Block 2 Flashcards
(124 cards)
1
Q
Per KDIGO, what is acute kidney injury?
A
- Increase SCr ≥0.3mg/dL within 48hrs
- Increase SCr ≥1.5 times baseline within 7 days
- Urine volume <0.5mL/kg/hr for 6 hrs
2
Q
What is an nonoliguric urine output?
A
> 500mL / 24hrs
3
Q
What is an oliguric urine output?
A
50 to 500mL / 24hrs
4
Q
What a an anuric urine output?
A
<50mL / 24hrs
5
Q
What are some risk factors for AKI?
A
Diabetes, HTN, Age >65yrs, AA, UT obstruction, volume depletion
6
Q
What does RIFLE stand for?
A
Risk Injury Failure Loss ESRD
7
Q
Describe R in RIFLE
A
UOP:
<0.5mL/kg/hr for 6 hrs
SCr:
1.5-2x increase from base OR Increase by ≥0.3mg/dL
8
Q
Describe I in RIFLE
A
UOP:
<0.5mL/kg/hr for 12 hrs
SCr:
2-3x increase from base
9
Q
Describe F in RIFLE
A
UOP:
<0.3mL/kg/hr for 24 hrs OR anuria for 12 hrs
SCr:
>3x increase from base OR if SCr is >4 w/ acute rise ≥0.5 OR if pt is on RRT
10
Q
Describe L in RIFLE
A
Persistent renal failure for >4 weeks
11
Q
Describe E in RIFLE
A
Persistent renal failure for >3 months
12
Q
Where is the highest % of incidence with regards to AKI?
A
ICU-acquired
13
Q
Where is the lowest survival rate with regards to AKI?
A
ICU-acquired
14
Q
Where is the highest survival rate with regards to AKI?
A
Community-acquired
15
Q
Prerenal
Intrinsic
Postrenal
Actual or functional intravascular volume depletion
A
Prerenal
16
Q
Prerenal
Intrinsic
Postrenal
Acute interstitial nephritis or tubular necrosis
A
Intrinsic
17
Q
Prerenal
Intrinsic
Postrenal
Obstruction preventing outflow
A
Postrenal
18
Q
Prerenal
Intrinsic
Postrenal
Most common AKI
A
Prerenal
19
Q
Prerenal
Intrinsic
Postrenal
Least common AKI
A
Postrenal
20
Q
Which drug classes can cause prerenal AKI?
A
NSAIDS + ACE inhibitors
21
Q
Which drug classes can cause intrinsic AKI?
A
Nephrotoxins such as antibiotics (aminoglycosides) or contrast
22
Q
Prerenal
Intrinsic
Postrenal
Cancer could cause which one?
A
Postrenal
23
Q
Prerenal
Intrinsic
Postrenal
Which one has a BUN/SCr ratio >20:1
A
Prerenal
24
Q
Prerenal
Intrinsic
Postrenal
Which one has a BUN/SCr ratio <20:1
A
Intrinsic + Postrenal
25
Prerenal
Intrinsic
Postrenal
Which one has <20 mmol/L of sodium in urine?
Prerenal
**<1% of FENa
26
Prerenal
Intrinsic
Postrenal
Which one has >40 mmol/L of sodium in urine?
Intrinsic + Postrenal
**>2% of FENa
27
How do you calculate FENa?
100 x (Na of Urine) x (Cr of Plasma) / (Na of Plasma) x (Cr of Urine)
28
Prerenal
Intrinsic
Postrenal
Which one's function usually returns?
Prerenal + Postrenal
29
Prerenal
Intrinsic
Postrenal
Which one typically has a less favorable prognosis?
Intrinsic
30
What is the goal MAP for AKI?
>65 mmHg
31
When should you use loop diuretics to treat AKI?
In hypervolemic pt w/ oliguria or non-oliguria
32
What are the 4 main things you could use to treat contrast-induced nephropathy?
1. NS
2. Sodium Bicarb
3. N-acetylcysteine
4. Rosuvastatin
33
How would you order a bicarb fluid for contrast-induced nephropathy?
Order 154mEq Bicarb in D5W @ 3mL/kg/hr x 1 hr prior to contrast, then to 1mL/kg/hr during contrast exposure and for 6 hours after
34
How would you order N-acetylcysteine for contrast-induced nephropathy?
600mg PO BID x 4 doses (3 before, 1 after) for CKD pt
35
How would you order rosuvastatin for contrast-induced nephropathy?
