Block 3 Flashcards
(257 cards)
1
Q
What are the vascular access types for hemodialysis?
A
- Fistula
- Graft
- Catheter
2
Q
Which vascular access types of hemodialysis is preferred?
A
Fistula
3
Q
Which vascular access types of hemodialysis is placed 6 months before dialysis?
A
Fistula
4
Q
Which vascular access types of hemodialysis is placed about 3 months before dialysis?
A
Graft
5
Q
Which vascular access types of hemodialysis does not require maturation?
A
Graft
6
Q
Which vascular access types of hemodialysis does require maturation?
A
Fistula
7
Q
Which vascular access types of hemodialysis is last line due to increased mortality and infection?
A
Catheter
8
Q
Which vascular access types of hemodialysis is placed if emergency exists?
A
Catheter
9
Q
A arteriovenous fistula consist of which artery/vein?
A
Radial artery + neighboring vein (usually cephalic)
10
Q
When is an arteriovenous graft typically used?
A
If vein is small for a fistula or there is a blocked vein
11
Q
An arteriovenous graft is placed where?
A
Between artery and vein w/ non-native vessel or artificial material
12
Q
Where is a central venous catheter placed?
A
Usually in the internal jugular vein
13
Q
Hemodialysis vs Peritoneal dialysis, which has more strict diet?
A
Hemodialysis
14
Q
What kind of diet exists for hemodialysis?
A
Limit fluids, salt, potassium, phosphate
Increase protein
15
Q
Advantage and Disadvantage of high flux hemodialysis
A
+ = large pores allow high clearance of middle-molecular weight molecules
- = requireds ultrafiltration system
16
Q
Advantage and Disadvantage of high efficiency hemodialysis
A
+ = better clearance of small solutes and better electrolyte control
- = vascular access damage and hemodynamic instability
17
Q
What are the main types of peritoneal dialysis?
A
- Automated PD
2. Continuous ambulatory PD
18
Q
What is the “best” type of peritoneal dialysis?
A
NIPD; overnight exchanges and dry during daytime
19
Q
What is the “worst” type of peritoneal dialysis?
A
CAPD; no machine needed, all physical exchange
20
Q
When should you initiate dialysis?
A
- Serositis
- Acid-base disturbance
- Pruritis
- Uncontrolled volume or BP
- Malnutrition unresponsive to dietary interventions
- Cognitive impairment
21
Q
When should you NOT initiate dialysis?
A
Dont base it off of GFR nor SCr!!!!
22
Q
What does diffusion remove in dialysis?
A
Small solutes (uses concentration gradient)
23
Q
What does convection remove in dialysis?
A
Excess body fluid + medium-sized solutes
24
Q
What does ultrafiltration remove in dialysis?
A
Body fluid (uses hydrostatic/osmotic pressure)
25
What is an adequate urea reduction ratio goal?
≥ 65%
26
What is the equation of urea reduction ratio?
(U pre - U post) / U pre x 100
27
How often is urea reduction ratio calculated in dialysis patients?
Once per month
28
When assessing Kt/V in dialysis, what is the goal?
≥ 1.2 per treatment
29
What makes up Kt/V in dialysis dosing?
```
K = dialyzer clearance
t = dialysis duration (min)
V = volume of water in body
```
V male = 50% TBW
V female = 60% TBW
30
Which is more accurate, URR or Kt/V in dialysis dosing and why?
Kt/V because it considers fluid removal
31
What are the indications for CRRT?
1. AKI + life-threatening change in fluid, electrolyte, and acid-base balance
2. Hemodynamic instability
3. Acute brain injury or increased ICP or brain edema
AEIOU rule
```
Acidosis
Electrolyte disturbances
Intoxication
Overload
Uremia
```
32
KDIGO guidelines on CRRT access
Uncuffed non-tunneled dialysis catheter
33
What does slow continuous ultrafiltration CRRT remove?
Fluids only
34
What is the rate of a slow continuous ultrafiltration CRRT?
500mL/hr
35
Who would be eligible for slow continuous ultrafiltration CRRT?
Volume overload WITHOUT electrolyte or acid/base abnormalities or uremia
36
What does a continuous venovenous hemofiltration CRRT remove?
Larger solutes and fluid volume
37
While slow continuous ultrafiltration CRRT is done via ultrafiltration, how does continuous venovenous hemofiltration CRRT work?
Ultrafiltration + convection
38
Who would be eligible for continuous venovenous hemofiltration CRRT?
