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DONE CLINICAL > KIDNEY > Flashcards

KIDNEY Flashcards

1
Q

Give two general signs/symptoms of AKI

A

Raised blood levels of creatinine and reduced urine output

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2
Q

Intravascular fluid overload can be managed in AKI by restricting NaCl intake to ___to___g/day if not hyponatraemic

A

1 to 2 g/day

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3
Q

What 4 serum electrolyte parameters should be monitored daily?

A

Acid base balance, Bicarbonate, Calcium, Phosphate, Potassium

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4
Q

List 3 drugs that can cause pre renal AKI…

A

Diuretics, NSAID’s and ACE inhibitors

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5
Q

Patients taking NSAID’s, ACEI or ARB’s need to be adequately _____

A

Hydrated

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6
Q

SICK DAY RULE: Consider stopping ____ and ____ in those with diarrhoea, vomiting or sepsis until clinical condition improved and stabilised

A

ACE inhibitors or ARB’s

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7
Q

CKD may lead to anaemia due to a fall in haemoglobin levels. This is due to damage of peritubular cells leading to inadequate secretion of …..

A

Erythropoietin - main regulator of RBC proliferation and differentiation in bone marrow

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8
Q

The hydroxylation of cholecalciferol takes place in the kidneys to produce active ______

A

Vitamin D (Calcitriol)

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9
Q

What can be used to treat anaemia in CKD caused by low EPO levels?

A

Erythropoiesis stimulating agents (ESA’s SC or IV) and iron (IV weekly darbepoietin)

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10
Q

In CKD Hb should be between 10-12g/dL TRUE or FALSE?

A

True as if treated to a higher level then hypertension may occur as blood thickens

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11
Q

High levels of phosphate can be managed using a phosphate binder such as…

A

Calcium acetate, calcium carbonate, Sevelamer

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12
Q

Low levels of calcium can lead to higher levels of…

A

PHOSPHATE

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13
Q

If the body is deficient in vitamin D and there is not an adequate supply of calcium to be absorbed in the gut then parathyroid hormone is produced to release calcium from _____ instead. This is known as WHAT?

A

Bones - secondary hyperthyroidism which leads to bone damage

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14
Q

To prevent secondary hyperparathyroidism a low dose of ______ can be given. Why is this vitamin D supplement a good choice?

A

Alfacalcidol - this is post renal vitamin D so is already active.

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15
Q

Name a drug that is useful in treating leg cramps

A

Quinine

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16
Q

Uraemia is…

A

Urea in the blood

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17
Q

Low levels of albumin can lead to…

A

Increased free drug in the body e.g phenytoin, sodium valproate, warfarin, diazepam, digoxin

Due to less binding

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18
Q

The MDRD takes WHAT into account? (4)

Is it useful for extremes in weight?

A
  • Race
  • Gender
  • Serum creatinine
  • Age

And NOT useful for extremes in weight

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19
Q

Stage 1 CKD = greater/equal to ___ GFR

A

90 GFR

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20
Q

Stage 2 CKD = ___ - 89 GFR

A

60

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21
Q

Stage 5 CKD =

A
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22
Q

15-29 GFR = Stage ?

A

4

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23
Q

Metabolic acidosis is due to what?

A

Reduced excretion of H+ ions by the kidneys

24
Q

In the cockloft-gault formula F=? and M=?

A

F=1.04 and M=1.23

25
Q

Dehydration can ____ urea levels

A

Elevate

26
Q

Is urea a reliable measure of renal function?

A

No - but it can be used as an indicator of the patient’s general condition and state of hydration

27
Q

Most patients with CKD will have ___tension and this may be a cause or a consequence of their kidney disease.

A

HYPERtension

28
Q

Severe renal impairment leads to sodium _____, which in turn produces circulatory volume expansion with consequent hypertension

A

Retention

29
Q

What are the symptoms of uraemia?

A

Anorexia, nausea, vomiting, constipation, foul taste and skin discolouration

30
Q

Potassium levels of over __mmol/L are life threatening and should be treated as an emergency

A

7

31
Q

High potassium levels can lead to ____ ____

A

Cardiac arrest

32
Q

Name two drugs that are known to cause hyperkalaemia

A

ARBs and ACEIs

33
Q

Name a sedating antihistamine used to treat pruritis

A

Chlorphenamine

34
Q

Bendroflumethiazide may not be appropriate for management of hypertension in CKD, as it is ineffective once eGFR falls below 30 mL/minute/1.73 m2. The use of ______ may be preferred in such people.