10mg PO QPM x 5 days (2 before, 3 after) for CKD pt
36
Which systems can produce ROS?
NADPH + Mitochondrial
37
Which complexes in the mitochondria produce ROS? Where specifically?
1 (intermembrane space) and 3 (matrix)
38
What is the mechanism of injury for aminoglycosides?
* Accumulates RX within proximal tubular epithelial cells
* Toxicity is related to positive charge of drug as they bind to negatively charged phospholipids -- this binding induces transportation of lysosomes
39
Which side of the glomerulus does cyclosporine affect?
Afferent vasoconstriction
40
Which side of the glomerulus does tacrolimus affect?
Afferent vasoconstriction
41
Which drug is B cell mediated?
Allopurinol
42
What is the pH range of urine?
4.5 to 7.8
43
Elevated pH of urine may indicate what?
Urea-splitting bacteria
44
Elevated specific gravity of urine may indicate what?
Dehydration
45
What is the normal range of SCr?
0.6 to 1.2mg/dL
46
As you age, what happens do your daily creatinine production?
It decreases
47
What is the normal range of BUN?
6 to 20 mg/dL
48
What are the stages for CKD?
```
G1 = >90mL/min/1.73m2
G2 = 60-89
G3a = 45-59
G3b = 30-44
G4 = 15-29
G5 = <15
```
49
When should you use the Jeliffe equation?
If pt height or weight are unknown, may be useful in unstable renal function
50
When should you use the Schwartz equation?
Calculating for pediatric or adolescent patients
51
What is the name of vitamin D that the liver produces?
25-Hydroxyvitamin D3
52
What is the name of vitamin D that the kidney produces?
1,25-Dihydroxyvitamin D3
53
What is needed to facilitates calcium absorption from the gut?
Vitamin D
54
Parathyroid (stimulate) + Calcium, what is the concentration in serum and urine?
Increase serum concentration and decrease urine concentration
55
How does cinacalcet work?
Reduces parathyroid and serum calcium
56
How is epoetin and darbepoetin alfa made?
Recombinant DNA technology
57
Epoetin vs Darbepoetin
Which one is identical to EPO?
Epoetin alfa
58
Epoetin vs Darbepoetin
Which one is the modified form of EPO?
Darbepoetin alfa
59
What is the most common inpatient type of drug-induced kidney injury?
Acute tubular necrosis
60
What is the incidence rate of aminoglycoside-related DIKI?
2-58%
61
What is the incidence rate of cisplatin/carboplatin-related DIKI?
6-13%
62
What is the incidence rate of amphotericin B-related DIKI?
80% w/ prolonged use
63
How does aminoglycoside cause renal damage?
Cation binds to tubules
64
How does amphotericin B cause renal damage?
Arterial vasoconstriction + direct
65
How do you prevent renal damage when using aminoglycosides?
Use one big dose rather than prolonged therapy
66
How do you prevent renal damage when using amphotericin B?
Slow down the infusion
67
What is the incidence rate of contrast-related DIKI?
2-50%
68
What RX should you avoid when using contrast?
Metformin
69
What are some prevention methods for acute tubular necrosis?
1. Hydrate
2. Acetylcysteine
3. Statin
4. Ascorbic acid
70
What RX can cause allergic interstitial nephritis?
Beta lactams + NSAIDs
71
How do you treat allergic interstitial nephritis?
Corticosteroids and d/c offending agent
72
What RX can cause chronic interstitial nephritis?
Lithium + Cyclosporine
73
What RX can cause renal vasculitis?
1. Hydralazine
2. Allopurinol
3. Propylthiouracil
4. Warfarin
74
How do you treat renal vasculitis?
1. Corticosteroids
2. Antiplatelets
3. Plasmapheresis
4. IVIG
75
What RX can cause obstructive nephropathy?
1. Sulfonamides
2. Acyclovir + Indinavir
3. Methotrexate
4. Ascorbic acid
76
How do you treat obstructive nephropathy?
1. Hydrate
2. d/c offending agent
3. Urine alkalization
77
What does fibroblast growth factor 23 do?
Decreases serum phosphorus
78
What is the main goal for CKD?
To delay or halt progression of CKD
79
What are some things to watch out for when using ESAs?