Moderate electrolyte imbalances or uremia
39
What does continuous venovenous hemodialysis CRRT remove?
Small to medium-sized solute, some fluid by diffusion
40
How does a continuous venovenous hemodialysis CRRT work?
Diffusion
41
Who would need a continuous venovenous hemodialysis CRRT?
Electrolyte abnormalities, uremia, azotemia, acidosis volume overload
42
How does a continuous venovenous hemodiafiltration CRRT work?
Diffusion + convection
43
What does a continuous venovenous hemodiafiltration CRRT remove?
Small-large sized solutes + fluid
44
Who would be eligible for a continuous venovenous hemodiafiltration CRRT?
Electrolyte abnormalities, fluid overload or SEVERE azotemia
45
What are some complications of CRRT?
Circuit clotting, hypotension, and medication clearance
46
What is the 1st line anticoagulant therapy for patients without increased bleeding risk on CRRT?
Regional citrate anticoagulation
47
When should argatroban be used for CRRT?
Heparin-induced thrombocytopenia
48
What is the 2nd line anticoagulant therapy for patients without increased bleeding risk on CRRT?
Unfractionated heparin or low molecular weight heparin
49
What should/shouldn't you use for patients with increased bleeding risk or impaired coagulation on CRRT?
Use = regional citrate anticoagulation
Do NOT use = Unfractionated heparin or low molecular weight heparin
50
MOA of regional citrate anticoagulation?
Binds w/ ionized calcium forming a complex that reduces number of ionized calcium available to clot blood
51
When should you worry about giving regional citrate anticoagulation?
Patients on calcium-containing dialysis solution (can clot circuit)
52
AE of regional citrate anticoagulation?
Metabolic alkalosis, hypocalcemia, hypomagnesemia
53
MOA of heparin?
Inhibits factor Xa and Ila
54
What is argatroban indicated for?
Heparin induced thrombocytopenia AND pt who does not have an increased bleeding risk
55
What are some advantages of CRRT?
- Safer in hemodynamically unstable pt
- provides nutritional support
- increased renal recovery
56
What are some disadvantages of CRRT?
- Hypothermia
| - need continuous anticoagulation
57
What are some complications of hemodialysis?
Infection, intradialytic hypotension, muscle cramps, and thrombosis
58
How do you prevent infection on catheters?
1. Antiseptic wash
2. Mupirocin 2% or topical triple ointment
3. Caregivers wear mask, limit catheter manipulation
59
If infection occurs in AV fistulas, how long should you treat it for?
6 weeks
60
If infection occurs in grafts, how long should you treat it for?
2 to 4 weeks
61
When should you remove a catheter in hemodialysis?
S. aureus
Pseudomonas
Candida
62
Which AB treats MRSA for hemodialysis infections?
Vanco
63
To treat with empric therapy for hemodialysis infections, what must you give?
Cover both gram + and -
64
Which AB treats Pseudomonas or G- bugs for hemodialysis infections?
Aminoglycosides, Zosyn, 3rd or 4th gen cephalosporin, carbapenem
65
Intradialytic hypotension exists below what range?
BP <90/60
66
What are some causes of intradialytic hypotension?
Excessive ultrafiltration, antihypertensives before dialysis, rise in body temp and maybe serotonin surge
67
Repeated intradialytic hypotension can cause what?
Nephron ischemia
68
When should you take antihypertensives if youre on dialysis?
After dialysis, can cause hypotension if taken before
69
What are some common medications to manage intradialytic hypotension?
MIDODRINE
Sertraline
Levocarnitine
Fludricortisone
70
What is the first line Tx for managing intradialytic hypotension?
Midodrine
71
What is the typical dose of Midodrine?
2.5 to 10mg PO before dialysis OR 5mg 3 times / week on non-dialysis days
72
What kind of class does Midodrine belong to?
Selective alpha 1 agonist
73
What are some immediate Tx plans for managing intradialytic hypotension?
1. Trendelenburg position
2. 100cc of NS or hypertonic solution
3. Decrease ultrafiltration rate
4. Lower dialysate temperature
74
What causes muscle cramps?
1. Hypoperfusion due to excessive ultrafiltration
| 2. Hypotension
75
How can you prevent muscle cramps?
1. Vit. E 400U nightly
2. Vit. C. 250mg daily
3. Quinine 324mg daily (last line)
76
How can you treat muscle cramps?
