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PHA 550 > Nephrology Topics > Flashcards

Nephrology Topics Flashcards

1
Q

How is CKD classified?

A

cause of disease
GFR
extent of proteinuria

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2
Q

Complications of advanced CKD

A 
altered Na and H2O balance
hyperkalemia
metabolic acidosis
anemia
CKD related mineral and bone disorder
cardiovascular disease
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3
Q

Etiology of CKD

A
  1. diabetes mellitus
  2. HTN
  3. glomerulonephritis

polycystic kidney dz
wegeners granulomatosis
vascular disease
HIV nephropathy

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4
Q

CKD pathophysiology: what is the final common pathway to renal parenchymal damage and ESRD?

is it reversible or irreversible?

A

loss of nephron mass
glomerular capillary HTN
proteinuria

irreversible

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5
Q

CKD: contributing concerns

A

smoking

  • red GFR
  • inc urinary albumin excretion
  • HR, BP

magnitude of obesity
-remained even after adjustment for DM and HTN

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6
Q

What is the first line treatment for diabetes?

A

ACE-I or ARB
(if urine albumin excretion >30)

inc dose until:

  • albuminuria red by 30-50%
  • drop in eGFR
  • hyperkalemia
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7
Q

Hypertension

A

ACE-I and ARB

  • effect on renal hemodynamics
  • red BP

(look at albuminuria, GFR and BP)

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8
Q

How do we manage anemia?

A

erythropoietic stimulating agents (ESAs)(epoetin alfa, darbepoetin alfa, methoxy PEG-epoetin beta)
AND
iron supplementation (oral, IV)

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9
Q

What indicates that the bone marrow is responding to anemic treatment?

A

inc in reticulocytes

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10
Q

When is ESA treatment for anemia in a ND-CKD pt contraindicated?

A

Hb >/= 10 (>11.5–> cardiovascular events)

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11
Q

Erythropoietin Stimulating Agents: MOI

A

stimulates division of differentiation of committed erythroid progenitor cells

induces release of reticulocytes from bone marrow into blood stream

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12
Q

Erythropoietin Stimulating Agents: indications

A

anemia due to:

  • myelosuppression
  • CKD
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13
Q

Erythropoietin Stimulating Agents: box warning, ADEs

A

box warning:
inc CV and CKD events w/ Hg >11g/dL

ADEs:

  • cancer (shortened survival, progression, recurrence) (>/=12g/dL)
  • inc risk of DVT
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14
Q

Chronic Kidney Disease - Mineral and Bone Disorder: abnormalities in

A 
parathyroid hormone 
calcium, phosphorus
the calcium–phosphorus product
vitamin D
bone turnover
soft-tissue calcifications
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15
Q

What is the net effect of PTH on serum levels?

A

inc ser Ca

dec ser phosphate

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16
Q

What is the net effect of vitamin D on serum levels?

A

inc ser Ca and phosphate

17
Q

What is the net effect of FGF 23 on serum levels?

A

dec ser phosphate

18
Q

What hormones control serum calcium and phosphate levels? On what organs?

A

PTH, vitamin D, FGF23

kidney, gut, bone

19
Q

CKD-MBD: management

A

dietary phosphate restriction
phosphate binding agents
vitamin D supplementation
calcimimetic therapy

**the problem is excess phosphate retention – be aware of dietary intake

20
Q

What are high phosphorus foods?

A 
Pumpkin seeds
Ground mustard seeds
Parmesan cheese
Brazil nuts
Cocoa powder
Edamame
Baker’s yeast
Bacon
Beef liver
Canned sardines
21
Q

What are the agents used for hyperphosphatemia in CKD?

A

Ca based binders: calcium acetate, calcium carbonate

Fe based binders: ferric citrate, sucroferric oxyhydroxide

Resin binders: sevelamer carbonate, sevelamer hydrochloride

lanthanum carbonate
aluminum hydroxide

22
Q

What is an ADE for iron based binders?

A

discolored/dark stools

23
Q

Calcium based phosphate binding agents: agents, clinical indication, ADEs

A

calcium acetate, calcium carbonate

CKD hyperphosphatemia

ADEs:
hypercalcemia
hypophosphatemia
milk alkali syndrome

24
Q

Sevelamer Hydrochloride: category, indication, additional considerations, ADEs, drug interactions

A

resin binder

hyperphosphatemia

LOWERS LDL
consider in pts at risk for extraskeletal calcification

ADEs:
metabolic acidosis (greater in children)
N/V/D
dyspepsia

may interact w/ cirpofloxacin, mycophenolate mofetil

25
Q

Lanthanum Carbonate: indication, bone half life, ADEs

A

indication:
hyperphosphatemia

bone half life: 2-3.6yrs

ADEs:
N/V
abdominal pain
BOWEL OBSTRUCTION, constipation, dyspepsia
fecal impaction, ileus
26
Q

Aluminum Hydroxide: indication, ADEs

A

hyperphosphatemia:
not a first line
short term use in pts not responding to other binders

risk of aluminum toxicity

ADEs:
constipation, fecal impaction
hypomagnesemia, hypophosphatemia

27
Q

Vitamin D Agents

A

nutritional vitamin D: ergocalciferol, cholecalciferol

vitamin D and analogs: calcitriol, doxercalciferol, paricalcitol

**kidney activates vitamin D

28
Q

Ergocalciferol, Cholecalciferol: MOI

A

stimulates Ca and P absorption in sm intestine

promotes Ca secretion from bone

promotes renal tubule P resorption

29
Q

Ergocalciferol, Cholecalciferol: indications

A

hypophosphatemia

hypoparathyroidism

30
Q

Ergocalciferol, Cholecalciferol: ADEs

A

hypercalcemia

PHA 550 (26 decks)

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