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Flashcards in Treatment Deck (18)
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1

What is the treatment for diabetic nephropathy?

- Intensive DM control prevents progression of microalbuminuria to macroalbuminuria
- ACEi and ARB for CV and renal protection above BP control
- sodium restriction to <2g/day
- Statins to reduce CV risk

2

How do you treat the complications of CKD?

- Anaemia - EPO (<110g/L Hb), oral or IV iron or B12/folate deficiency
- Acidosis - sodium bicarbonate (eGFR <30 + low serum bicarbonate)
- Bone health - alfacalcidol +/- phosphate binders (phosphate >1.5mmol/l). Also vitD supplements if deficient (cholecalciferol)
-Volume status - fluid and salt restriction, diuretics

3

What is the adequate BP control for CKD?

- 130/80 or less in all stages
- 125/75 or less in proteinuric states (uPCR >100)
- Use ACEi/ARBs
- Check K + creatinine 2/52 after starting dose change/increasing diuretics
- GFR <30ml/min, withdraw diuretic before ACEi/ARB
- Stop ACEi/ARB temporarily in acute hypovolaemia

4

What is the management for stage 1+2/3 CKD?

- Stop smoking
- Exercise
- Manage cholesterol

5

What is the management for stage 3/4?

- Aspirin
- EPO
- Alfacalcidol
- Bicarbonate
- Diuretic

6

What is the management for stage 4/5?

- Choice of modality
- Vascular access
- Transplant work-up

7

What are the drug interactions of amlodipine and simvastatin?

Increased risk of myopathy and rhabdomyolysis

8

What is given in DKA?

- Fluid resuscitation
- Insulin - drive glucose into cells (need to monitor K too)

9

What are osmotic diuretics?

e.g. mannitol, urea, dosorbide
- Limit water reabsorption in the tubule by increasing osmolality
- Increase excretion of Na, K, Ca, Mg, H2O

10

What are loop diuretics?

e.g. furosemide, bumetanide
- Increase urine flow
- Increase Na, Cl, K, H2O, Ca, Mg excretion
- Inhibiting Na reabsorption - decreases H2O reabsorption
- Induces renin release due to plasma volume depletion

11

What are thiazides diuretics?

e.g. hydrochlorothiazide
- Increases Na excretion and Cl, K, H2O
- Long term - decrease Ca, increase Mg secretion
- Increase reabsorption of urea in proximal tubule > increase plasma uric acid > gout

12

What are potassium sparing diuretics?

e.g. amiloride, trimeterine
- Inhibits Na reabsorption, prevents K excretion e.g. spironolactone
- Inhibits aldosterone receptor so inhibits Na/K pump

13

What is HD?

- Blood passed through a dialyser
- 4hrs 3x/week
- Dietary changes
- Fistula - 3 months to be ready

14

What is PD?

- Dialysate solution - diffuses waste product out blood
- CAPD - 4 exchanges per day
- APD - exchanges for 7-10hrs at night

15

What drugs are used in immunosuppression?

1. Cyclosporine + tacrolimus (T cells)
2. Prednisolone
3. MMF + azathioprine (T and B cells)

16

When should ACEi be stopped?

- K > 6mmol/l
- Decreased eGFR > 25%
- Decreased creatinine >30%

17

What are long term dialysis indications?

- Inability to control volume status, including pulmonary oedema
- Inability to control BP
- Acid base or electrolyte abnormalities
- Pruritis
- N+V/deterioration in nutritional status
- Cognitive impairment

18

How is CKD-MBD treated?

- Cholecalciferol (inactive form of vitD)
- Calcichew (calcium supplement between meals + phosphate binder with meals)
- Alfacalcidol (increases Ca and phosphate)
- Parathyroidectomy or calcimimetic (cinacalcet)