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Clin 3 > Renal Recap > Flashcards

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
Q

What is the phosphorus restriction for HD and PD?

A

800-1000mg/d

26
Q

What are high phosphorus foods?

A

Dairy
protein
vegetables

27
Q

What is the best order when doing diet calculations?

A
  • milk/dairy
  • meat
  • fruits/vegetables
  • starch according to protein left
  • fat
28
Q

What is the issue with magnesium (too low/high)?

A

Usually too high, limit sources of Mg, ex: water

29
Q

What is carnitine?

A

It is involved in the transfer of fatty acids into the mitochondria for oxidation
It is removed by dialysis

30
Q

What are the urinary protein losses in nephrotic syndrome?

A

> 3.5g/d

31
Q

What are some of the treatments for nephrotic syndrome?

A
  • diuretics
  • ACEi
  • Steroids
  • Statins
  • coumadin/heparin
32
Q

What is an important issue associated with nephrotic syndrome?

A

Hyperlipidemia

33
Q

What is the main treatment for kidney stones?

A

Plenty of fluids

Medical procedures if unable to pass (ESWL)

34
Q

What is the nutrition therapy for kidney stones?

A

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
Q

How do you limit oxalate absorption?

A

By increasing calcium intake and limiting vit C

36
Q

How is AKI classified?

A

Increase in s.Cr of >0.3mg or by 1.5x baseline
OR
Urine output < 0.5ml/kg/h for 6h

37
Q

What are the 3 phases of AKI?

A
  • 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
Q

What are the 4 main signs and symptoms of AKI?

A
  1. fluid retention/overload
  2. metabolic acidosis
  3. electrolyte abnormalities
  4. anemia
39
Q

What are the 2 advantages and disadvantages of renal transplant?

A

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
Q

What is cyclosporine and what are some of the side effects?

A 
A drug (immunosuppressant) to prevent organ rejection
Side effects:
- nephrotoxicity
- Gingival hyperplasia
- GI disturbances
- hyperglycemia
- hepatoxicity
41
Q

Why are corticosteroids used in renal transplant?

A

to inhibit the production of lymphokines

42
Q

What is hyperglycemia associated with in renal transplant?

A

Increased risk of infection, organ rejection and decreased survival rate

43
Q

What are two main immunosuppressants?

A

Tacrolimus and cyclosporine

Clin 3 (12 decks)

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