Renal Disease Flashcards
What are the most common causes of renal disease?
diabetes and hypertension
The primary functional unit of the kidney (nephron), job is to control the concentration of:
sodium and water
the afferent arteriole delivers blood into/out of the glomerulus
into
efferent = exit
what is used to assess the severity of kidney disease?
the amount of albumin in the urine along with the GFR
Is the proximal tubule closest to the bowman’s capsule?
yes (where SGLT2 inhibitors work)
where do loops diuretics work?
they inhibit the NA-K pump in the ascending lime of the loop of henle (cause Ca depletion)
Where do thiazides work?
the distal convoluted tubule - they inhibit the NaCl pump (increase Ca reabsorption – protective for bones)
aldosterone works where?
in the DCT and collecting duct to increase Na and water reabsorption and decrease K reabsorption. (aldosterone antagonists work against this - more Na and water excreted and serum K increases)
What are common key drugs that cause kidney disease?
AG
ampho B
cisplatin
cyclosporine
loops
NSAIDs
polymyxins
radiographic dye
tacrolimus
vanc
What is first line to prevent progression of disease in patients with CKD, diabetes and or HTN if albuminuria is present?
ACE or ARBs
inhibits RAAS, causing efferent arteriolar dilation
When starting treatment with an ACE or ARB, the baseline SCr can increase by up to…
30% - this is expected and treatment should NOT be stopped. however, if >30%, the treatment should be D/C
What should be monitored after starting ACE/ARBs?
potassium - up to 1-2 weeks
What are common key drugs that require dose increase or increase in CKD?
Anti-infectives:
anti-infectives-
AG (increase dosing) beta lactam (except anti staphylococcal PCNs and ceftriaxone) fluconazole quinolones (except moxi) Vancomycin
What are common key drugs that require dose increase or increase in CKD?
CV drugs:
LMWH (enoxaprin)
rivaroxaban (afib)
apixaban (afib)
dabigatran (afib)
What are common key drugs that require dose increase or increase in CKD?
GI drugs
H2RAs (famotidine, ranitidine)
metoclopramide
What are select drugs that are contraindicated in CKD?
CrCl <60
nitrofurantoin
What are select drugs that are contraindicated in CKD?
CrCl <50
tenofovir disoproxil fumarate (Stribild, Complera, Atripla, symfi, symfi lo)
voriconazole IV
What are select drugs that are contraindicated in CKD?
CrCl <30
tenofovir alafenamide (renvoya, biktarvy, descovy, odefsey, symtuza)
NSAIDs
dabigatran (DVT/PE)
rivaroxaban (DVT/PE)
What are select drugs that are contraindicated in CKD?
GFR <30
SGLT2 metformin
Patients with advanced kidney disease require monitoring of
PTH
phosphorus (phosphate and PO4)
Ca & vitamin D
when restricting dietary phosphate, what do patients avoid?
dairy products
cola
chocolate
nuts
What is first line in phosphate binders?
calcium-based: Phoslyra, PhosLo, Tums
TID with meals
What is the name of the non-calcium, non-aluminum based phosphate binder that is not systemically absorbed?
sevelamer carbonate (Renvela)
can lower LDL too
After controlling hyperphosphatemia, elevations in PTH are treated primarily with
vitamin D
What is the primary dietary source of vitamin d?
d2, ergocalciferol
this drug, _____, is the active form of vitamin D3
calcitriol (Rocatrol)
this drug mimics the actions of calcium on the parathyroid gland and causes further reduction in PTH, only used in dialysis patients
cinacalcet (Sensipar)
*hypocalcemia
ESAs are only effective if adequate ____ is available to make hemoglobin
iron
*need iron panel (iron, ferritin, and TSAT)
Renal potassium excretion is increased by the hormone_____, and this drug
aldosterone
loops (loops>thiazides)
what does insulin do to potassium?
causes potassium to shift into cells
*reasons why ESRD are at risk for hyperkalemia
what are symptoms of hyperkalemia?
muscle weakness, bradycardia and fatal arrhythmias
What are select drugs that increase potassium levels?
ACE/ARBs
aldosterone receptor antagonists
aliskiren
canagliflozin
dropirenone-containing COCs
Bactrim
transplant drugs
When treating severe hyperkalemia, what is the intervention when you want to stabilize the heart?
administer IV calcium gluconate
works by stabilizing myocardial cells - does not decrease potassium
1-2 min onset
When treating severe hyperkalemia, what is the intervention when you want to shift potassium back into the cells?
regular insulin IV – co-administered with glucose/dextrose
dextrose IV – stimulates insulin sectarian
sodium bicarb IV – when metabolic acidosis is present
albuterol (nebulized)
onset 30 mins
When treating severe hyperkalemia, what is the intervention when you want to remove potassium from the body?
furosemide IV, 5 mins******* for acute
sodium polystyrene sulfonate oral or rectal, ONE HOUR
patiromer oral - SEVEN HOURS
sodium zirconium cyclosilicate oral - ONE HOUR
hemodialysis - immediate
Brand: SPS, Kayexalate
generic: sodium polystyrene sulfonate
