Renal Disease Flashcards
(40 cards)
What are the most common causes for Chonic Kidney Disease?
- Diabetes
- Hypertension
What is the functional unit of the kidney and what is the way that it works?
- The Nephron
- Controls concentations fo Na and H20 [regulates Blood Volume, BP, and pH]
What are the different sections of the Nephron?
- Glomerulus
- Proximal Tubule
- Loop of Henle [Descending and Ascending]
- Distal Tubule
- Collecting Duct
What is the important things to note about the Glomerulus within the Nephron?
- Afferent arteriole brings blood in
- Efferent arterile take blood out
- HEALTHY = Protiens/Protien-bound drugs are NOT filtered and go back into blood
- DAMAGED = Albumin leaves in urine [shows severity of kidney disease]
What is important to notes about the Proximal Tubule in the Nephron?
- Na, Ca, Cl, H20 are filtered back into the blood
- Where SGLT-2’s work
What is importnat to note about the Loop of Henle in the Nephron?
- Descending = H20 reabsorbed & Na/Cl is not
- Ascending = Na/Cl reaborbed & H20 is not [unless vasopressin is there]
- Where Loop Diruetics work [inhibit Na-K pump in the Ascending increasing H20 in the urine]
What is important to note about the Distal Tubule in the Nephron?
- Helps regulate K, Na, Cl, pH
- Where Thaizide Diuretics work [Inhibits Na-Cl Pump; also keeps Ca = bone protection]
What are some of the risk factors associated with Drug-induced nephrotoxicity?
- Decreased Renal Flow
- Nephrotoxic Medications
- Age
Highest risk within the hospital for Mordity and Mortality
What are some of the medications that are considered to be Nephrotoxic?
- Tylenol
- Amp B
- Cisplatin
- Cyclosporine
- Loop Diuretics
- NSAIDS
- Polymixin
- Contrast Dye
- Tacrolimus
- Vancomycin
What are the 2 most common lab values that we look at when estimating kidney function?
- BUN [measures nitrogen in the blood; Kidney function decreases = increase BUN]
- Creatinine [waste product of muscle metabolism; Kidney function decreases = SCr increases]
What is the equation that we use to find the CrCl?
Cockcroft-Gault
CrCl = [140 - Age / 72 x SCr] x weight (kg)
x 0.85 if female
When should the Crockcroft-Gault equation not be used for finding CrCl?
- In frail elderly patients
- Childern
- Those with Kideny Failure
Those with unstable renal functions
What is the criteria in confirming that someone does have CKD?
- eGFR < 60
- Albuminuria > 30
For a patient with CKD & a comorbidity of HTN, what are some of the treatment options for them?
And why?
- ACEi & ARBs are first line
- Can increase SCr by 30% [this is ok]
- NEVER used together [increase hyperkalemia] & should monitor SCr and K x 2-4w
For a patient with CKD & a comorbidity of Diabetes, what are some of the treatment options for them?
And why?
- SGLT-2 are first line
- Reduce cardiovascular events and/or CKD progression
What are some of the reasons that a drug my need a dose adjustment due to kideny function?
- Reduction or interval change to prevent accumulation
- Some directly affect the kidney
- Less effective as kidney function decrease
What are some of the drugs that need dose adjustments when kidney function is changing?
Anti-infectives? Cardio? GI? Other?
- Anti-infectives: AGs, Beta-Lactams, Fluconazole, FQs, Vanc
- Cardio: LMWHs, Rivaroxaban, Apixaban, Dabigatran
GI: H2RAs, Metoclopramide
Others: Bisphophonates, Lithium
What are some of the minerals that should be monitored in those with advanced kidney disease?
- Parathyroid Hormone [PTH]
- Phosphorous
- Ca
- Vitamin D
What is important to know about hyperphosphatemia when it relates to kidney disease?
- Contributes to elevated PTH levels [can cause bone diseases and fractures]
What are the ways that we can treat hyperphophatemia and what are the different classes?
- Phosphate Binders: work by blocking absorption of PO4 [take before meals]
- Aluminum-Based, Calcium-Based, Aluminum/Calcium-Free
What are the Aluminum-Based Phosphate Binders?
- Aluminum Hydroxide 300-600 mg TID WITH MEALS
What are some of the side effects for the Aluminum-Based Phosphate binders?
- Aluminum intoxication
What are the Calcium-Based Phosphate Binders?
- Calcium Acetate [Calphron, Phoslya] 1,334 mg TID WITH MEALS
- Calcium Carbonate [Tums] 500 mg TID WITH MEALS
What are some of the side effects for the Calcium Based Phosphate Binders?
- Hypercalcemia, Constaption
