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My MNTII Test 2 > From Review: Kidney Disease > Flashcards

From Review: Kidney Disease Flashcards

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1
Q

oliguria

A

low urine output of <400 mL/day.

a sign/cause of CKD.

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2
Q

anuria

A

very low urine output of <75-100 mL/day

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3
Q

What should be in a renal vitamin supplement

A

w/o vitamin A (retinol).

serum vit D is often low so many ppl need sup.

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4
Q

renal MVTs

A

renax, dialyvite 800, dialyvite 800 +zinc, nephrocaps, nephrovit, renal tabs, diatx (lowers tHcy as it has more folate, B12, B6)

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5
Q

K mg to mEq

A

39 mg K = 1 mEq

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6
Q

Na mg to mEq

A

23 mg Na = 1 mEq

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7
Q

decreaased carnitine levels caused by kidney failure: s/s

A

muscular weak, arrhythmias, high plasma triglycerides

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8
Q

carnitine recommendation

A

max 2g/day. neg results w/higher dose.

oral dose = 2g/day or less
IV = 1.4g/day (20 mg/kg)

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9
Q

control high iPTH meds

A

hectoral (doxercalcipherol)
zemplar (paricalcitol)
sensipar (cinacalcet) - not vit D

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10
Q

vit D3 therapy will

A

suppress iPTH and help normalize serum Ca

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11
Q

vit D3 therapy meds

A

calcitriol intravenous (Calcijex®), calcitriol oral (Rocaltrol®)- 1, 25 dihydroxy D3 .

doxercalciferol intravenous (Hectorol®), or doxercalciferol oral (Hectorol®)-1-alpha-hydroxy-vitamin D2.

paricalcitol (Zemplar®)- 19-nor-1-alpha-25 dihydroxy D2).

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12
Q

Sensipar® (cinacalcet) control

A

hyperparathyroidism associated w/bone disease, vascular calcification and parathyroid hyperplasia

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13
Q

Sensipar® (cinacalcet) more effective at

A

lowering iPTH than vit D is

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14
Q

Sensipar® binds to the

A

calcium-sensing Receptor (CaR) increasing its sensitivity to extracellular Ca. when Ca binds to and activates the CaR, PTH release is inhibited.

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15
Q

severe hyperphosphatemia level

A

7 - 15 mg/dL

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16
Q

meds to lower phos

A

renagel or renvela (less toxic, more expensive).
fosrenal.
less common - aluminum actacids: amphogel, Alu-tabs, alu-caps to bind phos in gut and increase excretion in stool.

must be taken w/each meal and snack. only give Ca sup if phos is below 7

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17
Q

causes for poor EPO response

A

infection/inflam, chronic blood loss, osteitis fibrosa, aluminum toxicity, hemoglobinopathies, folate or B12 def, multiple myeloma, malnutrition, hemodialysis.

