Renal Disease

Question 1

Most common causes of CKD

Answer 1

HTN and Diabetes

Question 2

Proteins normally do not pass through the glomerulus (t/f)

Answer 2

true

if protein in urine, then that is indicative of kidney damage

Question 3

Which type of diuretic depletes calcium over a long period of time?

Answer 3

Loop diuretics

block resoprtion of Na and Ca in the loop of Henle

Question 4

role of aldosterone in the kidney

Answer 4

works in the distal conv tubules and collecting duct to incr Na and water retention, and decr K

Question 5

Drugs that cause kidney disease

Answer 5

Aminoglycosides
amphotericin B
Cisplatin
Cyclosporin/tacrolimus
loop diuretics
NSAIDs
Vanco

Question 6

What is BUN?

Answer 6

the amount of nitrogen that comes from urea
urea is a waste product of protein metabolism

kidney damage and dehydration can incr BUN

Question 7

Cockcroft-Gault formula might not be preferred in…

Answer 7

young children
ESRD
unstable renal function

will overestimate kidney func for frail pts with little muscle mass

Question 8

What values are used to classify CKD?

Answer 8

GFR and albumin in the urine

Question 9

When starting an ACEi/ARB how much will SCr generally increase?

Answer 9

up to 30% incr

stop if greater than 30% incr

Question 10

KDIGO recommendations for protienuria

Answer 10

start pt on ACEi/ARB, even if they don’t have HTN or diabetes

Question 11

Complications of CKD

Answer 11

Mineral and Bone disorder

Hyperphosphatemia (limit phos intake and take phos binders)

Question 12

Aluminum-based phos binders

Answer 12

Aluminum hydroxide
very potent
not used much due to Al toxicity (nervous system and bone toxicity)
duration limited to 4 weeks

Question 13

Calcium-based phos binders

Answer 13

Ca acetate (PhosLo)
Ca carbonate (Tums)
SEs: constipation, nausea, hypercalcemia

Question 14

Aluminum-free, calcium-free phos binders

Answer 14

Sucroferric oxyhydroxide (Velphoro)
Ferric citrate (Auryxia)
Lanthanum carbonate (Fosrenol)
chew tabs; n/v/d, constipation

no concerns for Al accumulation and hypercalcemia

Question 15

Sevelamer

Answer 15

Phosphate binder
Renvela
also lowers TC and LDL by 15-30%
N/v/d

Question 16

Phos binder notes

Answer 16

only take with meals
separate from other drugs bc they will bind
esp. levothyroxine, quinolones

Question 17

How to treat secondary hyperparathyroidism in CKD

Answer 17

generally treat with Vit D
Vit D –> incr Ca —> decr PTH
the kidney cannot activate vit D to it’s final active form 1,25-dihydroxy vit D

Question 18

Vitamin D2

Answer 18

ergocalciferol

produced from plant sterols
dietary intake

Question 19

Vitamin D3

Answer 19

cholecalciferol

synthesized in the skin from the sun

Question 20

Calcitriol

Answer 20

active form of Vit D3
Rocaltrol
0.25-0.5 mcg daily 
n/v/d
can cause hypercalcemia and hyperphosphatemia

Question 21

Calcifediol

Answer 21

vit D analog
Rayaldee
n/v/d
can cause hypercalcemia and hyperphosphatemia

Question 22

Doxercalciferol

Answer 22

vit D analog
Hectorol
n/v/d
causes less hypercalcemia and hyperphosphatemia

Question 23

Pariclcitrol

Answer 23

vit D analog
Zemplar
n/v/d
causes less hypercalcemia and hyperphosphatemia

Question 24

Cinacalcet

Answer 24

Sensipar
incr sensitivity of calcium receptor on PT gland, which decr PTH, Ca, PO4
30-180 mg daily with food
n/v/d, hypocalcemia

Etelcalcetide (Parsabiv); IV formulation, same MOA

Question 25

Anemia in CKD is usually caused by:

Answer 25

decreased production of erythropoietin (EPO) by the kidneys
EPO travels to bone marrow and stimulates RBC production

Treatment: EPO stimulating agents (Procrit, Epogen, Aranesp)
Warnings: incr blood pressure, clot risk
only use if Hgb < 10 and stop when Hgb > 11

Question 26

Pts with CKD will have hyper-/hypo-kalemia

Answer 26

Hyperkalemia

K+ is excreted by kidneys

Question 27

Hyperkalemia treatment: Agents that stabilize the heart

Answer 27

calcium gluconate

Question 28

Hyperkalemia treatment: agents that shift K+ inside the cells

Answer 28

IV regular insulin
IV dextrose
Sodium bicarbonate
neb albuterol

Question 29

Hyperkalemia treatment: remove K+ from the body

Answer 29

IV furosemide
sodium polystyrene sulfonate (Kayexalate. Kionex)
Patiromer (Veltassa)
Hemodialysis

Question 30

Pts with CKD are more likely to experience metabolic acidosis (t/f)

Answer 30

true
kidneys produce less bicarb

treatment: sodium bicarb or sodium citrate if serum Bicarb is < 22 mEg/L