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Clin Phys > Renal disease > Flashcards

Renal disease Flashcards

1
Q

What is SCr impacted by?

A

age (muscle declines as we age)
sex (men have more muscle)
race
dietary intake
body compsution (athletes have more muscle)
medications

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2
Q

What does SCr represent?

A

metabolic byproduct of muscle catabolism

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3
Q

What medications can fasely increase SCr?

A

Cimetidine
Trimethoprim

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4
Q

Why is cystatin C better than other renal measurements?

A

Better with changing renal function/ varying protein status

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5
Q

What do we need to calculate CrCl?

A
  1. Stable SCr
  2. baseline value
  3. more than a single value
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6
Q

What is the Cockcroft gault equation?

A

(140-age) X kg / (SCr x 72) x 0.85 if female

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7
Q

What are limitation to cockcroft gault?

A
  1. assumes muscle mass declines linearly with age
  2. different for weight
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8
Q

When is IBW used?

A

actual weight > ideal

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9
Q

How do you calculate IBW?

A

Men: 50 + (2.3 x in> 5ft)
Women: 45.5 + (2.3 x in > 5ft)

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10
Q

When is AdjBW used?

A

actual body weight > 30% than ideal

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11
Q

How do you calculate AdjBW?

A

IBW + 0.4 x (actual- ideal)

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12
Q

Why is the MDRD equation not utilized often?

A
  1. less accurate when GFR >60 mL/ min/ 1.73 m2
  2. lacks data in extreme body weight, pregnancy, elderly
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13
Q

Why is the CKD-EPI equation not used often?

A
  1. less accurate when eGFR < 60 mL/min/1.73 m2
  2. too complex for clinical application
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14
Q

What measurement is best for patients >80

A

cystatin C

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15
Q

What drugs are usually dosed using IBW?

A

Acyclovir
Colistin
Digoxin
Levothyroxine
Lorazepam
IVIG

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16
Q

What drugs are usually dosed with AjdBW?

A

Amikacin
Gentamicin
Heparin
Tobramycin

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17
Q

What is chronic kidney disease?

A

GFR < 60 mL/min/1.73m2 due to damages endothelium and sclerosis leading to proteinuria

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18
Q

What can CKD lead to?

A

fluid, electrolyte, acid-base disorders

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19
Q

GFR >/= 90

A

G1

20
Q

GFR 60-89

A

G2

21
Q

GFR 45-59

A

G3a

22
Q

GFR 30-44

A

G3b

23
Q

GFR 15-29

A

G4

24
Q

GFR <15

A

G5

25
Q

Albuminuria <30 mg/g

A

A1

26
Q

Albuminuria 30-300 mg/g

A

A2

27
Q

Albuminuria >300 mg/g

A

A3

28
Q

What are signs of uremia?

A

CrCl <10 mL/min
HTN
Asterixis
Jugular venous distension

29
Q

What increases as a result of CKD?

A

BUN
K
Phosphate
urinary acid

30
Q

What decreases as a result of CKD?

A

bicarbonate

31
Q

What are signs of CKD?

A

Edema
weight gain
changes in urine output
foaming of urine

32
Q

What disease can be cause as a result of CKD?

A

PTH

33
Q

What are symptoms of uremia?

A

anorexia
weight loss
dyspnea
fatigue
pruritis
sleep disturbance
encephalopathy
excess bleeding

34
Q

Why do thiazide diuretics have limited utility in stage 3-5 CKD?

A

loose effectiveness if CrCl <60

35
Q

What stage of AKI is 1.5-1.9x baseline
OR increase in 0.3 mg/dL within 48 hours
OR < 0.5 mL/kg/hr for 6-12 hours?

A

stage 1

36
Q

What stage of AKI is 2.0-2.9x baseline
OR < 0.5 mL/kg/hr for 12 hours or more?

A

stage 2

37
Q

What stage of AKI is 3.0x baseline
OR increase to 4.0 mg/dL
OR initiation of renal replacement
OR < 0.3 mL/kg/hr for 24 hours
OR anuria for 12 hours or more?

A

stage 3

38
Q

Can CrCl be calculated with an AKI?

A

no

39
Q

What labratory findings indicate prerenal AKI?

A
  1. Hyaline casts
  2. no urinary RBC
  3. > 40:1 BUN/SCr
40
Q

What is prerenal AKI associated with?

A

hypovolemia

41
Q

What laboratory findings indicate intrinsic AKI?

A
  1. granular casts, cellular debris
  2. urinary RBC 2-4+
  3. <20:1 BUN/SCr
42
Q

What is intrinsic AKI associated with?

A

drugs:
aminoglycosides
PPI
NSAIDs
acyclovir

43
Q

What laboratory findings indicate postrenal AKI?

A
  1. cellular debris
  2. urinary RBC variable
  3. <20:1 BUN/SCr
44
Q

What are symptoms of AKI?

A
  1. cola-colored urine
    2.. sudden decrease in urine output
  2. N/V
  3. fatigue
  4. weight gain/loss
  5. rashes
  6. fever
  7. arthalgias
45
Q

What needs to be considered when dosing drugs during an AKI?

A
  1. SCr lags behind true renal function
  2. volume of distribution changes may occur
  3. if anuric or rapidly increasing SCr–> assume CrCL <10mL/min

Clin Phys (15 decks)

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