Renal Recap Flashcards
Why is hyperkalemia more common in diabetic patients?
Due to renal tubular acidosis type 4
How many g of protein does a renal exchange contain?
6-8g
What % of dextrose if absorbed in CAPD and CCPD?
CAPD: 60-70%
CCPD: 40-50%
Which vitamin/mineral supplement do we recommend?
Replavite
Who could required IDPN?
HD patients
Explain the calcium and phosphorus metabolism in ESRD and RO/metastatic calcification.
low levels of Ca = high levels of PO4
causes calcium deposition on the bones
Calcification of blood vessels and soft tissues = metastatic calcification
How much PO4 (in g) is taken out per session?
800mg
How do you chose the dialysate K2 or K3?
K2 if they need more K taken out (high levels of K)
K3 if they need less K taken out (lower levels of K)
What are the 5 phosphate binders?
- calcium carbonate
- tums
- renagel
- renvela
- fosrenol
What are the 4 possible causes of constipation?
- inadequate fluid intake
- low physical activity
- low fiber intake
- use of PO4 binders
What are the treatments for constipation in ESDR?
- stool softeners (ducosate sodium/calcium)
- stimulants (senna, bisacodyl)
- osmotic laxatives (lactulose)
- bulking agents (unifiber, benefiber, metamucil)
- suppositories (glycerine)
- enemas
When is CRRT done?
In ICU settings
How can you tell if someone lost weight even though they have the same weight (due to fluid accumulation)?
By checking BP. If high BP -> more fluid so lost weight
What % dextrose solution would you chose for extra fluid removal?
A higher % one
What if a patient is diabetic but has a lot of fluid to be removed?
There are solutions based on a.a and not dextrose, they offer half the calories and does the same job
What is PET and what frequency should it be done at?
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
Why do we give them phosphate binders?
Because since they have increased protein needs, when they eat more protein they also increase PO4 levels, which we want to avoid
Should we look at blood tests before or after doing HD and PD?
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
Why are most patients on blood thinners while doing dialysis?
Because we don’t want the system to clogg
What is the normal serum potassium level? What is it during HD? During PD?
Normal: 3.5-6 mmol/L
HD: 2-3 g/d
PD: no restriction
What drugs may raise potassium?
ACEi, ARB, selective aldosterone receptor antagonists, NSAIDS, B-Blockers
What are some high K foods?
- fruits (dried, banana, juice, avocado)
- vegetables
- bran, chocolate, milk, molasses, nuts, seeds
What are some low K foods?
- fruits: apples, berries, grapes, pineapples
- vegetables
- rice, noodles, pasta, coffee, tea
What are the fluid needs if output<1L/d? If output > 1L/d? What are the fluid needs for PD?
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
What is the phosphorus restriction for HD and PD?
800-1000mg/d
What are high phosphorus foods?
Dairy
protein
vegetables
What is the best order when doing diet calculations?
- milk/dairy
- meat
- fruits/vegetables
- starch according to protein left
- fat
What is the issue with magnesium (too low/high)?
Usually too high, limit sources of Mg, ex: water
What is carnitine?
It is involved in the transfer of fatty acids into the mitochondria for oxidation
It is removed by dialysis
What are the urinary protein losses in nephrotic syndrome?
> 3.5g/d
What are some of the treatments for nephrotic syndrome?
- diuretics
- ACEi
- Steroids
- Statins
- coumadin/heparin
What is an important issue associated with nephrotic syndrome?
Hyperlipidemia
What is the main treatment for kidney stones?
Plenty of fluids
Medical procedures if unable to pass (ESWL)
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
How do you limit oxalate absorption?
By increasing calcium intake and limiting vit C
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
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
What are the 4 main signs and symptoms of AKI?
- fluid retention/overload
- metabolic acidosis
- electrolyte abnormalities
- anemia
What are the 2 advantages and disadvantages of renal transplant?
A:
- Increased survival rate
- Preferred method of treatment
D:
- Immunossuppressant therapy for the rest of their lives
- long waiting list
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
Why are corticosteroids used in renal transplant?
to inhibit the production of lymphokines
What is hyperglycemia associated with in renal transplant?
Increased risk of infection, organ rejection and decreased survival rate
What are two main immunosuppressants?
Tacrolimus and cyclosporine
