Renal disease Flashcards
1
Q
2 most common causes of renal disease
A
diabetes and hypertension
2
Q
acute kidney injury
A
sudden loss of kidney function due to non renal condition
(ex. drugs) often reversible/ temporary, but can be permanent.
3
Q
common cause of AKI
A
dehydration
BUN:SCR
20:1 or greater
4
Q
chronic kidney disease (ckd)
A
progressive loss of kidney function over months or years
5
Q
ESRD (end stage renal disease)
A
BAD! total and permanent renal failure
dialysis (or transplant) is needed to perform functions of the kidneys
6
Q
if the glomerulus is damaged some ___ passes into the urine and this is used along with glomeular filtration rate (GFR) to determine severity of kidney disease also called ____
A
albumin
nephropathy
7
Q
thiazides work on the
A
distal convoluted tubule
8
Q
afferent =
A
in
9
Q
efferent=
A
out
10
Q
SGLT2s work at the
A
proximal tubule
11
Q
k sparing diuretics work at the
A
collecting duct
12
Q
loops work at the
A
ascending loop of henle
13
Q
antidiuretic hormone (ADH) is also called
A
vasopressin
14
Q
loops inhibit the ___ pump
A
na-k pump
sodium potassium pump
15
Q
loops lose ___
A
calcium
so calcium is decreased
can lead to decreased bone density if used long term
16
Q
what pump do thiazides inhibit
A
na-cl
sodium chloride pump
17
Q
thiazides increase ___
A
calcium and have a protective effect on bones overtime
18
Q
spironolactone and epleronone increase
A
potassium
19
Q
must know! select drugs that can cause kidney disease
A
aminoglycosides amphotericin b cisplatin cyclosporine/tacrolimus loops NSAIDS polymyxins radiographic contrast dye vancomycin
20
Q
for crcl use
A
actual body weight if less than IBW
IBW if normal weight by BMI
adjusted body weight if overweight by BMI
21
Q
BUN is
A
blood urea nitrogen and measures the amount of nitrogen in the blood that comes from urea
22
Q
two common lab markers for kidney function
A
increased BUN- but can also be a sign of dehydration
increased SCr
23
Q
creatinine is a waste product of ___ metabolism
A
muscle
24
Q
normal range for SCr
A
0.6-1.3
25
GFR is calculated using which two equations
MDRD- modification of diet in renal disease
| CKD-EPI- chronic kidney disease epidemiology collaboration
26
____ is the primary protein that is measured in the urine to assess kidney diease
albumin
27
___ is sometimes referred to as proteinuria
albuminuria
28
aces and arbs increase what electrolyte
potassium
29
KDIGO
kidney disease improving global outcomes
30
what two things are measured to determine the degree of renal impairment
what are the levels that indicate a patient has ckd and requires specific treatments
GFR and albumin (ACR or AER)
GFR <60
Albuminuria (ACR or AER) 30 or greater
31
it's important to control what two things in CKD for progression of disease
blood pressure
| blood glucose
32
when starting tx with an ace or arb the baseline scr can increase by up to ___. this is expected and treatment should not be stopped. if scr increases by greater than ___ tx should be dc and patient will be referred to a nephrologist.
30%
| 30%
33
use an __ or __ if albuminuria is present acr or aer 30 or greater
ace or arb
34
basic principle of med dosing with impaired renal fx
dose adj. may be necessary when crcl is <60
when crcl is 30 or less additional adj. may be required or may be CI
35
renal fx
120 (normal)
60 (1/2 normal) dose adjust
30 (1/4 normal) CI/dose adjust
36
drugs that require decrease dose or increase interval in CKD
```
aminoglycosides
beta lactam antibiotics (except nafcillin,oxacillin etc. and ceftriaxone)
fluconazole
quinolones (except moxifloxacin)
vancomycin
```
LMWHs (enoxaparin, dalteparin)
apixaban
rivaroxaban
dabigatran
H2RAs (famotidine, ranitidine)
metoclopramide
Bisphosphonates
Lithium
37
drugs that are CI inCKD CRCL less than 60
macrobid
38
drugs that are CI inCKD CRCL less than 50
TDF products
stribild, complera, atripla, symfi, symfi lo
voriconazole IV only
39
drugs that are CI inCKD CRCL less than 30
TAF products
genvoya, biktarvy, descovy, odesefy, symtuza
NSAIDS
Dabigatran
Rivaroxaban
40
drugs that are CI inCKD GFR less than 30
```
SGLT2 I (canagliflozin, dapagliflozin, empagliflozin)
metformin, for treated patients, do not start treatment if gfr is 45 or less
```
meperidine not specified
41
complications that need treatment in CKD
high serum phosphate
anemia
hyperparathyroidism
vit d deficency
42
CKD-MBD is
CKD mineral bone disorder
43
treatment for high serum phosphate in CKD
1) dietary phosphate restriction
| 2) phosphate binders
44
how are phosphate binders taken
