Nephrology

Question 1

definition of AKI

Answer 1

increase in sCr > 0.3 or 1.5x baseline in last week

Question 2

anuria definition

Answer 2

urine output <50ml/day

Question 3

functional kidney injury causes

Answer 3

low blood flow
does not allow the kidneys to fxn as well

concentrated urine

Question 4

intrinsic kidney injury

Answer 4

infections or physical injury

urine is NOT concentrated

Question 5

drugs that hurt the kidneys

Answer 5

bactrim - inhibit tubular secretion of cr

cimetidine - inhibit tubular secretion of cr

corticosteroids - increase BUN

Tetracyclines - increase BUN

cephalosporins - interfere with cr assay

aminoglycosides - tubular necrosis

contrast dye - tubular necrosis

cisplatin - tubular necrosis

amphotericin B - tubular necrosis

Question 6

risk factors for nephrotoxicity with contrast dye

Answer 6

> 75 yo, anemia, DM, hypovolemia, decreased blood flow to kidney, hypotension, nephrotoxins, >140ml of contrast, kidney disease

Question 7

ACE/ARB effects on kidneys

Answer 7

dilates the efferent arteriole

Question 8

NSAID effects on kidneys

Answer 8

constrict afferent arteriole and reduce glomerular blood flow,

Question 9

cyclosporine and tacrolimus effect on kidneys

Answer 9

constrict afferent arterioles

Question 10

drugs that may cause tubulostitial disease

Answer 10

PCN
NSAIDs
Lithium

Question 11

drugs that cause postrenal (obstructive) nephropathy

Answer 11

sulfonamides, methotrexate, acyclovir, vitamin C

Question 12

drugs that cause nephrolithiasis

Answer 12

triamterene, sulfadiazine, ephedrine

Question 13

diabetic kidney disease

Answer 13

ACEi/ARB
Patiromer to bind K
HCTZ if stage 1-3, loop diuretic if stage 4-5
SGLT2 if DM, GFR>30, and ACR > 300

Question 14

thrombosis tx w/hemodialysis

Answer 14

alteplase 2mg OR
reteplase 0.4 units

Question 15

antibiotics to use for infected peritoneal cavity

Answer 15

vanc or 1st gen cephalosporin
PLUS
3rd gen cephalosporin, aminoglycoside, or aztreonam

Question 16

what medical condition contraindicates ESA’s?

Answer 16

uncontrolled hypertension

Question 17

Procrit dose (epoetin-alfa)
Epogen

Answer 17

SC or IV
50-100units/kg TIW

Question 18

Darbepoetin alfa (Aranesp)

Answer 18

SC or IV
Non-Dialysis: 0.45mcg/kg q4w
Dialysis: 0.45mcg/kg qweekly or 0.75mcg/kg q2w

Question 19

Mircera (methoxy-polyethylene glycol-epoetin beta)

Answer 19

takes 7-15 days after initial dose to see effects
SC or IV
0.6 mcg/kg q2w

Question 20

when to use iron supplements

Answer 20

serum ferritin <500ng/mL
OR
serum transferrin sat <30%

Question 21

iron dextran dosing

Answer 21

25mg test dose then
1g at once
OR
100mg IV TIW x 10 doses

Question 22

sodium ferric gluconate complex

Answer 22

Ferrlecit
125mg IV TIW x 8 doses

Question 23

Iron Sucrose

Answer 23

100mg IV TIW x 10 doses in Hemodialysis

200mg IV daily x 5 doses in Non-HD patients

Question 24

Ferumoxytol

Answer 24

Feraheme
510mg x 2, 3-8 days apart

Question 25

Ferric Carboxymaltose

Answer 25

Injectafer 750mg x 2, 7 days apart

Question 26

what happens to phosphorous and calcium when CrCl <30ml/min

Answer 26

parathyroid hormone leeches calcium from the bones, decreases reabsorption of calcium from kidneys

Question 27

calcium supplements for CKD

Answer 27

calcium carbonate 1250mg TID calcium acetate (Phoslo) 667mg tabs may decrease metabolic acidosis

Question 28

Sevelamer dosing

Answer 28

Renvela and Fosrenol decreases LDL and increases HDL may worsen metabolic acidosis may increase hypercalcemia

Question 29

Vit D Dosing

Answer 29

<5: weekly x 12, then monthly 5 - 15: weekly x 4, then monthly 16 - 30: monthly dosing

Question 30

Cacitriol

Answer 30

active Vitamin D3 PO or IV 0.25mcg daily for hypocalcemia and 2ndary hyperparathyroidism MOA: increases calcium and phosphate absorption from the small intestine, increases bone mineralization indirectly by increasing ions from absorption, may also cause bone absorption in bone remodeling, in kidneys it causes more reabsorption of Ca and Phos

Question 31

Vitamin D 2 brand name

Answer 31

ergocalciferol inactive

Question 32

Vitamin D 3 brand name

Answer 32

cholecalciferol inactive

Question 33

vitamin d - calcium - phosphorous pathways

Answer 33

liver converts D3 to another form w/magnesium, then kidney converts to active vitamin d w/magnesium D is made active if we need calcium absorption, if not it is made into an inactive form and excreted this conversion is regulated by calcium, phosphate, and PTH

Question 34

calcium mimetics on the market for hyperparathyroidism

Answer 34

calcitriol - active vitamin D paricalcitol - D analog, IV Doxercalciferol - D analog IV, requires hepatic activation analogs less hyper-Ca than calcitriol

Question 35

Cinacalcet (Sensipar) for secondary hyperparathyroidism

Answer 35

use for secondary high PTH if high calcium and phos and d cannot be increased will attach to PTH gland and increase sensitivity to serum Ca to reduce PTH, decreases blood Ca via increased uptake 30mg daily

Question 36

cinacalcet drug interactions

Answer 36

2D6 inhibitor - increases TCA's, flecainide, and thioridazine 3A - doubles [x] of ketoconazole

Question 37

etelcalcetide (parsabiv)

Answer 37

synthetic cinacalcet, same MOA 5mg IV TIW after HD stays in blood for a month