1. NS or hypertonic saline bolus
| 2. 50mL IV glucose
77
What is the definition of a thrombosis?
Blood flow <300mL/min thru catheter
78
Which Tx can prevent thrombosis?
1. Ticlopidine
2. Clopidogrel
3. Aspirin
4. Aspirin w/ Dipyridamole
5. Fish Oil
79
How does Ticlopidine prevent thrombosis?
Decreases fistula thrombosis
80
How does Clopidogrel prevent thrombosis?
Decreases graft thrombosis after surgery
81
How does Aspirin prevent thrombosis?
??Mixed data?? 500>325
82
How does Aspirin w/ Dipyridamole prevent thrombosis?
Significant reduction at average of 4.5 years
83
How does Fish Oil prevent thrombosis?
Reduces graft thrombosis at 1 year **trial
84
Which Tx can manage thrombosis?
1. Unfractionated heparin
2. T-PA
3. Sodium citrate
85
Which Tx for managing thrombosis is more efficacious?
Sodium citrate = UFH < T-PA
86
Which Tx for managing thrombosis is more safe?
Sodium citrate > UFH
87
Before giving a thrombolytic to treat a thrombosis, what must you do first?
Clear catheter with saline flush
88
What are some thrombolytics to treat thrombosis?
1. Alteplase
2. Tenecteplase
3. Reteplase
89
What are some complications of peritoneal dialysis?
1. Hyperglycemia
2. Weight gain
3. Peritonitis
90
Why do pt undergoing peritoneal dialysis suffer from hyperglycemia and weight gain?
Dialysate contains dextrose
91
What are the common bugs that cause peritonitis?
S. aureus and epidermidis
92
If a G+ bug exist in periotnitis, what can you use to treat it?
Vanco or cephalosporin (vanco for just hemodialysis infection)
93
Staphylococcus is catalase (positive/negative)
Negative
94
Anemia in males is considered:
Hb < 13
95
Anemia in females is considered:
Hb < 12
96
What is the formation of all cell lines called?
Hematopoeisis
97
Formation of blood cells occurs where?
Red bone marrow
98
Maturation of blood cells occurs where?
Red bone marrow
99
Erythropoiesis occurs where?
90% produced via kidneys
100
What conditions can stimulate EPO production?
Hypoxia and ischemia
101
What co-factors are required to form erythrocytes?
1. Iron
2. Folate
3. Vit. B12
102
How many iron atoms are in each Hb molecule?
4
103
How many oxygen atoms are found in each Hb molecule?
1 for every iron, so 4
104
What is the most clinically useful RBC index?
Mean corpuscular volume (MCV)
105
What is considered normocytic?
80 to 96 fL/cell
106
What is considered microcytic?
<80
107
What is considered macrocytic?
>96
108
What is a hematocrit?
Amount of Hb per volume of whole blood (usually 3x the amount)
109
What is a mean corpuscular hemoglobin?
Hb / RBC count
110
When would mean corpuscular hemoglobin increase?
B12/Folate deficiency
111
When would mean corpuscular hemoglobin decrease?
Iron deficiency
112
What is a mean corpuscular hemoglobin concentration?
Hb / Hct
113
When would mean corpuscular hemoglobin concentration increase?
Hyperlipidemia
114
When would mean corpuscular hemoglobin concentration decrease?
Iron deficiency
115
What is used to differentiate iron deficiency anemia from thalassemias?
RBC distribution width
116
When would RBC distribution width increase?
Iron deficiency
117
What are reticulocytes?
Immature RBC
118
How long do reticulocytes take to mature?
1 - 2 days in circulate
119
An increase of reticulocytes indicates what?
Anemia due to blood loss or hemolysis
120
A decrease of reticulocytes indicates what?
Untreated iron, B12 or folate deficiency
121
Increased RBC destruction is a result of what?
1. Drug-induced (methotrexate)
| 2. G6PD deficinecy
122
What are some genetic causes of anemias?
1. Sickle cell
2. Thallassemia
3. Aplastic anemia
123
What are some acute clinical presentations of anemia?
1. Tachycardia
2. Angina
3. Dyspnea
4. Hypotension
124
What are some chronic clinical presentations of anemia?
1. Headache
2. Vertigo
3. Pallor
125
What is the first step in diagnosing anemia?
Determine if pt is bleeding
126
Microcytic anemia is _____ related
Iron deficiency
127
Macrocytic anemia is _____ related
B12 + folate
128
What are some signs and symptoms of iron deficiency anemia?
