Renal disease

Question 1

What is SCr impacted by?

Answer 1

age (muscle declines as we age)
sex (men have more muscle)
race
dietary intake
body compsution (athletes have more muscle)
medications

Question 2

What does SCr represent?

Answer 2

metabolic byproduct of muscle catabolism

Question 3

What medications can fasely increase SCr?

Answer 3

Cimetidine
Trimethoprim

Question 4

Why is cystatin C better than other renal measurements?

Answer 4

Better with changing renal function/ varying protein status

Question 5

What do we need to calculate CrCl?

Answer 5

1. Stable SCr
2. baseline value
3. more than a single value

Question 6

What is the Cockcroft gault equation?

Answer 6

(140-age) X kg / (SCr x 72) x 0.85 if female

Question 7

What are limitation to cockcroft gault?

Answer 7

1. assumes muscle mass declines linearly with age
2. different for weight

Question 8

When is IBW used?

Answer 8

actual weight > ideal

Question 9

How do you calculate IBW?

Answer 9

Men: 50 + (2.3 x in> 5ft)
Women: 45.5 + (2.3 x in > 5ft)

Question 10

When is AdjBW used?

Answer 10

actual body weight > 30% than ideal

Question 11

How do you calculate AdjBW?

Answer 11

IBW + 0.4 x (actual- ideal)

Question 12

Why is the MDRD equation not utilized often?

Answer 12

1. less accurate when GFR >60 mL/ min/ 1.73 m2
2. lacks data in extreme body weight, pregnancy, elderly

Question 13

Why is the CKD-EPI equation not used often?

Answer 13

1. less accurate when eGFR < 60 mL/min/1.73 m2
2. too complex for clinical application

Question 14

What measurement is best for patients >80

Answer 14

cystatin C

Question 15

What drugs are usually dosed using IBW?

Answer 15

Acyclovir
Colistin
Digoxin
Levothyroxine
Lorazepam
IVIG

Question 16

What drugs are usually dosed with AjdBW?

Answer 16

Amikacin
Gentamicin
Heparin
Tobramycin

Question 17

What is chronic kidney disease?

Answer 17

GFR < 60 mL/min/1.73m2 due to damages endothelium and sclerosis leading to proteinuria

Question 18

What can CKD lead to?

Answer 18

fluid, electrolyte, acid-base disorders

Question 19

GFR >/= 90

Answer 19

G1

Question 20

GFR 60-89

Answer 20

G2

Question 21

GFR 45-59

Answer 21

G3a

Question 22

GFR 30-44

Answer 22

G3b

Question 23

GFR 15-29

Answer 23

G4

Question 24

GFR <15

Answer 24

G5

Question 25

Albuminuria <30 mg/g

Answer 25

A1

Question 26

Albuminuria 30-300 mg/g

Answer 26

A2

Question 27

Albuminuria >300 mg/g

Answer 27

A3

Question 28

What are signs of uremia?

Answer 28

CrCl <10 mL/min HTN Asterixis Jugular venous distension

Question 29

What increases as a result of CKD?

Answer 29

BUN K Phosphate urinary acid

Question 30

What decreases as a result of CKD?

Answer 30

bicarbonate

Question 31

What are signs of CKD?

Answer 31

Edema weight gain changes in urine output foaming of urine

Question 32

What disease can be cause as a result of CKD?

Answer 32

PTH

Question 33

What are symptoms of uremia?

Answer 33

anorexia weight loss dyspnea fatigue pruritis sleep disturbance encephalopathy excess bleeding

Question 34

Why do thiazide diuretics have limited utility in stage 3-5 CKD?

Answer 34

loose effectiveness if CrCl <60

Question 35

What stage of AKI is 1.5-1.9x baseline OR increase in 0.3 mg/dL within 48 hours OR < 0.5 mL/kg/hr for 6-12 hours?

Answer 35

stage 1

Question 36

What stage of AKI is 2.0-2.9x baseline OR < 0.5 mL/kg/hr for 12 hours or more?

Answer 36

stage 2

Question 37

What stage of AKI is 3.0x baseline OR increase to 4.0 mg/dL OR initiation of renal replacement OR < 0.3 mL/kg/hr for 24 hours OR anuria for 12 hours or more?

Answer 37

stage 3

Question 38

Can CrCl be calculated with an AKI?

Answer 38

no

Question 39

What labratory findings indicate prerenal AKI?

Answer 39

1. Hyaline casts 2. no urinary RBC 3. >40:1 BUN/SCr

Question 40

What is prerenal AKI associated with?

Answer 40

hypovolemia

Question 41

What laboratory findings indicate intrinsic AKI?

Answer 41

1. granular casts, cellular debris 2. urinary RBC 2-4+ 3. <20:1 BUN/SCr

Question 42

What is intrinsic AKI associated with?

Answer 42

drugs: aminoglycosides PPI NSAIDs acyclovir

Question 43

What laboratory findings indicate postrenal AKI?

Answer 43

1. cellular debris 2. urinary RBC variable 3. <20:1 BUN/SCr

Question 44

What are symptoms of AKI?

Answer 44

1. cola-colored urine 2.. sudden decrease in urine output 3. N/V 4. fatigue 5. weight gain/loss 6. rashes 7. fever 8. arthalgias

Question 45

What needs to be considered when dosing drugs during an AKI?

Answer 45

1. SCr lags behind true renal function 2. volume of distribution changes may occur 3. if anuric or rapidly increasing SCr--> assume CrCL <10mL/min