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Nephrology Flashcards

(66 cards)

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1
Q

anuric

A

UOP less than 50 mL/24 hours

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2
Q

oliguric

A

UOP less than 0.5 mL/mkg/hr for 12 hours or more

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3
Q

nonoliguric

A

UOP more than 500 mL/24 hours

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4
Q

Stage I AKI

A

SCr >= 0.3 increase or 1.5-2x baseline

UOP < 0.5 ml/kg/hr for 6-12 hrs

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5
Q

Stage II AKI

A

SCr 2-3x baseline

UOP < 0.5 mL/kg/hr for >= 12 hrs

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6
Q

Stage III AKI

A

SCr >3x baseline or SCr >=4 or on RRT

UOP <0.3 mL/mkg/hr for >= 24 hours or anuria for >=12 hours

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7
Q

prerenal AKI

A

hypoperfusion

BUN/SCr > 20:1
Urinary Na <20
FENa <1% ( hold onto water, sodium)

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8
Q

functional AKI

A

AKA prerenal azotemia
Undamaged kidneys

BUN/SCr > 20:1
Urinary Na <20
FENa <1% (hold onto water, sodium)

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9
Q

intrinsic AKI

A

kidney damage

May have rash, fever, persistent hypotension

Positive urinary WBC, RBC, proteinuria
Muddy brown granular casts; tubular epithelial casts; hyaline casts

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10
Q

postrenal AKI

A

kidney stones, BPH

Normal UA

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11
Q

FENa calculation

A

(Urinary Na/Serum Na) / (Urinary Cr/SCr) * 100

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12
Q

Meds causing pseudo-nephrotoxicity

A

Alter serum creatinine without affecting GFR

trimethoprim, cimetidine, steroids, tetracycline, cefoxitin

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13
Q

Aminoglycosides

A

Cause ATN (intrinsic AKI)

Starts ~6-10 days after therapy
Nonoliguric (500ml/24hrs)
Hypokalemia, hypomagnesemia

Risk if trough >2

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14
Q

Contrast

A

Cause ATN (intrinsic AKI)

SCr rises within 24 hours and peaks 2-5 days after procedure
Risk of oliguria, dialysis

Give NS or NaBicarb 6-12 hrs prior to procedure, avoid diuretics, and hold metformin for 48 hours after

Contrast treated as drug by Joint Commission

Gadolinium-based agents at risk for nephrogenic systemic fibrosis

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15
Q

Cisplatin

A

Causes ATN (intrinsitc AKI) - potentially irreversible

SCr peaks 10-12 days after therapy
May have hypokalemia and hypocalcemia (due to renal magnesium wasting)

Aggressively hydrate prior to treatment

Amifostine: cisplatin-chelating agent

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16
Q

Amphotericin B

A

Causes ATN (intrinsic AKI) - vasoconstriction decreases blood flow to kidney

Damage occurs after 2-3 g (2-5 days post initiation)
Electrolyte wasting

Hydrate with 1L NS prior to each dose
Use liposomal product

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17
Q

ACE/ARB possible nephrotoxicity

A

Causes functional AKI

Expect to rise 30% within 2-5 days, stabilize in 2-3 weeks
Inc >30% harmful

Avoid with diuretics (during drug initiation), NSAIDs

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18
Q

NSAIDs

A

Cause functional AKI (low urinary volume, Na; Inc in BUN, SCr, K, edema, weight)

Occurs within days of starting therapy

Avoid with concomitant meds of RAAS

Rapid recovery

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19
Q

Cyclosporine, tacrolimus

A

Cause functional AKI

Occurs days after starting therapy, along w/ HTN, Hyperkalemia, hypomagnesemia

Dose related

Monitor levels, use with other non-nephrotoxic immunosuppressants (steroids, mycophenolate)

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20
Q

Acute allergic interstitial nephritis

A

Allergic hypersensitivity reaction affecting interstitium of kidney

Caused by penicillins, nsaids (prolonged use)

DC offending agent, start steroid

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21
Q

Chronic interstitial nephritis

A

Progressive, irreversible

Caused by lithium, tacrolimus, cyclosporine after longterm use

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22
Q

Stage 1/G1 CKD

A

Kidney damage, normal GFR

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23
Q

Stage 2/ G2 CKD

A

Kidney damage with mildly decreased GFR 60-89)