1. Glossal pain
2. Smooth tongue
3. Reduced salivation
4. Pica
5. Pagophagia
129
Iron that is from diet is known as ______
Fe 3+
130
Where does the dietary iron go to once ingested?
Small intestines (duodenum)
131
What is special about the duodenum and iron?
It's where Fe 3+ converts to Fe 2+ and enters enterocytes
132
What is the fate of Fe 2+ once it enters enterocytes?
1. Oxidized and stored as ferritin
OR
2. Bound to transferrin and transported to bone marrow, liver, or spleen
133
What happens if Fe 2+ if transported to bone marrow?
Converted to Hb
134
What happens if Fe 2+ if transported to liver?
Converted to ferritin for storage
135
What happens if Fe 2+ if transported to spleen?
Converted to ferritin for storage
136
What is the purpose of transferrin saturation levels?
Tells you about amount of iron bound to transferrin
137
What is the purpose of total iron-binding capacity levels?
Tells you the iron binding capacity of transferrin
138
If iron deficient, what happens to serum iron?
Goes down
139
If iron deficient, what happens to ferritin?
Goes down
140
If iron deficient, what happens to transferrin?
Goes up
141
If iron deficient, what happens to transferrin saturation?
Goes down
142
If iron deficient, what happens to total iron-binding capacity?
Goes up
143
Which iron panel group may falsely elevate in acute illnesses?
Ferritin
144
What is the normal range of serum iron levels?
40 to 160
145
What is the normal range of total iron-binding capacity?
250 to 410
146
What is the normal range of transferrin saturation?
20 to 50%
147
What is the normal range of serum ferritin?
40 to 200
148
Which drug class can cause Vit. B12 deficiency?
PPIs or antacids
149
PPIs or antacids can cause what kind of deficiency?
Vit. B12
150
What are some signs and symptoms of Vit. B12 deficiency?
Neurological abnormalities
151
In B12 deficiency, what happens to both homocysteine and methylmalonic acid levels?
Both rise
152
In folic acid deficiency, what happens to both homocysteine and methylmalonic acid levels?
Only homocysteine levels rise
153
How do B12 and folate work together?
B12 converts folate to its active form and folate would be needed for DNA synthesis
154
What are the root causes of anemia of inflammation?
Inflammation occurs via IL-1, IL-6, and TNF.
Increases hepcidin which decreases iron uptake and iron storage release
155
What are the iron panel abnormalities with anemia of inflammation?
1. Decrease serum iron
2. Increase serum ferritin
3. Decrease transferrin
4. Decrease TSAT
156
What is thalassemia?
alpha or beta chain in Hb is malformed which hinders oxygen carry ability
157
What is aplastic anemia?
Inability for stem cells to produce RBC, WBC, or PLT because of genetics, drugs, etc
158
What is the most common enzyme defect in humans and what is the result of it? What RX can cause this?
G6PD deficiency; hemolysis due to oxidative stress to Hb
1. Antimalarials
2. Sulfonamides
3. Nitrofurantoin
4. ASA, Cipro, Vit. E, Metformin
159
Folate and Vit. B12 are needed for what?
RBC maturation and DNA synthesis
160
How does Vit. B12 cause neuropathies?
Methylmalonyl-CoA accumulates and form abnormal fatty acids
161
What is the target goal for oral iron therapy?
150 to 200mg of elemental iron dalily
162
What is the duration of therapy for oral iron therapy?
3 to 6 months after anemia has resolved
163
What is the max absorption of elemental iron / day?
40 to 80mg
164
How can you dose elemental PO iron to improve tolerability?
Dose every other day rather than TID dosing
165
Which iron preparations have the highest elemental iron %?
Carbonyl iron and iron polysaccharide complex
166
What are some things that decrease iron absorption?
Antacids, H2 blockers, PPIs, tetracyclines, coffee, tea, milk eggs
167
What are some things that increase iron absorption?
Vitamin C
168
How often should you monitor for iron efficacy?
Check CBC every 3 months for 1 year, then yearly if indication have improved
169
What are some general AE of oral iron?
GI effects, dark stools
170
What are some ways to improve tolerability of oral iron?
1. Switch to delayed release
2. Switch to less elemental iron
3. Liquid
4. Take with food
171
When is parenteral iron given to CKD patients?
TSAT <30
| Ferritin <500
172
How do you dose parenteral iron?