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18
Q

high BUN indicate that

A

too high protein intake

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19
Q

predialysis enteral formula names

A

Suplena

RenalCal

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20
Q

PreD enteral: Suplena kcal

A

1800 Kcal/L calorically dense for fluid restriction

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21
Q

PreD enteral: Suplena low in

A

protein (44.7g/L) but HBV
electrolytes
phosphorus
vit A & D

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22
Q

PreD enteral: Suplena high in

A

calcium

folic acid

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23
Q

PreD enteral: Suplena has

A

carb stead and FOS

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24
Q

PreD enteral: RenalCal kcal

A

2.0 kcal/L

negligible electrolytes

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25
PreD enteral: RenalCal AAs
67% essential and 33% non-essential L-AAs and histidine for + N balance and minimizing uremic symptoms
26
PreD enteral: RenalCal meets or exceeds
100% of RDI for water-sol vits in 1000 mL (2000 kcal)
27
PreD enteral: RenalCal fat source
contains 70% MCT LCT for improved tolerance
28
PreD parenteral nutrition
more essential AAs and less non-essential. Aminosyn RF, Nephramine, RenAmine, Aminess
29
dialysis enteral formula names
Nepro Novasource Renal Nutren Renal
30
dialysis enteral: Nepro kcal
1.8 cal/mL, 425 cal/8 fl oz, moderate protein content 81 g/L.
31
dialysis enteral: Nepro low in
electrolytes & fluid
32
dialysis enteral: Nepro vits
moderate in vit A and D. high in folic acid and B6. 2:1 Ca/P ratio to help optimize Ca and P balance
33
dialysis enteral: Nepro contains
carb steady and | FOS - indigestible carbs that ferment in the colon to produce short-chain fatty acids
34
dialysis enteral: Novasource Renal kcal and pro
2 kcal/mL | 74 g pro/1000 mL
35
dialysis enteral: Novasource Renal low
fluid and electrolytes. | oral or TF
36
dialysis enteral: Nutren Renal kcal
2.0 kcal/mL
37
IDPN - Intradialytic Parenteral Nutrition
PN during dialysis for pts not tolerating PO sups (not covered by medicare or insurance companies). pts don't want NG tube. most centers use standard PN formulas w/AAs, lipid, & glucose. Add insulin to PN for DM.
38
(PDK) Polycystic Kidney Disease: onset
hereditary, mostly 30-40 yrs. usually produce enough erythropoietin, not anemic
39
PKD: s/s & mgmt
hematuria, proteinuria, infection, flank pain mgmt: nephrectomy, no salt/fluid restriction (may need salt w/high urine output). meds: SAMSCA (tolvaptan) - Tx hyponatremia & slows progression. Naringenin may slow progress.
40
(AGN) Acute Glomerulonephritis: onset
rapid, children 3-21 yrs who had a beta hemolytic group A strep infection
41
AGN: s/s
hematuria, albuminuria, oliguria, azotemia, hypertension, edema
42
AGN: mgmt
bed rest, antibiotics, Na & fluid restrict if severe edema & HTN, diuretics, BP meds
43
Glomerulonephritis
many types, chronic/acute. diffuse inflammatory changes in glomerulus in nephron (glomerulus is where urine production begins)
44
(CGN) Chronic Glomerulonephritis
glomeruli and tubules are progressively destroyed
45
CGN: possible causes
diseases such as sickle cell, AGN, lupus, nephrosis, diabetic nephropathy, idiosyncratic
46
CGN: detection
may be asymptomatic and detected d/t proteinuria/albuminuria
47
CGN: progress to
nephrotic syndrome, CKD, ESRD. progress may be slowed by anti inflammatory meds, BG & BP control in DM, low protein diet
48
nephrotic syndrome: cause
idiopathic or as a phase of CGN/CKD
49
nephrotic syndrome: s/s
``` proteinuria w/ 3.5-30g protein/day in urine. hyperlipidemia and lipiduria. polyuria/polydipsia/oliguria. low plasma albumin. hypertension, edema. weakness/lethargy/muscle wasting. hypercoagulopathy. ```
50
nephrotic syndrome: meds
control edema & hypertension w/loop diuretics like lasix (furosemide), antihypertensives like ACE inhibitors (benazepril (lotensin), ramipril (altace)) also restriction fluid and sodium.
51
nephrotic syndrome: mgmt
monitor plasma electrolytes. restrict sat fat and may need a statin med. some pts respond to steroid therapy, immunosuppressants.
52
nephrotic syndrome: protein
0.7-0.8g pro/kg IBW/day + 1g pro/g urinary protein. high protein diet will not affect low albumin and too much pro increases proteinuria.
53
Alport's syndrome
hereditary, damages kidneys and eyes, may cause deafness
54
BUN dialysis target value
60-90 mg/dL is acceptable for dialysis pt, 40-85 mg/dL normal person <20
55
CKD stages BUN
1: 10-26 mg/dL 4: 30-60 mg/dL 5: 60-100 mg/dL
56
creatinine normal value
0.2-1.2 | target < 1.2 mg/dL
57
CKD stages creatinine
1: < 1.2 mg/dL 4: 2-6 mg/dL 5: 6-10 mg/dL
58
creatine levels vs. kidney damage
0.6-1.5 mg = up to 50% nephron loss 1.6-4.6 mg = over 50% 4.7-9.9 mg = up to 75% > 10 mg = 90% (ESRD)
59
when is dialysis needed
BUN > 80 mg/dL | creatinine > 8.0 mg/dL
60
iPTH target range
150-300 pg/mL, 150-650 pg/dL
61
high iPTH will
promote bone turnover and osteodystrophy
62
low iPTH may be present in
adynamic bone disease (lowering of vit D & Ca therapy will be needed)
63
K/DOQI corrected total serum Ca
parameter target range | 8.4-9.4 mg/dL
64
K/DOQI Ca x P
< 55
65
K/DOQI serum Phosphorus
3.5-5.5 mg/dL
66
K/DOQI serum HCO3
> 22 mEq/L
67
corrected Ca
.8 * (4 - pt alb) + serum Ca = corrected Ca
68
Ca x P
corrected Ca * Phos = product | should not > 55
69
volume conversions
1 c = 8 oz = 240 ml = 240 cc | 1 oz = 30 ml
70
absorption of glucose from dialysate (peritoneal glucose absorption)
ex. rate 5 L of 3% glucose solution: 3% = 3g/100ml or 30 g/L 5L * 30 g/L = 150 g/day * 3.4 kcal/g (glucose monohydrate) * 80% (glucose absorbed in dialysate) = 408 kcal
71
peritoneal dialysis protein req
1.2 - 1.5 g/kg dry wt/day ``` DOQI = 1.3 g/kg/day peritonitis = 2g/kg/day ```
72
HD protein req
1.0-1.5 g/kg dry wt/day DOQI = 1.2 g/kg/day acutely ill = 1.2-1.3

My MNTII Test 2 (7 decks)

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