Renal Failure Flashcards
Definition of CKD
CKD = eGFR <60 for >3mo
‘Triple whammy’ of meds causing AKI?
Ace Inhibitors/ARBs
NSAIDS
Diuretics
Pre renal causes of AKI
NSAIDs
Ace/ARBs
Hypovolemia (Hemorrhage, Gastrointestinal/Skin/Renal Losses)
Low Cardiac Output (Heart Failure, AAA, Obstructing Masses)
Liver Failure (Cirrhosis)
Sepsis
Third Spacing
Renal Artery Stenosis
Calcineurin Inhibitors
Hypercalcemia
Sx of uremia
Confusion
Seizures
Asterixis
Myoclonus
Peripheral Neuropathy
Hyporeflexia
Pericardial Friction Rub
Shortness of Breath
Fluid Overload
Pleuritic Chest Pains
Headache
Lethargy/Somnolence
Nausea/Vomiting
Loss of Appetite/Taste
Muscle Cramps
Weakness
Meds to hold in AKI
Sulfonylureas
Ace Inhibitors
Angiotensin Receptor Blockers
Diuretics
Biguanides
NSAIDs
SGLT-2 Inhibitors
Complications of renal failure
Uremia
Hyperkalemia
Hypercalcemia
Hypocalcemia
Hyperphosphatemia
Metabolic Acidosis
Hypertension
Osteodystrophy
Gout/Pseudogout
Anemia
Bleeding Disorders
Infections
Sleep Disturbances
Sexual Dysfunction
Death
RF for CKD
DM, HTN, vascular dz (renal artery stenosis), glomerular dz (autoimmune, malignant, infection, renally excreted drugs, neoplasia), tubulointerstitial dx (UTI, stones, obstruction), polycystic kidney dz, age, increased BMI, smoking, CVD
Factors that affect GFR
Extreme wts
Muscle mass
High/ low protein diet
Meds affecting Cr excretion
Ilness
Pregnancy
Paralysis
Amputation
Workup for CKD
BP
BW: Cr, BUN, ex lytes, BG, CBC, ferritin, albumin, serum protein electrophoresis + Bence Jones protein
UA
Albumin/ Cr ratio
Kidney US (stones, mass, cyst, hydronephrosis)
Management of CKD
Lifestyle: smoking cessation, reduce alcohol, wt control, exercise, hydration
Diet: 0.8g/kg/d protein K, Ph, Ca, Na
Meds: ACEi/ARB if proteinuria
Unwell plan: stop ACEi + diuretics, seek r/a
Drugs that need consideration in CKD
ACEi
ARBs
Metformin
Allopurinol
Abx
Nephrotoxins: NSAIDs, COX-2, aminoglycosides, radio contrast, alfalfa, dandelion, aristolchic
LMWH
DOACs
When to refer in CKD
Progressive renal failure (eGFR <45 or decline >5 within 6mo)
Glomerulonephritis or renal vasculitis
Resistant or secondary HTN
Complications of renal dz (anemia, hyperparathyroidism, EPO deficiency)
Bone disease
Young pt
Rx of volume overload
Restrict dietary sodium (eg. <2g/d)
Diuretic therapy (usually daily loop diuretic, eg. furosemide 80mg)
Rx for hyperphosphatemia
Restrict dietary phosphate (<0.8g/d)
Phospate binders (eg. Sevelamer 800mg PO TID meals)
Rx for Metabolic acidosis (low serum bicarbonate)
Sodium Bicarbonate (NaHCO3) 1000 mg BID to maintain normal serum bicarbonate (>20-22mEq/L)