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Pathopharmacology I > Wk 3 Chronic Kidney Disease > Flashcards

Wk 3 Chronic Kidney Disease Flashcards

1
Q

What is azotemia?

A

Elevated levels of urea and other nitrogen compounds in the blood

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2
Q

What is the medical term for decreased urine output?

A

Oliguria

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3
Q

What is oliguria defined by?

A

Less than 400mls per day

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4
Q

When does proteinuria happen?

A

Damage to the glomeruli and protein is allowed through and excreted in the urine

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5
Q

Kidneys maintain __ and __ balance

A

fluid and electrolyte

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6
Q

What do the kidneys excrete through the urine?

A

water soluble wastes and products of metabolism

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7
Q

List 3 important endocrine functions

A

1) Produces erythropoietin
2) Activates vitamin D
3) Produces renin, which helps regulate blood pressure

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8
Q

What are normal BUN lab values?

A

10-20 mg/dL

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9
Q

What are normal creatinine lab values?

A

0.5-1.2 mg/dL

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10
Q

BUN and creatinine maintain a __ ratio

A

10:1

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11
Q

What should your GFR be?

A

> 90 mL/min

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12
Q

What does GFR measure?

A

Amount of blood that is being filtered by the glomeruli

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13
Q

What is Vitamin D important for? (2)

A

Calcium absorption

Bone health

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14
Q

What is chronic kidney disease defined:

A

Presence of kidney damage for more than 3 months, with or without a GFR of less than 60

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15
Q

What are the 3 main effects of kidney disease

A

Can’t maintain acid-base balance
Can’t remove end products of metabolism
Can’t maintain fluid and electrolyte balance

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16
Q

What is stage 1 CKD?

A

Kidney damage with normal or increased GFR

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17
Q

What is stage 2 CKD?

A

Kidney damage with mild decrease in GFR

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18
Q

What is stage 3 CKD?

A

Moderate decrease in GFR

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19
Q

What is stage 4 CKD?

A

Severe decrease in GFR

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20
Q

What is stage 5 CKD?

A

End Stage Kidney Disease (ESRD)

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21
Q

What is the GFR for stage 1?

A

Greater than or equal to 90

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22
Q

What is the GFR for stage 2?

A

60-89

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23
Q

What is the GFR for stage 3?

A

30-59

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24
Q

What is the GFR for stage 4?

A

15-29

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25
Q

What is the GFR for stage 5?

A

Less than 15

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26
Q

What is the main cause of end-stage kidney disease?

A

diabetes (50%)

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27
Q

What is the second most common cause of end-stage kidney disease?

A

hypertension (30%)

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28
Q

What is the third most common cause of end-stage kidney disease?

A

Glomerulonephritis

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29
Q

What are 8 risk factors for CKD?

A 
Family history
Age over 60
Male
African American
Hypertension
Diabetes
Smoking
Obesity
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30
Q

The pathogenesis of CKD starts with __

A

glomerulosclerosis

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31
Q

What is glomerulosclerosis?

A

Scar tissue of the glomeruli

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32
Q

Glomerulosclerosis can lead to __ __

A

interstitial fibrosis

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33
Q

What is interstitial fibrosis characterized by?

A

Destruction of the interstitial capillaries and renal tubules

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34
Q

What plays a major role in the pathogenesis of CKD?

A

Complement

Angiotensin II

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35
Q

An increase in angiotensin II __ blood pressure

A

Increases

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36
Q

How does angiotensin II contribute to the pathogenesis of CKD?

A

It increases BP and that causes further damage to the kidneys

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37
Q

How does complement contribute to the pathogenesis of CKD?

A

It is part of the inflammatory process and causes further damage

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38
Q

Stage 1 CKD manifestations

A

Asymptomatic

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39
Q

Stage 2 CKD manifestations

A

Asymptomatic, possible hypertension

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40
Q

Stage 3 CKD manifestations

A

Hypertension, otherwise asymptomatic

41
Q

Stage 4 CKD manifestations

A

Manifestations becoming apparent, diagnosis often occurs here

42
Q

Stage 5 CKD manifestations

A

ESRD, main symptom is uremia

43
Q

What is uremia?

A

Retention of metabolic wastes

44
Q

What are the metabolic wastes that build up in CKD?

A 
Urea
Creatinine
Phenols
Hormones
Electrolytes
Water
45
Q

Uremia is often seen in a GFR less than

46
Q

How is the filtration of metabolic wastes measured?

