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Cardio Final > Renal failure - Kumar > Flashcards

Renal failure - Kumar Flashcards

1
Q

What is the normal function of the kidney related to homeostasis?

A

To maintain body homeostasis

This includes glomerular filtration, reabsorption of important compounds, and secretion of hormones like aldosterone and ADH.

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2
Q

Define Chronic Kidney Disease (CKD).

A

Structural/Functional kidney damage or a GFR <60ml/min/1.73m2 for > 3 months

CKD may require dialysis or kidney transplantation to sustain life.

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3
Q

What are the main causes of Chronic Kidney Disease?

A
  • Diabetes
  • Hypertension
  • Glomerulonephritis
  • Interstitial nephritis
  • Cystic kidney disease
  • Other

Percentages of occurrence are 40.3%, 24.6%, 10.5%, 4.2%, 2.5%, and 17.9% respectively.

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4
Q

List modifiable risk factors for renal failure.

A
  • Diabetes Mellitus
  • Hypertension
  • Hyperlipidemia
  • Proteinuria
  • Environmental exposures
  • Obesity
  • Tobacco use
  • Drug abuse

These factors can be managed to reduce the risk of renal failure.

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5
Q

What is the difference between GFR dysfunction and tubular dysfunction in renal failure?

A

GFR dysfunction shows a 40 BUN/Creatinine ratio, while tubular dysfunction shows a 10 BUN/Creatinine ratio.

Each type of dysfunction has different metabolic waste profiles and electrolyte imbalances.

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6
Q

What are examples of metabolic wastes excreted by the kidneys?

A
  • Urea
  • Creatinine
  • Uric acid

Urea is the most abundant organic waste, while creatinine is a by-product of muscle metabolism.

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7
Q

What is the role of erythropoietin in kidney function?

A

Production of red blood cells (RBCs).

Erythropoietin is essential for maintaining adequate RBC levels, especially in the context of renal failure.

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8
Q

True or False: Hyperkalemia is a complication of renal dysfunction.

A

True

Hyperkalemia can lead to serious cardiac issues and is often monitored in renal failure patients.

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9
Q

Fill in the blank: The primary treatment for metabolic acidosis in renal failure is _______.

A

Sodium bicarbonate

Sodium bicarbonate helps to alkalinize the urine and manage acidosis.

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10
Q

What are osmotic diuretics used for?

A
  • Decreasing intraocular pressure
  • Treating acute renal failure
  • Promoting urinary excretion of toxic substances

Mannitol is a common osmotic diuretic.

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11
Q

List some drugs used to treat hyperkalemia.

A
  • Calcium salts (IV)
  • Sodium bicarbonate
  • Dextrose-Insulin
  • Albuterol
  • Furosemide
  • Sodium Polystyrene sulfonate (Kayexalate)

These drugs help to lower serum potassium levels through various mechanisms.

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12
Q

What is the mechanism of action of Sodium Polystyrene Sulfonate (Kayexalate)?

A

It exchanges potassium for sodium in the gastrointestinal tract, increasing fecal potassium excretion.

This mechanism reduces serum potassium levels effectively.

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13
Q

What are phosphate binding agents used for in renal failure?

A

To treat hyperphosphatemia.

Examples include Sevelamer and Lanthanum.

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14
Q

What adverse effects are associated with Mannitol?

A
  • Congestive heart failure
  • Hypernatremia
  • Hyponatremia
  • Hyperkalemia
  • Pulmonary edema
  • Allergic reactions

Monitoring is crucial due to the potential for serious side effects.

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15
Q

What is the dosage range for Sodium Bicarbonate in renal failure?

A

20-50 meq per day

It is used primarily for managing hyperkalemia and metabolic acidosis.

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16
Q

What is the effect of Sevelamer in chronic renal disease?

A

It lowers total and LDL cholesterol while reducing phosphorus and parathyroid hormone levels.

Sevelamer helps manage both phosphorus levels and cardiovascular risk.

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17
Q

True or False: Thiazide diuretics are recommended in renal failure.

A

False

Thiazide diuretics are ineffective when creatinine clearance is <25 ml/min.

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18
Q

What does NVD stand for in the context of drug interactions?

A

Nausea, Vomiting, Diarrhea

19
Q

Name two drugs that have decreased absorption bioavailability due to drug interactions.

A
  • Warfarin
  • Digoxin
20
Q

What is the primary purpose of Lanthanum Carbonate?

A

To bind dietary phosphate in the GI tract

21
Q

What are common adverse effects of Lanthanum Carbonate?

A
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain
  • Constipation
22
Q

What is the mechanism of action for lanthanum ions released from Lanthanum Carbonate?

A

They bind dietary phosphate released during digestion

23
Q

What is a rare side effect associated with aluminum hydroxide gel?

A

Dialysis encephalopathy

24
Q

Which phosphate binder is associated with aluminum toxicity?

A

Aluminum hydroxide gel

25
Q

What are the common adverse effects of magnesium hydroxide used as a phosphate binder?

A
  • Severe diarrhea
  • Hypermagnesemia
  • CNS depression
26
Q

What is the use of Erythropoietin Alpha and Darbepoetin Alpha?

A

To treat anemia

27
Q

What is the mechanism of action of Erythropoietin?

A

It binds to the EPO-R on erythroid progenitor cells, activating JAK2 and initiating a signaling cascade

28
Q

How does Darbepoetin differ from Erythropoietin in terms of dosing frequency?

A

Darbepoetin is administered once a week, while Erythropoietin is given three times a week

29
Q

What is the main cardiovascular adverse effect associated with Erythropoietin stimulating agents?

A

Hypertension

30
Q

Fill in the blank: Desmopressin is a _______ analogue.

A

Vasopressin

31
Q

What is the primary use of Desmopressin?

A

To control bleeding in hemophilia and Von Willebrand disease

32
Q

What are common side effects of Desmopressin?

A
  • Facial flushing
  • Dizziness
  • Abdominal cramps
33
Q

What is the role of potassium chloride in electrolyte replacement?

A

To treat hypokalemia

34
Q

What EKG changes are associated with hypokalemia?

A

Fall in the S-T segment and decreased T wave

35
Q

What is the maximum recommended IV dose of potassium chloride for hypokalemia?

A

20-40 meq/hr

36
Q

What are the common adverse effects of magnesium sulfate?

A
  • Hyporeflexia
  • CNS depression
  • Respiratory depression
37
Q

What is the mechanism of action of calcium gluconate?

A

Moderates nerve and muscle performance via action potential excitation

38
Q

Fill in the blank: Cinacalcet is a calcium _______ that lowers PTH levels.

A

Sensitizer

39
Q

What is the primary indication for Cinacalcet?

A

Secondary hyperparathyroidism in patients with renal failure

40
Q

What adverse effects are associated with Cinacalcet?

A
  • Hypertension
  • Hypocalcemia
  • Dizziness
41
Q

What is the usual route of administration for Vitamin D3 analogues?

A

IV

42
Q

What is the role of Vaptans in managing hyponatremia?

A

They are vasopressin receptor antagonists that promote aquaresis

43
Q

What are two types of Vaptans mentioned?

A
  • Conivaptan
  • Tolvaptan
44
Q

True or False: Vaptans are associated with electrolyte abnormalities.

A

False

Cardio Final (2 decks)

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