HB x weight (lbs) = dose (mg)
173
What would be the iron overload levels for IV iron?
TSAT >45
| Ferritin >800
174
What is the BBW of iron dextran?
Anaphylaxis even with the test dose + increased % of hypotension
175
Which IV iron product is only used for patients receiving supplemental epoetin therapy?
Sodium ferric gluconate (Ferrlecit)
176
Which IV iron products have a BBW of anaphylaxis?
Iron dextran + Ferumoxytol
177
Which IV iron product cannot be used on dialysis patients?
Ferric carboxymaltose
178
How is cyanocobalamin given for neurological manifestations?
IM daily for 1 week then weekly for 1 to 2 months, then monthly for life
179
When are transfusions given?
Hb<7
Major bleed
Hemodynamically unstable`
180
How much folic is given for patients?
1mg daily
Unless pregnant or a child, then 0.4mg
181
How do you calculate mean corpuscular volume?
Hct / RBC count
182
What are glomerulonephropathies?
Disorders that affect the structure and function of the glomerulus
183
How are glomerulonephropathies classified?
1. Asymptomatic
2. Nephritic
3. Nephrotic
***based on lab and diagnostic findings, not cause of disease.
184
What are some hallmark features of nephritic syndrome?
Inflammation, hematuria, edema, proteinuria, and HTN
185
What are some hallmark features of nephrotic syndrome?
Profound proteinuria, edema, hypoproteinemia, and hyperlipidemia
186
Neonates, infants, children, and adolescents are how old?
Neonates: Birth to 28 days
Infant: 28 days to 12 months
Child: 1 yr to 13 yrs
Adolescent: 13yrs to 18yrs
187
Comparing preterm to term infants, who has a lower GFR and/or rate of improvement?
Preterm infants
188
When do infants reach mature GFR?
2yrs old
189
What is the most frequent cause of acute renal failure in children?
Hemolytic Uremic Syndrome
190
What causes typical hemolytic uremic syndrome in children?
Shiga-like toxin (E.coli)
191
How do you treat typical hemolytic uremic syndrome in children?
Dialysis
192
R for pediatric
Decrease CrCl by 25% or less than 0.5ml/kg/h for 8 hrs
193
I for pediatric
Decrease CrCl by 50% or less than 0.5ml/kg/h for 12 hrs
194
F for pediatric
Decrease CrCl by 75% or <35ml/min/1.73 or less than 0.5ml/kg/h for 24 hrs or anuria for 12 hrs
195
What is the gold standard biomarker for renal function of pediatrics?
SCr
196
Stage I AKI + Pediatrics
Increase in SCr by 0.3 during 48hrs or 1.5 to 2 times increase or <0.5ml/kg/hr for 8 hrs
197
Stage II AKI + Pediatrics
Increase in SCr by 2 to 3x or <0.5ml/kg/hr for 16hrs (12hrs for RIFLE criteria)
198
Stage III AKI + Pediatrics
Increase in SCr by at least 3x, or if GFR is below 35 or <0.5ml/kg/hr for 24hrs or anuria for 12 hrs
199
What are some complications with PD, IHD, or CRRT in infants?
Higher risk of hypothermia or hypotension due to smaller blood volume
200
What are the two recent AKI prevention projects in pediatric patients?
NINJA + RAI
201
What does a diffuse type damage look like?
All over the glomeruli
202
What does a focal type damage look like?
Some of the glomeruli
203
What does a segmental type damage look like?
Some of the glomerulus
204
What does a global type damage look like?
Most of the glomerulus
205
What are some ADR unique to cyclosporine?
Hypertrichosis + gingival hyperplasia
206
Which RX should you not give to pregnant women for nephritic/nephrotic syndrome?
MMF
207
Which RX to treat nephritic/nephrotic syndrome can cause cancer?
MMF, Azathioprine, Chlorambucil
208
Which drug alone is specifically used for lupus nephritis?
Hydroxychloroquine
209
Which RX to treat nephritic/nephrotic syndrome can cause retinal toxicity?
Hydroxychloroquine
210
Which RX to treat nephritic/nephrotic syndrome can cause gonadal toxicity?
Cyclophosphamide
211
Which RX to treat nephritic/nephrotic syndrome can cause hemorrhagic cystitis?
Cyclophosphamide
212
Which population group is more likely to get kidney stones?
Caucasians
213
What type of kidney stones are more prevalent?
Calcium stones
214
What is the gold standard to diagnose kidney stones?