A

Loop diuretics - E.G. Furosemide

35
Q

If a patients pre treatment serum potassium levels are greater than 5.0 mmol/L what should NOT be used to treat hypertension?

A

ACE inhibitor

36
Q

An increased ACR is associated with increase or decrease in adverse outcomes?

A

increase

37
Q

What should be prescribed to all patients with CKD? (eGFR

A

Statin 20mg od Atorvastatin - Primary prevention

38
Q

Accumulation of Metformin in those with stage 4 and 5 CKD can lead to…

A

Lactic Acidosis

39
Q

What are the 4 symptoms of anaemia?

A

1) Tiredness
2) SOB
3) Lethargy
4) Palpitations

40
Q

Calcium, phosphate and PTH should be measured in those with stage _ to _ CKD

A

4 to 5

41
Q

How does Calcium Resonium work and what is it used for?

A
  • Ion exchange resin
  • Exchanges K+ for Ca2+ in GI tract
  • Enhances potassium excretion
  • TREAT OF HYPERKALAEMIA
42
Q

How do Salbutamol nebs and insulin work in the treatment of hyperkalaemia?

A
  • Stimulate Na-K pump to increase cellular uptake of potassium
  • Decreases potassium levels in the blood
43
Q

Is CKD a risk factor for CVD?

A

YES

44
Q

What might an elderly person experience renal impairment but their serum creatinine levels might not reflect this?

A
  • Because elderly people have reduced muscle mass so less creatinine breakdown product from muscle
45
Q

What useful handbook can be referred to when dealing with a patient with impaired renal function?

A

Renal drug handbook

46
Q

Why might itching occur in a patient with CKD?

A
  • Due to build up of urea/waste products

- These cannot be excreted by kidneys as efficiently

47
Q

When is bendroflurothiazide rendered ineffective at removing xs fluid in a patient with CKD?

A
  • If their eGFR is below 30ml/min/1.73m2
48
Q

What is a pre-renal cause of renal impairment?

A
  • Reduction in renal blood flow
  • Cardiac failure, vomiting and diarrhoea without fluid replacement
  • Diuretics, NSAID’s, ACEI
  • Increased production of waste products (urea) e.g infection, upper GI bleeding, steroid therapy
49
Q

What are some post renal causes of reduced renal function?

A
  • Obstruction of urinary tract
  • Urinary stones
  • Constipation
  • BPHypertrophy
50
Q

Cockroft gault formula should NOT be used for who?

A
  • Children
  • High muscle mass
  • Elderly
  • Pregnant
  • Heart failure
51
Q

What is ACR used to detect?

A
  • Level of proteinuria
52
Q

What is the role of Calcium gluconate in those with CKD?

A
  • Protects the CV system from fatal arrhythmias in those with hyperkalaemia
53
Q

What happens to bicarbonate levels in those with CKD and why?

A
  • Kidney regenerates bicarbonate in the tubular cells and passes it back into the plasma
  • This buffers H+ ions
  • In RF there is reduced bicarb regen so reduced plasma levels of bicarb
54
Q

Why does phosphate accumulate in those with RF?

What effect does this have?

A
  • Reduced filtration and excretion of phosphate
  • Causes reduction in levels of calcium as inversely linked
  • Can lead to renal bone disease and secondary hyperparathyroidism
55
Q

What happens if hypercalcaemia persists?

A
  • Lead to formation of renal stones and cause more renal damage
56
Q

What happens to the excretion of sodium if kidney damage?

A
  • Ability to excrete excess sodium is lost
  • Total ECF volume expansion occurs
  • Fluid overload
57
Q

What effect can uraemia have on drug binding?

A
  • Urea can displace drug from protein binding sites
  • Causing more free drug
  • May be a need for therapeutic drug monitoring
  • e.g digoxin, phenytoin, warfarin, sodium valproate

DONE CLINICAL (10 decks)

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