Chronic kidney disease Flashcards Preview

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Flashcards in Chronic kidney disease Deck (30)
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1
Q

What is a normal albumin to creatinine ratio? (ACR)

A

<2mg/mmol is normal

2
Q

What can cause higher ACRs? (other than CKD)

A
UTI
Febrile illness
Exercise
Decompensated CHF
Menstruation
Acute, severe elevation of blood glucose or blood pressure
3
Q

What is the ACR range for microalbuminuria?

A

2-20

4
Q

How do you test for microalbuminuria?

A

Several samples over 3 months, 2 samples have to be positive

5
Q

What drug should diabetics with CKD or HTN receive? Why?

A

ACEi or ARB

Delay progression of CKD

6
Q

When do you want to check bloodwork when you start an ACEi? What are you looking for?

A

Within 1-2 weeks
Make sure potassium levels within normal range
Make sure SCr does not raise more than 30%

7
Q

Should you use an ACEi and ARB together??

A

no - more adverse outcomes

8
Q

Is an ACEi contraindicated if CrCl <30?

A

NO - unless SCr increases above 30%, or increase K+, or dehydrated

9
Q

How do you adjust calcium levels based on albumin?

A

For every 10g/L drop in albumin from 40g/L, calcium behaves like it’s 0.2 mmol/L higher

10
Q

Explain what happens if someone with kidney disease eats too much phosphate

A

Too much phosphate will accumulate because the kidney is not filtering efficiently. Also not removed by dialysis.
Phosphate binds with calcium, forms deposits in body (coronary arteries, under skin).

11
Q

How does the parathyroid react in regards to high phosphate levels?

A

Phosphate binds calcium, thus lowering calcium levels in blood. Parathyroid detects low calcium, releases PTH, takes calcium from bone.
= bone disease (osteitis fibrosa cystica)

12
Q

What’s the best way to manage phosphate levels in CKD?

A

Decrease phosphates in their diets.

13
Q

How do drugs that control phosphate levels work?

A

Drug binds to phosphate from food in stomach before getting absorbed, gets removed in stool

14
Q

What are the 3 phosphate binders we were told to know about?

A

Calcium Carbonate
Sevelamer (Renagel)
Lanthanum (Fosrenol)

15
Q

What’s a worry with taking calcium carbonate as a phosphate binder?

A

Hypercalcemia

Sometimes doesn’t control phosphates well enough

16
Q

What’s a normal phosphate level? What is the target in CKD?

A

Normal 1.45 mmol/L

Don’t really have a target, not much evidence in trying to get close to normal, generally target around 1.8 mmol/L

17
Q

Renagel… what is it, daily dose, when is it good

A

Sevelamer
800mg/day, given **with meals (titrate to adjust if needed)
Doesn’t have calcium
- Good if patient hypercalcemic with calcium carbonate
Really expensive

18
Q

Fosrenol - what is it, dose, what about it

A

Lanthanum
250-1000mg/day, given TID **with meals
Causes nausea, doesn’t work much better than renagel or calcium
More expensive than renagel

19
Q

How do you control high PTH levels?

A

Calcitriol (activated vitamin D – not OTC)

20
Q

When do you start calcitriol?

A

When calcium and phosphate levels are in normal range

21
Q

Why can’t you use regular OTC vitamin D to control phosphate levels?

A

Kidneys have to activate vitamin D first before it can work - if kidneys aren’t working, need to give activated vitamin D (calcitriol)

22
Q

What is the normal range for PTH?

A

300-350

23
Q

Side effects of calcium carbonate?

A
GI (N/V/D, constipation)
Hypercalcemia
Pruritis
Xerostomia
Muscle cramps
24
Q

Side effects of sevelamer (Renagel)?

A

GI (N/V/D, abdominal pain, constipation) - high
Metabolic acidosis
Peritonitis

25
Q

Side effects of lanthanum (Fosrenol)?

A
GI (N/V/D, constipation, dyspepsia)
Hypercalcemia
Muscle cramp
Edema
Myalgia
Peritonitis
26
Q

Calcium carbonate interactions?

A

Interferes with absorption of ASA, digozin, isoniazid, quinolone, tetracycline

27
Q

Which phosphate binder should not be taken on an empty stomach?

A

Lanthanum (fosrenol) - can cause nausea and vomiting

28
Q

Which phosphate binder should be taken just before eating, and can’t be cut or chewed?

A

Sevelamer (renagel) - contents expand in water, can cause choking

29
Q

List some high phosphorus foods

A
Bran
Basking powder
Milk products
Whole wheat bread
Dried beans and peas
Nuts
Pizza
Processed meats
Colas
Chocolate
TV dinners
30
Q

List some low phosphorous foods

A
Fresh meats
Fish
Plain cookie, soda crackers
White rice, bread, noodles
Cream of wheat
Corn flakes
Popcorn
Pie
Fresh fruit and vegetables
Jam
Coffee/tea/non-cola pop
Original rice beverage