CKD

Question 1

Cockroft and Gault (CrCl) =

Answer 1

(140-age) * (weight)
______________________ * (0.85 for females)
SCr * 72

Question 2

normal TSAT values

Answer 2

20-50%

Question 3

Major causes of CKD

Answer 3

1. diabetes
2. HTN
3. glomerulonephritis
4. polycystic kidney disease
5. HIV nephropathy

Question 4

What eGFR value indicates kidney failure/end stage kidney disease?

Answer 4

<15

Question 5

normal BUN levels

Answer 5

~ 6-20 mg/dL

Question 6

What are three causes of increased parathyroid hormone in ESRD patients?

Answer 6

1. hyperphosphatemia
2. hypocalcemia
3. decreased vitamin D

Question 7

Why are phosphate binders taken with food?

Answer 7

They bind the phosphorous in the food we eat to block it from getting absorbed

Question 8

What are two other benefits patients may get from taking sevelamer carbonate (besides decreased phosphate levels)?

Answer 8

1. decreases uric acid
2. decreases LDL levels

Question 9

normal phosphate levels

Answer 9

2.5 - 4.5 mg/dL

Question 10

Two forms of UNACTIVATED vitamin D

Answer 10

1. cholecalciferol (D3)
2. Ergocalciferol (D2)

Question 11

Three forms of ACTIVATED vitamin D

Answer 11

1. Calcitriol
2. Paricalcitol
3. Doxercalciferol

Question 12

What is the main cause of anemia in ESRD patients?

Answer 12

decreased production of erythropoietin

Question 13

What is the best assessment parameter for anemia?

Answer 13

Hemoglobin

Question 14

When is it suggested to start an ESA for CKD 3-5ND?

Answer 14

1. Hb < 10g/dL
2. Hb falling at a rapid rate
3. needed to avoid blood transfusion

Question 15

When is it suggested to start an ESA for CKD 5D?

Answer 15

when Hb is between 9-10 g/dL

Question 16

Do NOT use ESA to push Hb > ____________

Answer 16

11.5 g/dL

Question 17

What are two adverse effects of ESA?

Answer 17

1. PRCA: antibodies develop to erythropoietin
2. increased BP

Question 18

What is one major cause of ESA therapy failure?

Answer 18

Lack of vitamins/IRON

Question 19

Which IV iron product requires a test dose the first time it’s administered?

Answer 19

Iron dextran (InFed, Dexferrum)

Question 20

Which ESA has the shortest half-life and which one has the longest half-life?

Answer 20

shortest = recombinant human erythropoietin (epoetin alfa, Epogen)

longest = methoxy polyethylene glycol-epoetin beta (Mircera)

Question 21

For which stage of CKD is IV the preferred route for iron?

Answer 21

CKD 5D

Question 22

What are two causes of microcytic anemia?

Answer 22

1. Iron deficiency
2. Aluminum toxicity

Question 23

What are two causes of macrocytic anemia?

Answer 23

1. Folate deficiency
2. Vitamin B12 deficiency

Question 24

3 types of acute kidney injury

Answer 24

1. pre-renal
2. intrinsic
3. post-renal

Question 25

3 major causes of intrinsic AKI

Answer 25

1. ischemia
2. sepsis
3. nephrotoxins

Question 26

Drugs associated with impaired renal autoregulation

Answer 26

1. NSAIDS
2. ACEi/ARBs
3. cyclosporine

Question 27

Three criteria for acute kidney failure

Answer 27

1. increase in SCr > 0.3mg/dL within 48 hours
   OR
2. increase in SCr > 50% within last 7 days
   OR
3. reduction in urine output (<0.5mL/kg/h for 6 hours)

Question 28

Serum Osmolality (Osm) =

Answer 28

(Na*2) + (BUN/2.8) + (glucose/18)