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Renal Disease Flashcards

1
Q

What is the difference AKI and CKD? ESRD?

A

AKI: A sudden loss of kidney function that is often reversible (can be permanent)

CKD: A progressive loss of kidney function over months or yrs

ESRD: Total and permanent kidney failure where fluid and waste accumulate

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2
Q

Most common causes of renal disease?

A

HTN and diabetes

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3
Q

Criteria for dehydration?

A

BUN:sCR of >20:1
Low urine output
Dry mucus membranes
Tachycardia

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4
Q

Drug that acts on the DCT? Electrolyte?

A

Thiazide and potassium-sparing

Na reabsorbed here

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5
Q

Drug that acts on the PCT? Electrolyte?

A

SGLT2i

Na and Ca reabsorbed here

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6
Q

Where do loop diuretics work on? Electrolyte?

A

Ascending loop of Henle

Na and Ca reabsorbed here

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7
Q

Drug that acts on the collecting duct?

A

Potassium sparing

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8
Q

Drugs that can cause nephrotoxicity?

A
  1. Aminoglycosides
  2. Amph B
  3. Cisplatin
  4. Cyclosporine
  5. Loops
  6. NSAIDs
  7. Polymixins
  8. Contrast dyes
  9. Tacrolimus
  10. Vanc
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9
Q

What is the criteria for CKD?

A

Decreased GFR or albuminuria ≥3 months

eGFR <60

Albuminuria: AER ≥30 mg/d or UACR ≥ 30 mg/g

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10
Q

GFR 60-89 + kidney damage

A

Stage 2

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11
Q

GFR 30-44

A

Stage 3b

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12
Q

GFR ≥90 + kidney damage

A

Stage 1

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13
Q

GFR 15-29

A

Stage 4

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14
Q

GFR 45-59

A

Stage 3a

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15
Q

GFR <15

A

Stage 5

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16
Q

A1

A

ACR or AER <30

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17
Q

A2

A

ACR or AER 30-300 (microalbuminuria)

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18
Q

A3

A

ACR or AER >300 (macroalbuminuria)

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19
Q

Why is ACE or ARB first line for albuminuria?

A
  1. Reduce pressure in the glomerulus
  2. ↓ albuminuria
  3. Delay progression to ESRD
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20
Q

BP goal for HTN according to KDIGO?

A

<120

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21
Q

Drugs requiring adj at CrCl <60

A

Nitrofurantoin

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22
Q

Drugs requiring adj at CrCl <50

A

TDF
IV Voriconazole (vehicle)

