresh apricot, dates

86
Q

5 foods low in K and what is low?

A

Less than 200 mg/serving.

Canned apricots, berries, apples, brassica family, fresh broccoli, zucchini cooked

MNT Prep (27 decks)

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