A

BUN

Creatinine

47
Q

Patients who have CKD will __ water

48
Q

Patients with CKD have a __ in erythropoietin

49
Q

Patients with CKD have a __ in Vitamin D activation

50
Q

What are the manifestations of abnormal fluid and electrolyte balance? (5)

A 
edema
hyperkalemia
hyperphosphatemia
hypermagnesemia
metabolic acidosis
51
Q

What are the manifestations of abnormal removal of metabolism waste products? (4)

A

anorexia
malnutrition
itching
CNS changes

52
Q

Why does a patient with CKD become acidotic?

A

They lose sodium bicarbonate

53
Q

What is the manifestation of decreased production of erythropoietin?

54
Q

What is the manifestation of decreased activation of Vitamin D?

A

Renal osteodystrophy

55
Q

What is the goal for hemoglobin for CKD patients?

A

Less than 10 because they don’t tolerate it higher than that. Their bodies are used to lower hemoglobin since the disease develops over a long period of time

56
Q

What is renal osteodystrophy?

A

Weakening of the bones

57
Q

What is the itchy white coating on the skin that some patients with CKD get?

A

Uremic frost

58
Q

Why are patients with CKD so tired?

A

They are anemic

59
Q

What is the cause of the decreased appetite?

A

Increase in metabolic wastes in the blood

60
Q

Why do patients with CKD sometimes feel sad?

A

Uremia can affect mood

61
Q

How do we slow the progression of CKD?

A

Keep BP less than 140/90

Treat hyperlipidemia

62
Q

What is the goal for cholesterol in patients with CKD?

A

Less than 200

63
Q

Concerning blood volume, what is a complication of CKD?

A

Volume overload

64
Q

What would we do to treat volume overload in a patient with CKD?

65
Q

What are the starting medications to control BP in a patient with CKD?

A

ACE or ARB

66
Q

What is used to treat hyperlipidemia?

67
Q

What type of diuretic would be used to treat the volume overload?

A

Loop diuretic

68
Q

What is a teaching point for a patient with volume overload?

A

Low salt diet

69
Q

In ESRD, what takes care of the hyperkalemia?

A

hemodialysis

70
Q

What is used to treat the metabolic acidosis?

A

Sodium bicarbonate

71
Q

Sodium bicarbonate is an __ agent

72
Q

What is used to treat the hyperphosphatemia?

A

Calcium carbonate

73
Q

Calcium carbonate is a __ __

A

phosphate binder

74
Q

What is used to treat the renal osteodystrophy?

75
Q

What is calcitrol?

A

Activated vitamin D

76
Q

What is given to treat the anemia?

77
Q

How often is erythropoietin given?

78
Q

A patient taking epoetin must have enough __ in their body for it to be effective

79
Q

When is epoetin contraindicated?

A

Hgb over 10

80
Q

What are the 3 goals of sodium bicarbonate therapy?

A

Slow progression of CKD
Prevent bone loss
Improve nutritional status

81
Q

When do you initiate sodium bicarbonate therapy?

A

When plasma HCO3 is less than 15 mEq/mL

82
Q

Titrate sodium bicarbonate to a plasma HCO3 of…

83
Q

What is the lab test used to measure HCO3 levels?

A

CO2 on a BMP

84
Q

What is the main adverse effect of sodium bicarbonate?

85
Q

What should a provider do if a patient has significant bloating on sodium bicarbonate?

A

Consider switching to sodium citrate

86
Q

What is used to treat hyperphosphatemia?

A

Calcium carbonate

87
Q

What is another name for calcium carbonate?

88
Q

What is the MOA of calcium carbonate?

A

It binds to phosphate

89
Q

What are the goals of therapy with calcium carbonate?

A

Keep phosphate levels normal

Reduce mortality

90
Q

What is the main adverse effect of calcium carbonate?

A

Hypercalcemia

91
Q

Why should a patient take calcium carbonate with meals?

A

It’s so the drug can bind to the phosphate that the patient eats with their meals

92
Q

What is calciferol used to treat?

A

renal osteodystrophy

93
Q

What is the MOA of calcitrol?

A

Stimulates intestinal absorption of calcium/phosphate and bone mineralization

94
Q

What is the activated form of Vitamin D?

95
Q

What are the major adverse effects of calcitrol?

A

Hypercalcemia

Hyperphosphatemia

96
Q

What are the s/s of calcium toxicity?

A

GI upset
Bone pain
Neuro effects - confusion, lethargy, depression
Cardiac arrhythmias

97
Q

What is renal dosing?

A

Medications that are excreted through the kidneys are given in smaller doses

98
Q

What drugs are we particularly concerned about in patients with CKD because they are excreted through the kidneys? (4)

A

Digoxin
Diabetic agents - metformin, glyburide
Vancomycin
Opioids - morphine

99
Q

What lab would you watch when giving digoxin to a patient with CKD?

Pathopharmacology I (33 decks)

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