Renal Disease Flashcards
Define AKI
a sudden loss of kidney function due to a non-renal condition. often reversible but can be permanent if the precipitating condition is not corrected
BUN:SCr ratio to define dehydration
> 20:1
Define CKD
a progressive loss of kidney function over months or years. the egree of kidney function is measured by the GFR or CrCl and how much albumin is in the urine
Define ESRD
Total and permanent kidney failure. Fluid and waste accumulates. Dialysis or transplant is needed to assume the functions of the kidneys
Function of the nephron
control the concentrations of sodium and water. Regulates blood volume thus blood pressure
Function of arteriole
delivers blood into the glomerulus
where is most of the Na and Ca resabsorbed
Proximal Tubule
~65% Na
~ 70% Ca
Where is water reabsorbed
loop of henle
MOA of loop diuretics
inhibit the Na-K pump in the ascending limb of the loop on henle. less Na is is reabsorbed back into the blood thus less water to be reabsorbed as well
Loop diuretics on Ca
By blocking the Na-K pump it will cause less Ca reabsorption leading to depletion thus can decrease bone density over time
MOA of thiazide diuretics
inhibit the Na-Cl pump in the DCT.
Are loop or thiazide diuretics weaker?
thiazide b/c only ~5% Na is reabsorbed in the DCT where thiazides work versus ~25% for loop diuretics in the loop of henle
Thiazide diuretics on Ca
increase Ca reabsorption at the Ca pump in the DCT thus has protective effect on bones
Aldosterone and the collecting duct
increase Na and water reabsorption and decrease K reabsorption
Aldosterone antagonists (2)
sprinolactone
eplerenone
Aldosterone antagonists MOA
block aldosterone, more Na and water is excreted in the urine and serum K increases
Drugs that cause kidney disease (10)
aminoglycosides amophotericin B Cisplatin Cyclosporine Loop diuretics NSAIDs Polymyxins Contrast Dye Tacrolimus Vancomycin
What does BUN measure
the amount of nitrogen in the blood that comes from urea, a waste product of protein metabolism. As kidney function declines, BUN increases
What does Creatinine measure
a waste product of muscle metabolism is mostly filtered by the glomerulus and is easily measured. As kidney function declines creatinine increases. Any creatinine that is not filtered is secreted into nephron tubules. the amount secreted increases as renal function declines and less creatinine is filtered (a compensatory mechanism)
normal range for SCr
0.6-1.3 mg/dL
albuminuria is also known as
proteinuria
At what GFR and albuminuria indicates CKD
GFR < 60 ml/min/1.73m2 and ACR or AER >30
KDIGO guidlines for BP
<140/90 with no proteinuria
<130/80 with proteinuria
ACEi and ARB MOA
inhibit RAAS causing efferent arteriolar dilation
normal CrCl for a young adult
120-125 mL/min
Hyperphosphatemia
contributes to chronically elevated PTH levels since in renal failure there is less PO4 clearance
Hyperphosphatemia causes (3)
High serum PO4
dec. in Ca abosprtion
dec. in EPO production
High PTH (hyperparathyroidism) causes (2)
fractures
-b/c Ca is being pulled from bones d/t low Ca
CVD
-b/c high serum vascular calcification
Treatment for High serum PO4
dietary phosphate restriction
phosphate binders
treatment for dec. Ca absorption
Vit. D
Calcimemetic
Treatment for dec. EPO production
Iron
ESA
Phosphate binders-calcium based (2)
Calcium acetate (phoslo) calcium carbonate (Tums)
Phosphate binders- Al-free, Ca-free (4)
Sucroferric oxyhydroxide
Ferric citrate
Lanthanum carbonate
Sevelamer-not systemically absorbed
Cholecalciferol is what
vitamin D3
synthesized in the skin after exposure to UV
Ergocalciferol is what
vitamin D2
produced from plant sterols and primary dietary source of vit D
Name the active form of Vitamin D3
calcitriol
Calcimimetic MOA
inhibit PTH release by increasing the sensitivity of the Ca receptor on the parathyroid gland
Calcimimetic (1)
cinacalcet
What level is defined as anemia
HgB < 13 g/dL
EPO (erythropoietin) function
produced by the kidneys and travels to the bone marrow to stimulate the production of RBC
ESAs (erhytropoiesis stimulating agents (3)
Procrit-epoetin Alfa
Epogen- epoetin alfa
Aranesp-longer lasting formulation darepoetin
When to use an ESA
when HgB <10 g/dL
What major risk does ESA carry
thrombosis: risk is increased with higher HgB levels so d/c ESA if Hbg >11
What to check prior to starting ESA
iron levels: b/c iron is required to make hemoglobin. so assess iron panel (iron, ferritin, and TSAT)
Hyperkalemia treatment steps
- stabilize the heart (prevent arrhythmias)
- shift excess K intracellularly
- Enhance K elimination
Hyperkalemia treatment: stabilize the heart
Ca Gluconate
Hyperkalemia treatment: shift K intracellularly
Regular insulin
dextrose
Na Bicarbonate
Albuterol
Hyperkalemia treatment: enhance K elimination
furosemide Na polystyrene sulfonate (kayexalate) patiromer (Veltassa) Na zirconium cyclosilicate(Lokelma) hemodialysis
kidney function in CKD with bicarb
the ability of the kidney to reabsorb bicabonate decreases as CKD progresses this can result in the development of metabolic acidosis
When to replace bicarbonate
when serum bicarb <22 mEq/L
3 drug absorption factors affected by HD
molecular weight: smaller molecules easily removed by HD
volume of distribution: drug w/ large Vd less likely to be removed by HD
Protein-binding: highly protein bound less likely to be removed
Brand name for cinacalcet
Sensipar