CT
215
What is special about CT scans and diagnosing kidney stones?
Gold standard + no contrast required
216
What is special about the renal ultrasound and diagnosing kidney stones?
Less expensive + sensitive
217
What is special about the x-ray and diagnosing kidney stones?
Less expensive + can differentiate stone types
218
Which pH causes calcium phosphate kidney stones?
Basic
219
Which pH causes uric crystal kidney stones?
Acidic
220
Which pH causes calcium oxalate stones?
Acidic
221
What is the Dx of idiopathic hypercalciuria?
High urine calcium
| Normal serum calcium
222
What is the Dx of primary hyperparathyroidism and calcium stones?
High urine calcium
High serum calcium
Low serum phosphate
223
How do you treat calcium stones as a result of hyperparathyroidism?
Surgery
224
How do you treat idiopathic hypercalciuria?
Use thiazide or thiazide like diuretics (chlorthalidone, HCTZ) or Indapamide (ACE + thiazide-like), reduce sodium and protein
225
What is the Dx of hyperuricosuria?
High uric acid excretion
226
How do you treat hyperuricosuria?
Allopurinol, thiazide, potassium citrate, reduce meat
227
What pH level do you want to reach to treat uric acid stones?
6 to 6.5
228
What is the SIG of potassium citrate + uric acid stones?
10 to 30 mEq BID; follow up in 6 wks
229
What is the SIG of allopurinol + uric acid stones?
Only used for prevention, not treatment
230
What medications should you use to treat cystine stones?
Potassium citrate, chelating agent, captopril
231
What is the SIG of potassium citrate + cystine stones?
20 to 30 mEq BID
232
What causes stuvite stones?
Bacteria during UTIs
233
What does the prognosis look like for someone w/ ADPKD1?
Shorter life and faster progression
234
What does the prognosis look like for someone w/ ADPKD2?
Longer life expectancy vs ADPKD1, and shorter progression
235
How is PKD type 1 diagnosed?
```
<30yo = 2+ cysts
30-59 = 2+ cysts in each kidney
60+ = 4+ cysts in each kidney
```
236
Which abx can you use for PKD?
Must have good cyst penetration such as: fluroquinolones, SMX/TMP, or chloramphenicol
237
What should the diet be for someone who has PKD?
No caffeine and low-protein
238
Who is more likely to get diagnosed with atherosclerotic RAS?
Pts >50 yo
239
Who is more likely to get diagnosed with fibromuscular dysplasia RAS?
Young women
240
What labs should pop out when diagnosing RAS?
Elevated BUN and SCr
| Proteinuria
241
What are some diagnostic and screening tools to look for when looking at RAS?
>60% reduction in RA diameter, HTN before 30, severe HTN after 55, malignant or resistant HTN, sudden pulmonary edema
242
What are some non-pharmacological Tx for RAS?
Increased fruit and vegetables and low-fat dairy for calcium intake
243
Which RX do not need to be adjusted?
```
Azithromycin
Ceftriaxone
Metronidazole
Nafcillin
Abacavir
Tenofovir alafenamide
Aspirin
Clopidogrel
Enalapril
HCTZ
Atorvastatin
Omeprazole
Glipizide
Glyburide
```
244
Who is more likely to get diagnosed with fibromuscular dysplasia RAS?
Young women
245
What labs should pop out when diagnosing RAS?
Elevated BUN and SCr
| Proteinuria
246
What are some diagnostic and screening tools to look for when looking at RAS?
>60% reduction in RA diameter, HTN before 30, severe HTN after 55, malignant or resistant HTN, sudden pulmonary edema
247
What are some non-pharmacological Tx for RAS?
Increased fruit and vegetables and low-fat dairy for calcium intake
248
Which diuretic needs to be renally adjusted?
Spironolactone
249
Which pH causes cystine kidney stones?
Acidic
250
Which H2RA/PPI needs to be renally adjusted?
Famotidine
251
Which chromosome is affected by ADPKD2?
4
252
Which beta blocker needs to be renally adjusted?
Sotalol
253
Which diuretic needs to be renally adjusted?
Spironolactone
254
Which pH causes cystine kidney stones?
Acidic
255
Which chromosome is affected by ADPKD1?
16
256
Which chromosome is affected by ADPKD2?
4
257
Which immunosuppressive agents for GN are most specific?
Cyclosporine + tacrolimus (reduces T-lymphocyte activity?)
