Renal Disease

Question 1

What are the most common causes of renal disease?

Answer 1

diabetes and hypertension

Question 2

The primary functional unit of the kidney (nephron), job is to control the concentration of:

Answer 2

sodium and water

Question 3

the afferent arteriole delivers blood into/out of the glomerulus

Answer 3

into

efferent = exit

Question 4

what is used to assess the severity of kidney disease?

Answer 4

the amount of albumin in the urine along with the GFR

Question 5

Is the proximal tubule closest to the bowman’s capsule?

Answer 5

yes (where SGLT2 inhibitors work)

Question 6

where do loops diuretics work?

Answer 6

they inhibit the NA-K pump in the ascending lime of the loop of henle (cause Ca depletion)

Question 7

Where do thiazides work?

Answer 7

the distal convoluted tubule - they inhibit the NaCl pump (increase Ca reabsorption – protective for bones)

Question 8

aldosterone works where?

Answer 8

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)

Question 9

What are common key drugs that cause kidney disease?

Answer 9

AG

ampho B

cisplatin
cyclosporine

loops
NSAIDs

polymyxins

radiographic dye

tacrolimus

vanc

Question 10

What is first line to prevent progression of disease in patients with CKD, diabetes and or HTN if albuminuria is present?

Answer 10

ACE or ARBs

inhibits RAAS, causing efferent arteriolar dilation

Question 11

When starting treatment with an ACE or ARB, the baseline SCr can increase by up to…

Answer 11

30% - this is expected and treatment should NOT be stopped. however, if >30%, the treatment should be D/C

Question 12

What should be monitored after starting ACE/ARBs?

Answer 12

potassium - up to 1-2 weeks

Question 13

What are common key drugs that require dose increase or increase in CKD?
Anti-infectives:

Answer 13

anti-infectives-

AG (increase dosing)
beta lactam (except anti staphylococcal PCNs and ceftriaxone)
fluconazole
quinolones (except moxi)
Vancomycin

Question 14

What are common key drugs that require dose increase or increase in CKD?
CV drugs:

Answer 14

LMWH (enoxaprin)
rivaroxaban (afib)
apixaban (afib)
dabigatran (afib)

Question 15

What are common key drugs that require dose increase or increase in CKD?
GI drugs

Answer 15

H2RAs (famotidine, ranitidine)

metoclopramide

Question 16

What are select drugs that are contraindicated in CKD?

CrCl <60

Answer 16

nitrofurantoin

Question 17

What are select drugs that are contraindicated in CKD?

CrCl <50

Answer 17

tenofovir disoproxil fumarate (Stribild, Complera, Atripla, symfi, symfi lo)

voriconazole IV

Question 18

What are select drugs that are contraindicated in CKD?

CrCl <30

Answer 18

tenofovir alafenamide (renvoya, biktarvy, descovy, odefsey, symtuza)

NSAIDs

dabigatran (DVT/PE)
rivaroxaban (DVT/PE)

Question 19

What are select drugs that are contraindicated in CKD?

GFR <30

Answer 19

SGLT2 metformin

Question 20

Patients with advanced kidney disease require monitoring of

Answer 20

PTH
phosphorus (phosphate and PO4)
Ca & vitamin D

Question 21

when restricting dietary phosphate, what do patients avoid?

Answer 21

dairy products
cola
chocolate
nuts

Question 22

What is first line in phosphate binders?

Answer 22

calcium-based: Phoslyra, PhosLo, Tums

TID with meals

Question 23

What is the name of the non-calcium, non-aluminum based phosphate binder that is not systemically absorbed?

Answer 23

sevelamer carbonate (Renvela)

can lower LDL too

Question 24

After controlling hyperphosphatemia, elevations in PTH are treated primarily with

Answer 24

vitamin D

Question 25

What is the primary dietary source of vitamin d?

Answer 25

d2, ergocalciferol

Question 26

this drug, _____, is the active form of vitamin D3

Answer 26

calcitriol (Rocatrol)

Question 27

this drug mimics the actions of calcium on the parathyroid gland and causes further reduction in PTH, only used in dialysis patients

Answer 27

cinacalcet (Sensipar)

*hypocalcemia

Question 28

ESAs are only effective if adequate ____ is available to make hemoglobin

Answer 28

iron

*need iron panel (iron, ferritin, and TSAT)

Question 29

Renal potassium excretion is increased by the hormone_____, and this drug

Answer 29

aldosterone

loops (loops>thiazides)

Question 30

what does insulin do to potassium?

Answer 30

causes potassium to shift into cells

*reasons why ESRD are at risk for hyperkalemia

Question 31

what are symptoms of hyperkalemia?

Answer 31

muscle weakness, bradycardia and fatal arrhythmias

Question 32

What are select drugs that increase potassium levels?

Answer 32

ACE/ARBs

aldosterone receptor antagonists

aliskiren

canagliflozin

dropirenone-containing COCs

Bactrim

transplant drugs

Question 33

When treating severe hyperkalemia, what is the intervention when you want to stabilize the heart?

Answer 33

administer IV calcium gluconate

works by stabilizing myocardial cells - does not decrease potassium

1-2 min onset

Question 34

When treating severe hyperkalemia, what is the intervention when you want to shift potassium back into the cells?

Answer 34

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

Question 35

When treating severe hyperkalemia, what is the intervention when you want to remove potassium from the body?

Answer 35

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

Question 36

Brand: SPS, Kayexalate

Answer 36

generic: sodium polystyrene sulfonate