Renal Failure I

Question 1

(a) Stimulate division and differentiation of erythroid progenitor cells
(b) Increase hemoglobin synthesis
(c) Induce the release of reticulocytes from the bone marrow to the bloodstream where they mature into erythrocytes (red blood cells)

Answer 1

Erythropoietic growth factors (epoetin alfa)

Question 2

Additional factors contributing to the development of anemia of chronic
kidney disease include:

Answer 2

Decreased red cell life span in the presence of uremia
Iron deficiency
Blood loss

Question 3

Adverse effects
 i. Hypercalcemia
ii. Hyperphosphatemia
iii. soft-tissue and vascular
calcification 
are seen less often with?

Answer 3

paricalcitol

Question 4

Clinical use: Anemia of chronic kidney disease

Answer 4

Erythropoietic growth factors (epoetin alfa); Ferrous sulfate and ferric gluconate

Question 5

Contraindications:
antacids, proton-pump inhibitors, H2-receptor antagonists (decrease absorption)

Do not take with food or with other drugs concurrently (decrease bioavailability)

Answer 5

Ferrous sulfate and ferric gluconate

Question 6

Calcimimetics

Acts on calcium-sensing receptors on the surface of the parathyroid gland to mimic the effect of extracellular ionized calcium which increases
the sensitivity of the calcium-sensing receptor to calcium subsequently reducing PTH secretion

Answer 6

Cinacalcet

Question 7

Contraindication: Cholestyramine (reduces absorption)

Answer 7

Calcitriol, paricalcitol

Question 8

Evaluation and treatment of (1) should occur prior to
starting therapy with erythropoietic growth factors; (1) is
the primary cause of resistance to therapy with erythropoietic agents

Answer 8

iron deficiency

Question 9

GI side effects including constipation, diarrhea, nausea, vomiting,
and abdominal pain

Answer 9

Sevelamer

Question 10

GI side effects including constipation, diarrhea, nausea, vomiting,
and abdominal pain

Hypercalcemia

Answer 10

Calcium acetate & calcium carbonate

Question 11

i. Hypercalcemia
ii. Hyperphosphatemia
iii. soft-tissue and vascular
calcification

Answer 11

Calcitriol, paricalcitol

Question 12

i. Hypertension
ii. Thrombotic/vascular events
iii. Deep vein thrombosis

Answer 12

Erythropoietic growth factors (epoetin alfa)

Question 13

i. Nausea and vomiting
ii. Hypocalcemia manifested as paresthesias, myalgias, cramping,
tetany, and convulsions

Answer 13

Cinacalcet

Question 14

Interferes with absorption of other drugs including oral iron

Answer 14

Calcium acetate & calcium carbonate

Question 15

Iron is carried by (1) to the bone marrow for red cell
production. Iron is stored as a complex with (2), called (3),
in the reticuloendothelial system (e.g., liver and spleen). Thus, iron
status is best evaluated by determining the percent saturation of
(4)

Answer 15

1. transferrin
2. apoferritin
3. ferritin
4. transferrin (TSat) and serum ferritin

Question 16

Normally, plasma concentrations of EPO increase exponentially in
individuals with normal kidney function as (1) declines (i.e., in
response to decreased oxygenation). In patients with chronic kidney
disease, they are unable to increase production of EPO in response to
(2). The result is a (3) anemia.

Answer 16

1. hematocrit
2. hypoxia
3. normochromic, normocytic

Question 17

(a) heartburn
(b) constipation or diarrhea
(c) nausea
(d) upper abdominal pain

Answer 17

Ferrous sulfate

Question 18

Pharmacologic therapy for anemia of chronic kidney disease includes:

Answer 18

chronic erythropoietic therapy

iron supplementation

Question 19

Phosphate binding agents

Reduce phosphorus absorption and serum phosphorus concentrations by binding dietary phosphorous in the GI tract forming insoluble compounds which are excreted in feces

also lowers LDL cholesterol and increases HDL
cholesterol (an added beneficial effect in a population at risk for cardiovascular events)

Answer 19

Sevelamer

Question 20

Phosphate binding agents

Reduce phosphorus absorption and serum phosphorus concentrations by binding dietary phosphorous in the GI tract forming insoluble compounds which are excreted in feces

helps to control calcium in early stages of chronic kidney disease when hypocalcemia
is common

Answer 20

Calcium acetate & calcium carbonate

Question 21

prevent secondary
hyperparathyroidism (sHPT) and subsequent renal osteodystrophy
(ROD)

Answer 21

Calcium acetate & calcium carbonate; Sevelamer; Calcitriol, paricalcitol; Cinacalcet

Question 22

promotes production of hemoglobin and its subsequent incorporation in red blood cells, the net result of which is an increase in the transportation of oxygen to tissues

Answer 22

Ferrous sulfate and ferric gluconate

Question 23

Take with food to increase bioavailability

Answer 23

Cinacalcet

Question 24

The primary cause of anemia in patients with chronic kidney disease is?

Answer 24

decrease in production of the hormone erythropoietin (EPO) by the
progenitor cells of the kidney, where 90% of production typically occurs

Question 25

Vitamin D therapy

required for patients with severe kidney disease since these agents do not require conversion
by the kidney to the most biologically active form

raises serum calcium concentration; suppresses PTH secretion

Answer 25

Calcitriol, paricalcitol

Question 26

anaphylaxis
hypotension
dizziness
iron overload

Answer 26

ferric gluconate

Question 27

Taken on empty stomach 1)

Taken with meals 2)

Answer 27

1) iron supplementation e.g ferrous sulfate and ferric gluconate
2) phosphate binding drugs and calcimimetics (Cinacalcet)

Question 28

_____ interfere with absorption of oral iron such as Ferrous sulfate

Answer 28

Calcium acetate and calcium carbonate; NOT sevelamer