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PHAR 255 > Kidney 3 > Flashcards

Kidney 3 Flashcards

(50 cards)

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1
Q

Fluid and electrolyte abnormality complications

A

Sodium and water imbalance
Metabolic acidosis
Hyperkalemia

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2
Q

General complications of CKD

A

CKD-mineral bone disease
Anemia
CV
GI
Neurological

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3
Q

What causes a sodium and water imbalance?

A

Progressive loss of ability of the kidneys to excrete excess water and sodium

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4
Q

When do we see sodium and water imbalance in CKD and what does it look like?

A

Usually stage 4 CKD
- weight gain
- hypertension
- peripheral and pulmonary edema

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5
Q

Treatment for sodium and water imbalance

A

Sodium and water restriction
- <2g of sodium and 1-2L of fluid per day
Furosemide +/- metolazone
Stage 5: dialysis

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6
Q

What effect does metolazone have when added to furosemide?

A

They have a synergistic effect to increase excretion of sodium because it blocks the uptake of of sodium at the distal convoluted tubule

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7
Q

What needs to be monitored for diuretic use?

A

Electrolytes (specifically K+)
- every 1-2 weeks initially then 3-6 months when stable
Signs and symptoms of dehydration

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8
Q

What is metabolic acidosis?

A

Decrease in the pH of the blood and a decrease in serum bicarbonate levels

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9
Q

What may cause metabolic acidosis?

A

Impaired excretion of acids and/or reabsorption of bicarbonate

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10
Q

At what stage of CKD is metabolic acidosis most prominent?

A

Stage 4-5

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11
Q

What is the treatment for metabolic acidosis?

A

Sodium bicarbonate tablets (325-500mg BID-TID)

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12
Q

What is the concern with sodium bicarbonate tablets?

A

Possibility of sodium loading

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13
Q

When would IV sodium bicarbonate be used?

A

Severe acidosis in hospitalized patients

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14
Q

What is hyperkalemia primarily due to?

A

Decreased potassium excretion

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15
Q

What are the exacerbating factors for hyperkalemia?

A

Metabolic acidosis
Excessive potassium intake from diet
Potassium sparing diuretics
ACEi/ARB
NSAIDs

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16
Q

Symptoms of mild to moderate hyperkalemia (5.1-7mmol/L)

A

Weakness, confusion, muscle & respiratory paralysis, ECG changes

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17
Q

Symptoms of severe hyperkalemia (>7mmol/L)

A

ECG changes widened QRS complex, small amplitude P wave, sinus waves, heart block, ventricular tachycardia, sudden cardiac death

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18
Q

Treatment for hyperkalemia

A

Identify/correct exacerbating factors
- drugs, diet
Kayexalate (potassium binders) - for mild acute or refractory chronic hyperkalemia

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19
Q

What is the formulation for kayexalate?

A

Oral powder or liquid suspension
- should not be mixed into liquid high in K+
15-60g daily-QID

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20
Q

What are the newer K+ binders available?

A

SZC
Patiromer
*they are better tolerated

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21
Q

How should K+ binders be taken?

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A

Spaced by 3 hours from other drugs due to binding drug interactions

22
Q

Treatment for severe hyperkalemia

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A

MEDICAL EMERGENCY
- Calcium gluconate IV (to stabilize myocardium)
- glucose + human regular insulin
- sodium bicarbonate IV (only if metabolic acidosis)
- salbutamol via nebulizer
- kayexalate until K+ normalized

23
Q

What is CKD-MBD

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A

A systemic disorder of mineral and bone metabolism due to CKD manifested by one of a combination of there characteristics

24
Q

What are the three characteristics of CKD-MBD?

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A
  • Abnormalities of calcium, phosphorus, PTH, or vitamin D meatabolism
  • abnormalities in bone turnover, mineralization, volume, linear growth, or strength
  • vascular or other soft tissue calcification
25
At what stage of CKD do bone and mineral metabolism changes begin?
Stage 3
26
What are the outcomes of CKD-MBD?
Bone pain, fractures, CVD, death
27
What are the 4 main issues that we target with treatment for CKD-MBD?
- increased serum phosphate - decreased serum calcium - decreased vitamin D - increased PTH
28
What are the three main calcium sources in the body?
Kidney Bone Gut
29
What are the three ways to look at calcium on a lab?
Ionized calcium (active calcium) Total calcium (free ionized + calcium bound to albumin) Corrected calcium (calcium adjusted for albumin levels)
30
What are the types of renal osteodystrophy?
Hyperparathyroid bone disease Adynamic bone disease Osteomalacia
31
Hyperparathyroid bone disease
High bone turnover (increased) Increased PTH levels
32
Adynamic bone disease
Low bone turnover (decreased) Normal or decreased PTH levels
33
Osteomalacia
Decreased vitamin d activity
34
What is calciphylaxis?
Calcification and occlusion of small blood vessels - leads to ulceration, gangrene, secondary infection (sepsis), and is associated with with a high mortality rate
35
How is Hyperparathyroid bone disease treated?
Restrict dietary phosphate Phosphate binders - calcium, aluminum or magniusm binders Vitamin D - calcitriol Parathyroidectomy
36
When do phosphate binders need to be taken?
Within first few bites of a meal
37
What are the 1st line phostphate binders?
Calcium carbonate (TUMS) - 500mg elemental TID WITH MEALS
38
Why is vitamin D used to treat HPT bone disease?
Helps suppress PTH levels - reserved for severe and progressive HPT
39
What are the antiresorptive treatments?
Denosumab (Prolia) Bisphosphonates (alendronate)
40
What is adynamic bone disease associated with and what is the treatment?
More fractures and calcification Treatment: stop vitamin D supplementation
41
Treatment for osteomalacia
Stop aluminum-containing phosphate binders
42
What is vascular calcification?
Vascular smooth muscle cells change into an osteoblast-like cell
43
What does anemia in CKD look like?
Normochromic, normocytic Hgb < 130g/L or 120g/L Hypo-proliferative (inadequate production) - decreased Reticulocytes
44
Drug Treatment for anemia in CKD
Erythropoiesis stimulating agents
45
Overall treatment options for anemia in CKD
Correct blood loss Replace vitamin, iron deficiencies ESA (drugs) Dialysis to correct Uremia Blood transfusions
46
What are the ESAs?
Epoetin alfa (shorter half life) Darbepoetin Alfa (longer half life)
47
What might cause erythropoietin resistance?
Iron deficiency* Vitamin deficiency Bleeding Inflammation/infection Inadequate dialysis
48
What are the contributing factors to HTN in CKD?
Salt and water retention Activation of RAAS ESA therapy Hyperparathyroidism Renal vascular disease
49
What is the most common structural cardiac abnormality in CKD?
Left ventricular hypertrophy
50
Treatment options for chronic pruritis/uremic pruritis
Difelikefalin** (when associated with HD) Gabapentinoids Capsaicin Sertraline Antihistamines Uremol lotion

PHAR 255 (8 decks)

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