Renal Disease Flashcards
Most common causes of CKD
HTN and Diabetes
Proteins normally do not pass through the glomerulus (t/f)
true
if protein in urine, then that is indicative of kidney damage
Which type of diuretic depletes calcium over a long period of time?
Loop diuretics
block resoprtion of Na and Ca in the loop of Henle
role of aldosterone in the kidney
works in the distal conv tubules and collecting duct to incr Na and water retention, and decr K
Drugs that cause kidney disease
Aminoglycosides amphotericin B Cisplatin Cyclosporin/tacrolimus loop diuretics NSAIDs Vanco
What is BUN?
the amount of nitrogen that comes from urea
urea is a waste product of protein metabolism
kidney damage and dehydration can incr BUN
Cockcroft-Gault formula might not be preferred in…
young children
ESRD
unstable renal function
will overestimate kidney func for frail pts with little muscle mass
What values are used to classify CKD?
GFR and albumin in the urine
When starting an ACEi/ARB how much will SCr generally increase?
up to 30% incr
stop if greater than 30% incr
KDIGO recommendations for protienuria
start pt on ACEi/ARB, even if they don’t have HTN or diabetes
Complications of CKD
Mineral and Bone disorder
Hyperphosphatemia (limit phos intake and take phos binders)
Aluminum-based phos binders
Aluminum hydroxide
very potent
not used much due to Al toxicity (nervous system and bone toxicity)
duration limited to 4 weeks
Calcium-based phos binders
Ca acetate (PhosLo) Ca carbonate (Tums) SEs: constipation, nausea, hypercalcemia
Aluminum-free, calcium-free phos binders
Sucroferric oxyhydroxide (Velphoro) Ferric citrate (Auryxia) Lanthanum carbonate (Fosrenol) chew tabs; n/v/d, constipation
no concerns for Al accumulation and hypercalcemia
Sevelamer
Phosphate binder
Renvela
also lowers TC and LDL by 15-30%
N/v/d
Phos binder notes
only take with meals
separate from other drugs bc they will bind
esp. levothyroxine, quinolones
How to treat secondary hyperparathyroidism in CKD
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
Vitamin D2
ergocalciferol
produced from plant sterols
dietary intake
Vitamin D3
cholecalciferol
synthesized in the skin from the sun
Calcitriol
active form of Vit D3 Rocaltrol 0.25-0.5 mcg daily n/v/d can cause hypercalcemia and hyperphosphatemia
Calcifediol
vit D analog
Rayaldee
n/v/d
can cause hypercalcemia and hyperphosphatemia
Doxercalciferol
vit D analog
Hectorol
n/v/d
causes less hypercalcemia and hyperphosphatemia
Pariclcitrol
vit D analog
Zemplar
n/v/d
causes less hypercalcemia and hyperphosphatemia
Cinacalcet
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
