CKD and End Stage Renal

Question 1

T/F: Cockroft and Gault can be used for all stages of renal disease

Answer 1

FALSE: only accurate for patients with stable kidney fxn; tends to overestimate renal fxn in mod-severe kidney impairment

Question 2

BB is a 56 yom with serum creatinine of 1.5 mg/dL. His weight is 80 kg and high height is 5’11”. Calculate his creatine clearence.

Answer 2

Question 3

FH is an 80 yof with a serum creatinine of 2.3 mg/dL. Her weight is 70 kg and her height is 5’4”. Calculate his creatine clearence.

Answer 3

Question 4

GT is a 67 yof with serum creatinine of 1.7 mg/dL. Her weight is 100 kg and her height is 5’5”. Calculate his creatine clearence.

Answer 4

Question 5

What complication can occue when the kidneys fail to excrete waste products of metabolism from the blood?

Answer 5

Uremia

Question 6

What lab value can clinicians use to assess signs and symptoms of uremia?
A. SCr
B. BUN
C. Ca
D. eGFR

Answer 6

B. BUN

Question 7

(Loops/Thiazides) will work when CrCl <30 mL/min, but (loops/thiazides) will NOT work when CrCl <30 mL/min

Answer 7

Loops will work when CrCl <30 mL/min, but thiazides will NOT work when CrCl <30 mL/min

Question 8

Which of the following diuretics is least likely to cause an allergic sulfa reaction?
A. Furosemide
B. Ethacrynic acid
C. Toresemide
D. Bumetanide

Answer 8

B. Ethacrynic acid

Question 9

When should phosphate binders be given?

Answer 9

With meals

Question 10

What are two calcium containing phosphate binders and their side effect?

Answer 10

Calcium carbonate (Tums)
Max: 1500 mg/day

Calcium acetate (PhosLo)
fewer hypercalcemia events

SE for both: constipation

Question 11

Which of the following non-calcium containing phosphate binders decreases LDL by 15-30% and is most common in ESRD patients?
A. Sevelamer carbonate (Renvela)
B. Lanthanum carbonate (Fosrenol)
C. Sucroferric oxyhydroxide (Velphoro)
D. Auryxia (ferric citrate)

Answer 11

A. Sevelamer carbonate (Renvela)

Question 12

Which of the following non-calcium containing phosphate binders has increased efficacy with a lower pH?
A. Sevelamer carbonate (Renvela)
B. Lanthanum carbonate (Fosrenol)
C. Sucroferric oxyhydroxide (Velphoro)
D. Auryxia (ferric citrate)

Answer 12

B. Lanthanum carbonate (Fosrenol)

Question 13

Which of the following non-calcium containing phosphate binders are used for patients on dialysis and help iron stores?
A. Sevelamer carbonate (Renvela)
B. Lanthanum carbonate (Fosrenol)
C. Sucroferric oxyhydroxide (Velphoro)
D. Auryxia (ferric citrate)

Answer 13

D. Auryxia (ferric citrate)

Question 14

What should dietary phos intake be restricted to?

Answer 14

800-100 mg/day

Question 15

Which of the following phosphate binders will affect the patient’s calcium serum conc?
A. Renvela (sevelamer carbonate)
B. Fosrenol (lanthanum carbonate)
C. Tums (calcium carbonate)
D. Velphoro (sucroferric oxyhydroxide)

Answer 15

C. Tums (calcium carbonate)

Question 16

JT is a 78 yom starting hemodialysis. His current lab values are
Ca 11
Phos 6
PTH 1200
SCr 12
Uric Acid 8

Which of the following would be the best option for treating JT’s hyperphosphatemia?
A. Tums (calcium carbonate)
B. Velphoro (sucroferric oxyhydroxide)
C. Fosrenol (lanthanum carbonate)
D. Renvela (sevelamer carbonate)

Answer 16

D. Renvela (sevelamer carbonate)

Question 17

How does increases PTH affect Phos, Ca, and Vit D?

Answer 17

Phos: increases
Ca: decreases
Vit D: unable to activate

Question 18

Where does Vit D activation occur?
A. 25-hydroxylase in liver
B. 1-alpha-hydroxylase in kidney
C. 7-dehydrocholesterol in skin

Answer 18

B. 1-alpha-hydroxylase in kidney

Question 19

Which of the following require activation? (Mulitple)
A. Calcitriol
B. Cholecalciferol
C. Paricalcitol
D. Ergocalciferol

Answer 19

B. Cholecalciferol
D. Ergocalciferol

Question 20

Which of the following have both PO and IV? (Mulitple)
A. Calcitriol
B. Cholecalciferol
C. Paricalcitol
D. Ergocalciferol

Answer 20

A. Calcitriol
C. Paricalcitol

Question 21

What should be monitored when aiming to increase Vit D?

Answer 21

Ca, iPTH

Question 22

Which of the following Vit D products DOES NOT require activation by a body organ prior to activation?
A. cholecalciferol
B. calcitriol
C. doxercalciferol
D. ergocalciferol

Answer 22

B. calcitriol

Question 23

Mrs. Jenkins is an 82 yof hemodialysis patient who presented to the clinic today with persistent secondary hyperparathyroidism. Her labs are:
Ca 7.2 mg/dL
Phos 4.0 mg/dL
PTH 1300 pg/mL
Vit D 35 ng/mL

Which of the following meds should be recommedned for treating her secondary hyperparathyroidism?
A. cinacelcet (Sensipar)
B. ergocalciferol
C. paricalcitol (Zemplar)
D. cholecalciferol

Answer 23

C. paricalcitol (Zemplar)

Question 24

What is the two main causes of anemia with ESRD patients?

Answer 24

Decreased production of erythropoietin and decreased life span of red blood cells

Question 25

What is the best assessment parameter for anemia?
A. BUN
B. Hb
C. CrCl
D. Phos

Answer 25

B. Hb

Question 26

At what values of Hb level should diagnose anemia in females and males?

Answer 26

Hb <12 g/dL in females
Hb <13 g/dL in males

Question 27

KDIGO suggests iron supplementation if TSAT ____ and serum ferritin is _______

Answer 27

TSAT <30%
Ferritin <500 ng/mL

Question 28

A patient has a TSAT of 15% and ferritin of 100. They are scheduled for an MRI within the next month. What medication should NOT be distributed?
A. Ferrlicit
B. Injectafer
C. Venofer
D. Feraheme

Answer 28

D. Feraheme