prior to each meal
| they bind phosphate from meals in the intestine
45
if meal is skipped phosphate binder should be ___
skipped
46
3 types of phosphate binders
1 aluminum based
2 calcium based (first line)
3 aluminum free-calcium free
47
aluminum hydroxide suspension
rarely used due to risk of aluminum accumulation
can cause nervous system and bone toxicity
"dialysis dementia"
48
aluminum hydroxide suspension is a ___ that is limited to how long of a treatment duration
phosphate binder
| 4 weeks
49
calcium based phosphate binders are ___ ___
| what are the two examples
first line
calcium acetate and calcium carbonate
50
calcium acetate brands
phoslyra, phosLo
51
calcium carbonate brands
tums
52
SEs with calcium based phosphate binders
hypercalcemia, consipation
53
what binds more dietary phosphorus calcium acetate or carbonate
acetate
54
what vitamin increases the risk of hypercalemia when taking calcium
vitamin d
55
```
sucroferric oxyhydroxide (velphora)
ferric citrate (auryxia)
what are these
```
aluminum free
calcium free
phosphate binders
no aluminum accumulation
less hypercalemia
but more expensive
*warnings: iron absorption occurs with ferric citrate
56
lanthanum carbonate brand name
fosrenol
57
fosrenol (lanthanum carbonate)
| what is it
phosphate binder
aluminium free calcium free
GI obstruction! must chew tablet throughly to avoid
N/V/D/C (lots of GI)
58
a non aluminium non calcium baded phosphate binder that is not systemically absorbed
```
sevelamer carbonate (renvela)
sevelamer hcl (renagel)
```
59
sevelamer (renvela) SEs
N/V/D
can lower TC and LDL by 15-30%
can reduce absorption of ADEK consider multivitamin
60
phosphate binders BIND so because of this they have many __, seperate administration from ___ and ___ that chelate.
DI
levothyroxine
antibiotics(quinolones, tetracyclines
61
calcium based phosphate binders interact with what drugs
quinolones
tetracyclines
bisphosphonates
thyroid products
62
in general drugs to seperate from phosphate binders are
levothyroxine
quinolones
bisphosphonates
tetracyclines
63
elevations in parathyroid hormone are treated primarily with
vitamin D
| or calcimimetic to decrease pth
64
vitamin d3
cholcalciferol skin and sun
65
vitamin d2
ergocalciferol dietary source
66
what is the active form of vitamin d3
calcitriol
67
cinacalcet or senispar is only used in ___ patients
dialysis
68
what are the vitamin d analogs
calcitriol
calcifediol
doxercalciferol
paricalcitol
69
what do vitamin d analogs do
they increase intestinal absorption of calcium
which provides negative feedback to the parathyroid gland
and reduces elevations in pth
70
vit d analogs SEs
hypercalcemia, monitor calcium
71
sensipar causes hypo or hypercalcemia
hypo
72
anemia is defined as a hgb or hemoglobin level of less than
13
73
anemia of CKD is caused by lack of ___
epo
| as kidney function declines, epo declines
74
esas can prevent the need for ___ in CKD
blood transfusions
75
esas include
```
epoetin alfa (procrit, epogen)
darbopoetin alfa (aranesp)
```
76
longer lasting esa
aranesp (darbopoetin alfa)
77
risks with ESAs
high BP
| thrombosis (clots)
78
only use ESAs when Hgb is less than
10
| DC if hgb exceeds 11
79
ESAs require adequate ___
iron
80
what is a normal potassium
3.5-5
81
drugs that raise potassium
```
aces
arbs
aliskiren
aldosterone receptor antagonists
canagliflozin
drosperinone containing OCs
bactrim
transplant drugs (cyclosporine/tacrolimus)
NSAIDs
```
82
insulin causes potassium to shift
into the cells, it can treat hyperkalemia
83
the most common cause of hyperkalemia is decreased renal excretion due to ___ failure
kidney
84
patients with diabetes are at increased risk of hyperkalemia as insulin deficiency reduces the ability to shift ___ into the cells and many of these patients take aces or arbs
potassium
85
symptoms of hyperkalemia
muscle weakness, bradycardia, fatal arrhythmias
86
steps for treating hypercalemia acute/emergency
1) stabilize the heart: to prevent arrhythmias: calcium gluconate
2) move the potassium: shift it intracellulary: regular insulin, dextrose, sodium bicarb, albuterol
3) remove it: eliminate k from the body: furosemide, sodium polystyrene sulfonate
87
sodium polystyrene sulfonate (kayexalate)
```
potassium binder (non absorbed cation exchange resin)
can bind other oral meds (separate)
```
88
metabolic acidosis can happen in CKD when to treat
when serum bicarb is less than 22
89
treat low bicarb with
sodium bicarb or sodium citrate/citric acid soln and monitor sodium level and use caution in patients with hypertention and CVD
