Renal Disease Flashcards
(45 cards)
What are the two most common causes of renal disease?
diabetes and hypertension
What is an Acute Kidney Injury?
- A sudden loss in kidney function due to another condition (drugs, dehydration). Often reversible but can be permanent if not corrected
Chronic Kidney disease?
- Progressive loss of kidney function over months or years
- Measured by GFR CrCl, albuminuria
End-Stage-renal disease
Total and permenant kidney failure
dialysis required
What is the nephrons primary function?
What else does this regulate?
To control the concentration of sodium and water
Regulates blood volume–> in turn effects blood pressure
Where does a majority of Na, H2O and Cl, Ca get reabsorbed within the kidneys?
In the proximal tubule: closest to the bowmans capsule
How is blood pH regulated?
By the exchange of hydrogen and Bicarb ions
If antidiuretic hormone is present (vasopressin) what happens?
Water passes through the ascending limb and is reabsorbed into the blood reducing water excretion
What do loop diuretics do?
- inhibit the Na-K pump in the ascending limb of the Loop of Henle
- less Na is reabsorbed and increased in urine
- By blocking this pump they also limit Ca reabsorption leading to Ca depletion which can decrease bone density
What is the distal convoluted tubule responsible for?
Regulation of, Na, K, Ca, pH
What do thiazide diuretics do?
What type of effect do they have?
Na-Cl pump inhibition
Less potent compared to loops due to small amount of Na
Facilitate Ca reabsorption so actually have a bone protection effect
What is the collecting duct involved with?
water and electrolyte balance
What does aldosterone do?
works in the collecting and distal convoluted tubules to increase Na and water reabsorption
When Aldosterone antagonists are used like spironolactone or eplerenone there is an increase in Na and H20 excretion and increased serum K
10 select drugs that cause kidney disease
- NSAIDs
- Aminoglycosides
- Vancomycin
- Amphotericin B
- Cisplatin
- Cyclosporine
- Loop diuretics
- Polymyxins
- Radiographic contrast dye
- Tacolimus
As kidney function declines what happens to BUN?
BUN increases
As kidney function declines what happeneds to SCr?
- SCr increases
- Normal range is 0.6-1.3 mg/dL
Cockcroft is not recommended in what patients?
in very young children or in unstable renal function
What drugs use GFR for dosing?
SGLT2 and Metformin
What wt to use in Cockcrauft?
Use Actual body wight if < IBW, use IBW if normal weight by BMI, use adjusted if pt is overweight
What levels indicate a pt has CKD?
GFR < 60 ml/min/1.72 m2
Albuminuria ACR or AER >=30
What is first line for the prevention of progression of CKD, DM and or HTN if proteinuria is present?
ACE or ARB
ACE and ARB notes
- SCr can increase by 30% when therapy is initiated which is ok
- if > 30% med should be stopped
- They iincrease potassium which can cause hyperkalemia patients should be monitors by Scr and K 1-2 wks after initiation
What drugs need dosage adjustments or interval changes?
- Aminoglycosides increase dosing interval
- Beta-lactams (most)
- Fluconazole
- Quinolones (except moxifloxacin)
- Vancomycin
- LMWH
- Rivaroxaban
- H2RA (famotidine, ranitidine)
- Metoclopramide
- Bisphosphonates
- Lithium
- Ampho B
- Anti TB (ethambutol, pyrazinamide)
- Antivirals (acyclovir, valacy, ganciclovir, valgan, oseltamivir)
- Aztreonam
- NRTIs including tenofovir
- Polymyxins
- Bactrim
- Digoxin, disopyramide, dofetilide, procainamide, sotalol
- Apixaban
- Dabigatran
- Statins (most)
- Allopurinol
- Colchine
- gabepentin, pregabalin
- Morphine and codeine
- Tramadol ERRRR
- Cyclosporine
- Tacrolimus
- Topiramate
Drugs that are contraindicated in CKD
CrCl < 60 ml/minute
- Nitrofurantoin
<50
- Tenofovir containing products (Stribild, Complera, Atripla, Symfi, Symfi Lo
- Voriconazole IV due to the vehicle
GFR < 30
- SGLT2 flozins
- Metformin
- Other meperidine
