Nephrology

Question 1

Labs to assess kidney function

Answer 1

SCr, BUN, CrCl, GFR, MDRD, Urinalysis, salt/H2O balance, acid/base balance

Question 2

Problems with MDRD

Answer 2

although it is very accurate, very little research, all dosing is based on CrCl

Question 3

Problems with CrCl

Answer 3

serum creatinine is just a “snapshot”, weight discrepancies , diet can effect, athletically fit

Question 4

Problems with GFR

Answer 4

less reliable, varies w/ age, ethnicity, and body comp

Question 5

Problems w/ 24 hr urine

Answer 5

cumbersome, prone to error

Question 6

What do you not use to assess AKI

Answer 6

CrCl, too rapid of a change to be accurate, instead use I&Os

Question 7

AKI definition

Answer 7

acute decrease in kidney function over hrs, days or weeks, associated w/ accumulation of waste products and volumes, increase of SCr of .5mg/dL in 24 hrs

Question 8

AKI risk factors

Answer 8

pre-existing CKD, volume depletion/ decrease perfusion, using nephrotoxic agents, obstruction of urinary tract

Question 9

Causes of AKI

Answer 9

Pre-renal (affecting blood flow before kidneys), Postrenal (problem with moving urine out of kidneys), Intrinsic (problem w/ kidney, preventing filtration or urine production)

Question 10

When you hear pre-renal what should you think

Answer 10

Hypoperfusion, it’s the most common type of AKI, too

Question 11

Pre-renal AKI can be caused by

Answer 11

dehydration, disruption of bllod flow, dec in BP, emboli, MI, CHF, liver failure

Question 12

Treatment for Pre-renal

Answer 12

usually reversible (hydration, fixing other disease), but can cause CKD,

Question 13

Postrenal is caused by

Answer 13

kidney stone, enlarged prostate, CA

Question 14

Intrinsic is caused by

Answer 14

blood vessel disease, injury to tissue or cells, glomerulonephritis, acute interstitial nephritis, acute tubular necrosis, medications

Question 15

Medications known to cause AKI

Answer 15

Aminoglycosides, NSAIDs, ACE-Is (usually only makes preexisting worse), contrast dye, amphotericin-B

Question 16

Acute interstitial nephritis

Answer 16

sudden decline in kidney function from inflammation of interstitial kidney tissue, usually reversible if treated early (steroids)

Question 17

Acute interstitial nephritis is caused by

Answer 17

Medications, infections, lupus, lymphoma, leukemia, sarcoidosis

Question 18

Acute tubular necrosis

Answer 18

kidney tubule damaged and do not function normally, usually end result of acute renal failure

Question 19

Nephrotoxic ATN caused by

Answer 19

aminoglycosides, amphotericin B, Cisplatin, contrast media, vancomycin

Question 20

Treatment AKI

Answer 20

volume control with RRT and diuretics

Question 21

start RRT if

Answer 21

Renal replacement therapy, Acid/base problem, electrolyte abnormality (usually K), Intoxication, fluid overload, uremia

Question 22

Chronic kidney disease definition

Answer 22

kidney damage lasting more than 3 months, including structural or functional abnormality of the kidney w/ or w/out decreased GFR, with pathologic abnormalities or markers of damage; also GFR

Question 23

Stage 1 CKD

Answer 23

kidney damage with normal or inc GFR

Question 24

Stage 2 CKD

Answer 24

kidney damage w/ mild decrease GFR, 60-80 ml/min

Question 25

Stage 3 CKD

Answer 25

moderate dec GFR, 30-50 ml/min

Question 26

Stage 4 CKD

Answer 26

severe dec GFR, 15-29 ml/min

Question 27

Stage 5 CKD

Answer 27

kidney failure,

Question 28

CKD risk factors

Answer 28

diabetes, HTN, CVD, obesity, age, race, acute kidney injury, malignancy, family hx, hep C, HIV, Lupus, NSAIDS, polycystic kidney disease

Question 29

Why do you not want to use CrCl for CKD

Answer 29

will overestimate renal function if it is moderate to severe, so use MDRD instead

Question 30

CKD manifestations

Answer 30

abnormal sodium-water handling (edema, HTN, CVD), metabolic acidosis, anemia, uremia, abnormal Ca-P metabolism due to lack of Vit D

Question 31

Management of CKD

Answer 31

treat fluid retention/overload, hyperphophatemia/hyperkalemia, hyperparathyroidism, dyslipidemia, anemia, proper drug dosing, prep for RRT

Question 32

Treating fluid overload

Answer 32

restrict Na, avoid excessive amts of H2O at one time, keep all fluids in mind (diet, drugs etc)

Question 33

Diuretics for Fluid overload

Answer 33

not for stage 5, do not use thiazides if CrCl

Question 34

Treating hyperkalemia

Answer 34

restrict intake of Potassium to 3 gm/day, dialysis, calcium gluconate, albuterol, insulin+glucose, sodium polystyrene, sodium bicarbonate

Question 35

Hyperphosphatemia causes

Answer 35

inhibition of Vit D activation, dec in ionized Ca conc, direct stimulation of parathyroid hormone secretion

Question 36

Treating hyperphosphatemia

Answer 36

Diet of 800-1200 mg/day phos, phosphate binders- Calcium carbonate, calcium acetate (phoslo), aluminum hydroxide (amphogel), sevelamer (Renagel), lanthanum (Fosrenol)

Question 37

MOA of phosphate binders

Answer 37

binds to phosphate found in diet and thus it is not absorbed and eliminated in feces, must take with a meal, be wary of hypercalcemia with calcium containing pho binders

Question 38

Dosage of Phosphate binders

Answer 38

calcium acetate (phosplo)- 667 mg PO TID, sevelamer (renagel)- 800 PO TID

Question 39

ADRs of phosphate binders

Answer 39

constipation, GI upset

Question 40

hyperparathroidism treatment

Answer 40

Clacitriol (Rocaltrol), Paricalcitol (Zemplar), Doxercalciferol (Hectoral), Cinacalcet (Sensipar)

Question 41

Calcitriol (rocaltrol)

Answer 41

active vit D, IV or PO, decreased PTH secretion by increasing [Ca] via increased gut absorption, monitor for hypercalcemia

Question 42

Paricalcitol (Zemplar)

Answer 42

IV/PO, IV for ESRD pts, favorable due to decrease risk of hypercalcemia, dose based on PTH levels

Question 43

Docercalciferol (Hectoral)

Answer 43

similar to paricalcitol, must avoid in pt w/ liver failure

Question 44

Dyslipidemia in CKD

Answer 44

elevated LDL, be aggressive w/ treatment to decrease morbidity, frequently in glomerular disease w/ proteinuria