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24
Q

Stage 3 / G3a,b CKD

A

Moderate decrease in GFR (30-59)
G3a: 45-59
G3b: 30-44

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25
Stage 4/ G4 CKD
Severe decrease in GFR 15-29
26
Stage 5/G5 CKD
Kidney failure <15
27
A1 albuminuria
Normal to mildly increased ACR <30 <30mg/24hr
28
A2 albuminuria
Moderately increased ACR 30/300 30-300mg/24hr
29
A3 albuminuria
Severely increased albuminuria ACR > 300 >300mg/24hrs Nephrotic-range proteinuria >3000mg/24hrs
30
T1D monitoring for albuminuria
5 years after diagnosis Twice annually if ACR > 300mg/g and/or GFR 30-60
31
T2D monitoring for albuminuria
Immediately Twice annually if ACR > 300mg/g or GFR 30-60
32
Goal BP via KDIGO
SBP 120
33
BP management
Start ACE/ARB with any degree of proteinuria, even if normotensive. Monitor BP, SCr, K within 2-4 weeks (Hold if K >5.6 or SCr increases by more than 30%) Add thiazide if Stage 1-3; Loop if stage 4-5 CCB as second line to ACE/ARB
34
A1c goal
<7%
35
SGLT2i
Use if CKD & T2DM, with GFR >20 (can consider if no diabetes) Can continue if GFR falls below 20 If still uncontrolled, add GLP1
36
Finerenone
nonsteroidal MRA Add if on max ACE/ARB, T2DM, normal potassium, GFR >25 and ACR >30
37
When to NOT start a statin
dialysis-dependent CKD If already on statin when start dialysis, can continue
38
Indication for RRT
Acidosis (not responding to bicarb) Electrolyte abnormality (hyperkalemia, hyperphosphatemia) Intoxication (ethylene glycol, lithium, methanol, phenobarbital, salicylate, theophylline) Overload (fluid) Uremia
39
Preferred access for HD
arteriovenous fistula
40
Urea Reduction Ratio (URR)
URR = [(preBUN - postBUN)/preBUN] * 100% Goal >65% with target of 70% Demonstrates adequacy of dialysis
41
Most common organism for HD infection
S. aureus
42
Thrombosis of catheter
Alteplase or reteplase
43
Sieving coefficient
SC = concentration of drug in ultrafiltrate / concentration of drug in blood Predicts drug removal in continuous RRT
44
Common pathogen for PD infection; Empiric regimen
S. epi, S. aureus, streptococci, E. coli, P. aeruginosa Vanco OR first gen ceph + Third gen ceph or aminoglycoside Cefepime monotherapy Intraperitoneal administration preferred
45
When to start anemia workup
CrCl <60 or Hgb < 12
46
Frequency of Hgb/Hct monitoring in CKD stages
Stage 3: annually Stage 4: twice per year Stage 5: every 3 months
47
TSAT
(Serum iron / TICB) * 100 Assesses available iron Goal between >20 - <30% depending on source Monitor every 3 months
48
Ferritin
measures stored iron Goal varies between >100 and <500 depending on source Monitor every 3 months
49
ESAs
Start if Hgb <10 (in dialysis; or along w/ other factors in non-dialysis) AVOID if hx of stroke or cancer CI in uncontrolled HTN Replace iron stores FIRST. Iron deficiency is most common cause of erythropoeitin resistance Maz increase in Hgb is ~ 1 every 2-4 weeks; do not adjust dose more than every 4 weeks. Adjust in 25% increments
50
Epoetin alfa
50-100 units/kg three times per week Same molecular structure as human erythropoietin
51
Darbepoetin alfa (Aranesp)
Non-dialysis: 0.45mcg/kg every 4 weeks Dialysis: 0.45 mcg/kg weekly or 0.75mcg/kg every 2 weeks Modified to be longer acting
52
Mircera
methoxy polyethylene glycol-epoetin beta 0.6mcg/kg every 2 weeks Modified for longer duration of action Onset = 1-2 weeks
53
Iron therapy in dialysis
Avoid PO replacement Generally use standard 1000mg over 10 days
54
Parenteral iron requiring test dose
iron dextran
55
Corrected calcium
Serum Ca + 0.8 (4- albumin)
56
Phosphate goal Stage 5 CKD
2-9x ULN
57
First line phosphate binders in stage 3-4 CKD
Calcium carbonate Calcium acetate (PhosLo, Phoslyra) Limited by hypercalcemia
58
Sevelamer (Renvela)
Nonabsorbable phosphate binder Primary therapy in CKD Stage 5, especially if hypercalcemic
59
Lanthanum carbonate
Not widely used; indication similar to sevelamer -- if patient has hypercalcemia
60
Ferric citrate
Iron based phosphate binder Can be used for iron supplementation if not on dialysis GI upset
61
Sucroferric oxyhydroxyide
iron based phosphate binder chew GI upset
62
Target vitamin d goal
>30 ng/mL
63
Calcitriol
FDA approved to manage hypocalcemia and preventing/treating secondary hyperparathyroid High incidence of hypercalcemia Not routinely used in CKD 3a-5
64
Paricalcitol
vitamin D analog approved for treatment/prevention of secondary hyperparathyroidism Lower incidence of hypercalcemia than calcitriol
65
Doxercalciferol
vitamin D analog for treatment/prevention of secondary hyperparathyroidism Lower risk of hypercalcemia than calcitriol
66
Cinacalcet (sensipar)
Calcimimetic - indicated for secondary hyperparathyroidism Increases sensitivity of receptors to serum calcium, thus reducing PTH 30mg daily Caution in seizure disorder CYP2D6 inhibitor, 3A4 substrate

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