Renal Recap Flashcards

1
Q

Why is hyperkalemia more common in diabetic patients?

A

Due to renal tubular acidosis type 4

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2
Q

How many g of protein does a renal exchange contain?

A

6-8g

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3
Q

What % of dextrose if absorbed in CAPD and CCPD?

A

CAPD: 60-70%
CCPD: 40-50%

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4
Q

Which vitamin/mineral supplement do we recommend?

A

Replavite

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5
Q

Who could required IDPN?

A

HD patients

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6
Q

Explain the calcium and phosphorus metabolism in ESRD and RO/metastatic calcification.

A

low levels of Ca = high levels of PO4
causes calcium deposition on the bones

Calcification of blood vessels and soft tissues = metastatic calcification

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7
Q

How much PO4 (in g) is taken out per session?

A

800mg

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8
Q

How do you chose the dialysate K2 or K3?

A

K2 if they need more K taken out (high levels of K)

K3 if they need less K taken out (lower levels of K)

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9
Q

What are the 5 phosphate binders?

A
  • calcium carbonate
  • tums
  • renagel
  • renvela
  • fosrenol
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10
Q

What are the 4 possible causes of constipation?

A
  • inadequate fluid intake
  • low physical activity
  • low fiber intake
  • use of PO4 binders
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11
Q

What are the treatments for constipation in ESDR?

A
  • stool softeners (ducosate sodium/calcium)
  • stimulants (senna, bisacodyl)
  • osmotic laxatives (lactulose)
  • bulking agents (unifiber, benefiber, metamucil)
  • suppositories (glycerine)
  • enemas
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12
Q

When is CRRT done?

A

In ICU settings

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13
Q

How can you tell if someone lost weight even though they have the same weight (due to fluid accumulation)?

A

By checking BP. If high BP -> more fluid so lost weight

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14
Q

What % dextrose solution would you chose for extra fluid removal?

A

A higher % one

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15
Q

What if a patient is diabetic but has a lot of fluid to be removed?

A

There are solutions based on a.a and not dextrose, they offer half the calories and does the same job

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16
Q

What is PET and what frequency should it be done at?

A

PET: peritoneal equilibration test -> tests the permeability of the peritoneal membrane and helps to determine the % dextrose absorbed, which helps choosing the proper formula/solution
Should be done every 6 months

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17
Q

Why do we give them phosphate binders?

A

Because since they have increased protein needs, when they eat more protein they also increase PO4 levels, which we want to avoid

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18
Q

Should we look at blood tests before or after doing HD and PD?

A

HD: BEFORE (to see how they are managing diet at home), after dialysis everything should be normal
PD: does not matter - patient is on dialysis everyday

19
Q

Why are most patients on blood thinners while doing dialysis?

A

Because we don’t want the system to clogg

20
Q

What is the normal serum potassium level? What is it during HD? During PD?

A

Normal: 3.5-6 mmol/L
HD: 2-3 g/d
PD: no restriction

21
Q

What drugs may raise potassium?

A

ACEi, ARB, selective aldosterone receptor antagonists, NSAIDS, B-Blockers

22
Q

What are some high K foods?

A
  • fruits (dried, banana, juice, avocado)
  • vegetables
  • bran, chocolate, milk, molasses, nuts, seeds
23
Q

What are some low K foods?

A
  • fruits: apples, berries, grapes, pineapples
  • vegetables
  • rice, noodles, pasta, coffee, tea
24
Q

What are the fluid needs if output<1L/d? If output > 1L/d? What are the fluid needs for PD?

A

Less 1L/d: 1-1.5 L/d and 2g of Na
Over 1L/d: 2L/d and 2-4g of Na
PD: 1-3L and 2-3g of Na

25
What is the phosphorus restriction for HD and PD?
800-1000mg/d
26
What are high phosphorus foods?
Dairy protein vegetables
27
What is the best order when doing diet calculations?
- milk/dairy - meat - fruits/vegetables - starch according to protein left - fat
28
What is the issue with magnesium (too low/high)?
Usually too high, limit sources of Mg, ex: water
29
What is carnitine?
It is involved in the transfer of fatty acids into the mitochondria for oxidation It is removed by dialysis
30
What are the urinary protein losses in nephrotic syndrome?
>3.5g/d
31
What are some of the treatments for nephrotic syndrome?
- diuretics - ACEi - Steroids - Statins - coumadin/heparin
32
What is an important issue associated with nephrotic syndrome?
Hyperlipidemia
33
What is the main treatment for kidney stones?
Plenty of fluids | Medical procedures if unable to pass (ESWL)
34
What is the nutrition therapy for kidney stones?
Check for excessive electrolyte/mineral intake and inadequate fluid intake Fluids: 3L/d Avoid >200mg of vit D (why?) Use probiotics DASH diet is good
35
How do you limit oxalate absorption?
By increasing calcium intake and limiting vit C
36
How is AKI classified?
Increase in s.Cr of >0.3mg or by 1.5x baseline OR Urine output < 0.5ml/kg/h for 6h
37
What are the 3 phases of AKI?
- prerenal: impaired blood flow to kidneys resulting in low urine output - intrinsic: damage within kidney cells (acute tubular nerosis) - postrenal: obstruction in urine flow
38
What are the 4 main signs and symptoms of AKI?
1. fluid retention/overload 2. metabolic acidosis 3. electrolyte abnormalities 4. anemia
39
What are the 2 advantages and disadvantages of renal transplant?
A: 1. Increased survival rate 2. Preferred method of treatment D: 1. Immunossuppressant therapy for the rest of their lives 2. long waiting list
40
What is cyclosporine and what are some of the side effects?
``` A drug (immunosuppressant) to prevent organ rejection Side effects: - nephrotoxicity - Gingival hyperplasia - GI disturbances - hyperglycemia - hepatoxicity ```
41
Why are corticosteroids used in renal transplant?
to inhibit the production of lymphokines
42
What is hyperglycemia associated with in renal transplant?
Increased risk of infection, organ rejection and decreased survival rate
43
What are two main immunosuppressants?
Tacrolimus and cyclosporine