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Renal Exam 2 > Lect 5 > Flashcards

Lect 5 Flashcards

1
Q

PTH effects on Ca and phos

A

increase in serum Ca

decrease in serum phos

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2
Q

Vit D effects on Ca and phos

A

increase in serum Ca

increase in serum phos

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3
Q

Calcitonin

A

decrease in serum Ca

decrease in serum phos

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4
Q

loss of nephrons

A

increased phos retention

decreased prod of 1,25 DH D3

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5
Q

secondary hyperparathyroidism

A

HD pts= PTH >495 pg/mL assoc w/ increased sudden death, increased morbidity and mortality

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6
Q

corrected Ca

A

Ca(corr)= [(4-albumin) x 0.8] + Ca(obs)

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7
Q

soft tissue calcification

A

rate is high when Ca x P >70 mg2/dL2
uncommon below 50 mg2/dL2
recommended to maintain below 55 mg2/dL2

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8
Q

elevated Ca x P assoc with ___

A

vascular calcification, CV disease, calciphylaxis, death

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9
Q

reference range of Ca

A

8.5-10.5

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10
Q

goal Ca for CKD stages

A

for all stages= w/in reference range

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11
Q

hypocalcemia

A

serum Ca less than 8.5

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12
Q

sx of hypocalcemia

A

depend on acuity of onset
acute= neuromuscular, CV
chronic= CNS, dermatologic

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13
Q

WHAT MEDS COMMONLY CAUSE HYPOCALCEMIA?

A

bisphosphonates, calcitonin, furosemide, oral phosphorus therapy

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14
Q

common causes of hypoCaemia

A

ICU, elderly, malnourished, pts who have received sodium phos as bowel prep, Vit D deficiency, parathyroidectomy or thyroidectomy, drugs

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15
Q

treatment for acute, symptomatic hypocalcemia

A

100-300 mg elemental Ca IV over 5-10 min (should not be infused faster than 60 mg/min due to cardiac dysfunction)

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16
Q

treatment for asymptomatic hypocalcemia

A

oral calcium 1-3 g/day

correct underlying cause if possible (replace Mg, replace Vit D)

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17
Q

treatment for acute, symptomatic hypocalcemia

A

100-300 mg elemental Ca IV over 5-10 min (should not be infused faster than 60 mg/min due to cardiac dysfunction)
continuous infusion 0.5-2 mg/kg/hr elemental Ca

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18
Q

treatment for asymptomatic hypocalcemia

A

oral calcium 1-3 g/day

correct underlying cause if possible (replace Mg, replace Vit D)

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19
Q

hypercalcemia

A

serum Ca >10.5 mg/dL

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20
Q

sx of hypercalcemia

A

Ca less than 13= asymptomatic
Ca >13= depends on acuity of onset
acute= anorexia, N/V, constipation, polyuria/dipsia; hypercalcemic crisis (acute elevation to >15 mg/dL)
chronic= metastatic calcification, nephrolithiasis, chronic renal insuffienciency

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21
Q

sx of hypercalcemia

A

Ca 13= depends on acuity of onset
acute= anorexia, N/V, constipation, polyuria/dipsia; hypercalcemic crisis (acute elevation to >15 mg/dL)
chronic= metastatic calcification, nephrolithiasis, chronic renal insuffienciency