Higher % of HTN, Hb, MI
Watch Hb and make sure it doesnt go over 13!!!! Increased CV events
80
ESA treatment and Hb monitoring
Acceptable rate of increase should be 1 to 2g/dL per month, increases dose if it doesnt rise by 1g/dL in weeks
Should not exceed 1g/dL in 2 weeks
81
CKD Stage 3a/3b, what is the corrected calcium level?
Within normal range
82
CKD Stage 4, what is the corrected calcium level?
Within normal range
83
CKD Stage 5, what is the corrected calcium level?
8.4 to 9.5
84
CKD Stage 3a/3b, what is the phosphorus level?
2.7 to 4.6
85
CKD Stage 4, what is the phosphorus level?
2.7 to 4.6
86
CKD Stage 5, what is the phosphorus level?
3.5 to 5.5
87
CKD Stage 3a/3b, what is the Ca x P level?
<55 for all stages
88
CKD Stage 3a/3b, what is the intact PTH level?
35 to 70
89
CKD Stage 4, what is the intact PTH level?
70 to 110
90
CKD Stage 5, what is the intact PTH level?
150 to 300
91
When should you d/c or reduce dose of Aranesp?
Reduce dose by at least 25% if increased rate of Hb
92
When should you increase dose of Aranesp?
If Hb is not rising by 1g/dL in 4 weeks and no causes of resistance
93
What is the level of 25(OH) D found in CKD level 3,4, and 5?
>30
94
If someone has iron deficiency while using an ESA agent, what should you correct first?
Iron
95
When should you start using Sevelamer (Renvela) for pt with CKD-MBD?
Ca x P >55
Primary therapy in CKD Stage G5
96
What are some issues with using aluminum hydroxide for pt with CKD-MBD?
Risk of aluminum toxicity
Do not use with citrate-containing products
97
When should a pt use aluminum hydroxide if they have CKD-MBD?
For short term (<4wks) with hyperphosphatemia not responding to other binders
98
What are the non-calcium containing RX for CKD-MBD?
Ferric Citrate, Sevelamer (Renvela), Lanthanum, and Aluminum hydroxide
99
What are some comments to know about ferric citrate?
Do not take more than 12 tabs/day
Iron-containing; may reduce ESA and iron dosing
Expensive
100
What are some things to watch out for when using Sevelamer for CKD-MBD?
Removes bicarb, caution in metabolic acidotic pts
101
When taking other RX with phosphate-binding agents for CKD-MBD, how should you administer the other medications?
1 hour before or 3 hours after
102
What are some key counseling points with phosphate-binding agent?
1. Take w/ meals or immediately prior to them
| 2. Avoid in pt w/ high CaxP (risk of calcification) or low PTH
103
Brand of Ferric Citrate
Auryxia
104
Generic of Auryxia
Ferric Citrate
105
Brand of Lanthanum
Fosrenol
106
Generic of Fosrenol
Lanthanum
107
Brand of Aluminum hydroxide
AlternaGel
108
Generic of AlternaGel
Aluminum hydroxide
109
Brand of Sevelamer
Renvela
110
Generic of Renvela
Sevelamer
111
Brand of calcium acetate
PhosLo
112
Generic of PhosLo
calcium acetate
113
Which vitamin D analog has the highest chance of hypercalcemia?
Calcitriol
114
Prior to starting vitamin D analogs, when should you consider withholding it?
If Ca x P >55
115
MOA of Cinacalcet?
Increase sensitivity of serum Ca located on chief cells of parathyroid gland to reduce PTH secretion
116
If a pt has a high level of Ca x P, could you give them Cinacalcet?
Yes
117
When should you start monitoring pt once initiated w/ Cinacalcet?
ONLY FOR DIALYSIS PATIENTS
Within 1 week after initiation or dose change
PTH = within 1 to 4 weeks after initiation or dose adjustment
118
What are some RX interactions w/ Cinacalcet?
CYP3A4 inhibitors + Rx that utilize CYP2D6
119
MOA of Vitamin D analogs?
Promote calcium reabsorption + suppress PTH secretion
120
MOA of Phosphate-binding agents?
Binds to dietary phosphorus in GI tract to form insoluble phosphate that is then excreted
121
Cystatin C has been proven most useful in which condition?
Contrast-induced renal disease + cardiac disease
122
What range of SCr would not be a good indicator of a patient's true renal function?
<1
123
When is the Salazar-Corcoran equation used?
For obese patients
124
If a pt is not responding to an ESA agent, what could be the cause?
1. Low iron
2. Hyperparathyroidism
3. Infection