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23
Q

Drugs requiring adj at CrCl <30

A

TAF
NSAIDs
Dabigatran

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24
Q

Drugs requiring adj at eGFR <30

A

Metformin

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25
Labs to monitor for CKD-MBD?
PTH, PO4, Ca, Vit D
26
How can CKD affect phosphate levels?
1. Low renal clearance of PO4 leading to high serum PO4 2. Vit D can't be activated by the kidneys leading to low Ca absorption and low serum Ca 3. Low Ca and high PO4 in serum increases PTH that allow Ca to be pulled from the bones leading to bone demineralization and increased fractures 4. Kidneys produce less EPO leading to decreased RBC (anemia)
27
What are the classes of phosphate binders?
1. Aluminum-based 2. Calcium-based 3. Aluminum and calcium free
28
Aluminum-based PO4 binder?
Aluminum hydroxide
29
ADR of AlOH
Aluminum tox (CNS and bone tox → confusion, seizures, osteomalacia) constipation
30
Dosing of AlOH
TID with meals
31
Ca-based PO4 binders
Calcium acetate Calcium carbonate
32
Dosing of Ca-based PO4 binders
TID with meals
33
Ca-based PO4 binders ADR
Hypercalemia (especially with Vet D → increased Ca absorption), constipation,
34
Total daily dose of elemental Ca
≤2000 mg
35
Elemental Ca amounts
Citrate: 21% Carbonate: 40% Acetate: 25%
36
Aluminum and calcium free PO4 binder
Sucroferric oxyhydroxides Ferric citrate Lanthanum carbonate Sevelamer carbonate Sevelamer HCl
37
Sevelamer carbonate
Renvela
38
Sevelamer HCl
Renagel
39
Dosing of Aluminum and calcium free PO4 binder
TID with meals Lanthanum carbonate: chew tablet thoroughly
40
ADR of ferric citrate and sucroferric
Diarrhea, black feces, constipation (ferric citrate → iron absorption)
41
ADR of Lanthanum
N/V, diarrhea, constipation
42
ADR of Sevelamer
N/V/D Lower LDL
43
DDI with phosphate binder?
Separate admin from Levothyroxine, quinolones, and tetracyclines Can bind to polyvalent cations chelating other drugs
44
Vit D3
Cholecalciferol
45
Vit D2
Ergocalciferol
46
How CKD leads to Vet D deficiency?
Kidneys are unable to hydroxylate Vit D to final active form 1,25-dihydroxy Vit D
47
Active form of Vit D3
Calcitriol (Rocaltrol)
48
Calcimimetic mechanism and agents?
Mimics the action of Ca on parathyroid gland and causes a further reduction in PTH Only used for dialysis Cinacalcet Etelcalcetide
49
ADR of Vit D analogs? Dosing
Hypercalcemia (less with paricalcitol and doxercalciferol) Take with food to ↓ GI upset (calcitriol)
50
Vit D analogs
Calcitriol Calcifediol Doxercalciferol Paricalcitol
51
Calcitriol
Rocaltrol
52
Cinacalcet
Sensipar
53
ADR of Calcimimetic
Hypocalemia → decreased bone turnover Etelcalcetide: Muscle spasms and paresthesia
54
Indication to use calcimimetics
Dialysis
55
Agent for anemia of CKD
ESAs
56
ESAs
Epoetin alfa (Procrit, Epogen, Retacrit) Longer agent: Darbepoetin alfa (Aranesp)
57
ADR of ESAs
Elevated BP, thrombosis
58
Indication for ESA
1. Hgb <10, dose should be held of dc'd is Hgb >11 due to thrombosis risk 2. Only effective with adequate iron (IV iron is given at dialysis centers)
59
PO ESA
Daprodustat (Jesduvroq)
60
Normal K levels
3.5-5
61
Drugs that raise K levels
1. ACEI 2. Aliskiren 3. ARB 4. Canagliflozin 5. K fluid and supplements 6. K-sparing diuretics 7. Bactrim 8. Transplant drugs (cyclosporine, tacrolimus)
62
Why are diabetics at higher risk for hyperkalemia
Insulin deficiency reduces the ability to shift K into cells
63
Sx of hyperkalemia
Muscle weakness, bradycardia, fatal arrhythmia
64
Step to address symptomatic hyperkalemia?
1. Stabilize the heart to prevent arrhythmias 2. Shift K intracellularly 3. Remove K
65
Agents to stabilize heart. Onset
Calcium gluconate (1st line) Calcium chloride 1-2 min
66
Agent to shift K, Onset
1. Regular insulin + Dextrose (Give insulin alone if BG ≥250) 2. Sodium bicarb (if metabolic acidosis is present) 3. Albuterol (monitor tach and chest pain) 30 min
67
Agents to remove K. Onsets
1. Loops: 5 min 2. Sodium polystyrene sulfonate (SPS) PO or rectal: 2-24 hrs 3. Patiromer PO: 7 hrs 4. Sodium zirconium cyclosilicate PO: 1 hr 5. Hemodialysis: immediate
68
Potassium binders
1. SPS 2. Patiromer 3. SZC
69
SPS limitation of use
GI necrosis risk when administered with sorbitol → limited usage Hypernatremia, fecal impaction
70
Patiromer
Veltassa
71
Patiromer ADR and limitation of use
Hypomagnesemia, constipation Delayed onset of action and powder must be stored in fridge
72
SZC use and ADR
Fastest onset of action ADR: Worsen GI motility, peripheral edema due to sodium
73
Counseling of potassium binders
Separate other drugs at least 2 hrs before or 2 hrs after
74
Agents for metabolic acidosis
1. Sodium bicarb 2. Sodium citrate/citric acid solution (Cytra-2, oracrti)
75
When is metabolic acidosis treated?
Serum bicarb <22
76
Drugs that can be removed by dialysis?
1. Small size 2. Large Vd 3. Low PPH
77
Dialysis factors that can remove more drug?
1. High flux (large pore size) and high-efficiency (large surface area) HD filters 2. Higher dialysis flow rates
78
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NAPLEX Prep (35 decks)

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