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22
Q

common causes of hyperCaemia

A

malignancy, primary hyperparathyroidism, meds

23
Q

common drug causes of hyperCaemia

A

Vit D analogs, Ca supplements, lithium

24
Q

tx for hyperCaemia

A
  • rehydration with NS 200-300 mL/h
  • loop diuretics: furosemide 40-80 mg IV Q1-4h
  • calcitonin 4 units/kg SQ or IM Q12h (use when hydration is C/I)= use in hemodialysis or ESRD
  • bisphosphonates: zoledronate 4-8 mg IV given over 5 min
25
hypophosphatemia causes
decreased GI absorption (phos binders, sucralafate) increased urinary excretion extracellular to intracellular redistribution (refeeding syndrome)
26
hypophosphatemia symptoms
``` mild-mod= aysymptomatic severe= arrhythmias, resp muscle fatigue/ failure, myalgias, weakness, coma ```
27
treatment for severe symptomatic hypophosphatemia
phos 15-30 mmol IV over 3 hours
28
causes of hyperPhosemia
renal failure | intracellular phos release (tumor lysis syndrome)
29
sx of hyperphosphatemia
soft tissue calcification N/V, diarrhea, lethargy, seizures renal osteodystrophy
30
phos restriction
restrict to 800-1000 mg/day when: phos levels >4.7 mg/dL plasma conc of PTH elevated above target
31
reference range for phos
2.6-4.5
32
calcium citrate
phos binder | not to be used concurrently w/ aluminum-based binders
33
aluminum-based phos binders
slowly removed by dialysis so can accumulate in various tissues toxicity treated with deferoxamine
34
aluminum-based phos binders
slowly removed by dialysis so can accumulate in various tissues toxicity treated with deferoxamine
35
when are non-Ca, non-Mg, non-Al based binders first line?
when hypercalcemic, low PTH, or vascular calcification
36
examples of non-Ca, non-Mg, non-Al based binders
* sevelamer HCl (Renagel)= lowers LDL, increases HDL; should not be broken or chewed * lanthanum carbonate (Fosrenol)= chewable wafer
37
when is it ok to use aluminum-based binders?
in pts with phos >7 mg/dL, they may be used for less than 4 weeks
38
Stage 3 & 4 phos binders first line
calcium-based
39
Stage 5 primary phos binder therapy
either calcium-based binders OR non-Ca, non-Mg, non-Al based binders can use combo if monotherapy ineffective
40
stage 5 use of calcium binders
total daily dose of elemental Ca should not exceed 2 g/day (1500 mg phos binder, 500 mg diet)
41
when do you start a Vit D COMPOUND in CKD?
Stage 3 or 4 | when serum conc of 25-hydroxyvitamin D is less than 30
42
when do you start a Vit D STEROL in CKD?
serum conc of 25(OH)D less than 30 and PTH is above target range when PTH is progressively increasing and remain persistently higher than the upper reference limit only in pts with Ca and phos at goal do not use in rapidly worsening kidney function or non-compliant
43
when is it ok to use aluminum-based binders?
in pts with phos >7 mg/dL, they may be used for
44
which Vit D therapies are compounds?
ergocalciferol and cholecalciferol
45
which Vit D therapies are sterols?
calcitriol, paricalcitol, doxecalciferol
46
ADR's of Vit D tx
increased intestinal absorption of Ca and phos (can lead to hyperCaemia or aggravate hyperPhosemia) decreased PTH --> adynamic dbone disease
47
when do you start a Vit D COMPOUND in CKD?
Stage 3 or 4 | when serum conc of 25-hydroxyvitamin D is
48
when do you start a Vit D COMPOUND in CKD?
Stage 3 or 4 | when serum conc of 25-hydroxyvitamin D is
49
when do you start a Vit D STEROL in CKD?
serum conc of 25(OH)D target range when PTH is progressively increasing and remain persistently higher than the upper reference limit only in pts with Ca and phos at goal do not use in rapidly worsening kidney function or non-compliant
50
PTH reference ranges
Stage 3-5= 35-70 | Stage 5 dialysis= 130-600
51
calcimimetics (cinacalet HCl)
decrease PTH secretion and Ca x P | majority of pts receiving concurrent Vit D and phos binders
52
ADR's of calcimimetics
N/V, hypoCaemia inhibitor of CYP2D6 take with meals
53
calcimimetics place in therapy
alternative or adjunct to Vit D analogs

Renal Exam 2 (10 decks)

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