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Pathopharmacology I > Wk 3 Chronic Kidney Disease > Flashcards

Wk 3 Chronic Kidney Disease Flashcards

(99 cards)

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1
Q

What is azotemia?

A

Elevated levels of urea and other nitrogen compounds in the blood

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2
Q

What is the medical term for decreased urine output?

A

Oliguria

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3
Q

What is oliguria defined by?

A

Less than 400mls per day

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4
Q

When does proteinuria happen?

A

Damage to the glomeruli and protein is allowed through and excreted in the urine

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5
Q

Kidneys maintain __ and __ balance

A

fluid and electrolyte

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6
Q

What do the kidneys excrete through the urine?

A

water soluble wastes and products of metabolism

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7
Q

List 3 important endocrine functions

A

1) Produces erythropoietin
2) Activates vitamin D
3) Produces renin, which helps regulate blood pressure

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8
Q

What are normal BUN lab values?

A

10-20 mg/dL

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9
Q

What are normal creatinine lab values?

A

0.5-1.2 mg/dL

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10
Q

BUN and creatinine maintain a __ ratio

A

10:1

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11
Q

What should your GFR be?

A

> 90 mL/min

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12
Q

What does GFR measure?

A

Amount of blood that is being filtered by the glomeruli

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13
Q

What is Vitamin D important for? (2)

A

Calcium absorption

Bone health

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14
Q

What is chronic kidney disease defined:

A

Presence of kidney damage for more than 3 months, with or without a GFR of less than 60

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15
Q

What are the 3 main effects of kidney disease

A

Can’t maintain acid-base balance
Can’t remove end products of metabolism
Can’t maintain fluid and electrolyte balance

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16
Q

What is stage 1 CKD?

A

Kidney damage with normal or increased GFR

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17
Q

What is stage 2 CKD?

A

Kidney damage with mild decrease in GFR

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18
Q

What is stage 3 CKD?

A

Moderate decrease in GFR

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19
Q

What is stage 4 CKD?

A

Severe decrease in GFR

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20
Q

What is stage 5 CKD?

A

End Stage Kidney Disease (ESRD)

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21
Q

What is the GFR for stage 1?

A

Greater than or equal to 90

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22
Q

What is the GFR for stage 2?

A

60-89

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23
Q

What is the GFR for stage 3?

A

30-59

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24
Q

What is the GFR for stage 4?

A

15-29

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25
What is the GFR for stage 5?
Less than 15
26
What is the main cause of end-stage kidney disease?
diabetes (50%)
27
What is the second most common cause of end-stage kidney disease?
hypertension (30%)
28
What is the third most common cause of end-stage kidney disease?
Glomerulonephritis
29
What are 8 risk factors for CKD?
``` Family history Age over 60 Male African American Hypertension Diabetes Smoking Obesity ```
30
The pathogenesis of CKD starts with __
glomerulosclerosis
31
What is glomerulosclerosis?
Scar tissue of the glomeruli
32
Glomerulosclerosis can lead to __ __
interstitial fibrosis
33
What is interstitial fibrosis characterized by?
Destruction of the interstitial capillaries and renal tubules
34
What plays a major role in the pathogenesis of CKD?
Complement | Angiotensin II
35
An increase in angiotensin II __ blood pressure
Increases
36
How does angiotensin II contribute to the pathogenesis of CKD?
It increases BP and that causes further damage to the kidneys
37
How does complement contribute to the pathogenesis of CKD?
It is part of the inflammatory process and causes further damage
38
Stage 1 CKD manifestations
Asymptomatic
39
Stage 2 CKD manifestations
Asymptomatic, possible hypertension
40
Stage 3 CKD manifestations
Hypertension, otherwise asymptomatic
41
Stage 4 CKD manifestations
Manifestations becoming apparent, diagnosis often occurs here
42
Stage 5 CKD manifestations
ESRD, main symptom is uremia
43
What is uremia?
Retention of metabolic wastes
44
What are the metabolic wastes that build up in CKD?
``` Urea Creatinine Phenols Hormones Electrolytes Water ```
45
Uremia is often seen in a GFR less than
10
46
How is the filtration of metabolic wastes measured?
BUN | Creatinine
47
Patients who have CKD will __ water
Retain
48
Patients with CKD have a __ in erythropoietin
decrease
49
Patients with CKD have a __ in Vitamin D activation
decrease
50
What are the manifestations of abnormal fluid and electrolyte balance? (5)
``` edema hyperkalemia hyperphosphatemia hypermagnesemia metabolic acidosis ```
51
What are the manifestations of abnormal removal of metabolism waste products? (4)
anorexia malnutrition itching CNS changes
52
Why does a patient with CKD become acidotic?
They lose sodium bicarbonate
53
What is the manifestation of decreased production of erythropoietin?
anemia
54
What is the manifestation of decreased activation of Vitamin D?
Renal osteodystrophy
55
What is the goal for hemoglobin for CKD patients?
Less than 10 because they don't tolerate it higher than that. Their bodies are used to lower hemoglobin since the disease develops over a long period of time
56
What is renal osteodystrophy?
Weakening of the bones
57
What is the itchy white coating on the skin that some patients with CKD get?
Uremic frost
58
Why are patients with CKD so tired?
They are anemic
59
What is the cause of the decreased appetite?
Increase in metabolic wastes in the blood
60
Why do patients with CKD sometimes feel sad?
Uremia can affect mood
61
How do we slow the progression of CKD?
Keep BP less than 140/90 | Treat hyperlipidemia
62
What is the goal for cholesterol in patients with CKD?
Less than 200
63
Concerning blood volume, what is a complication of CKD?
Volume overload
64
What would we do to treat volume overload in a patient with CKD?
diuretics
65
What are the starting medications to control BP in a patient with CKD?
ACE or ARB
66
What is used to treat hyperlipidemia?
Statins
67
What type of diuretic would be used to treat the volume overload?
Loop diuretic
68
What is a teaching point for a patient with volume overload?
Low salt diet
69
In ESRD, what takes care of the hyperkalemia?
hemodialysis
70
What is used to treat the metabolic acidosis?
Sodium bicarbonate
71
Sodium bicarbonate is an __ agent
Alkaline
72
What is used to treat the hyperphosphatemia?
Calcium carbonate
73
Calcium carbonate is a __ __
phosphate binder
74
What is used to treat the renal osteodystrophy?
Calcitrol
75
What is calcitrol?
Activated vitamin D
76
What is given to treat the anemia?
epoetin
77
How often is erythropoietin given?
Weekly
78
A patient taking epoetin must have enough __ in their body for it to be effective
Iron
79
When is epoetin contraindicated?
Hgb over 10
80
What are the 3 goals of sodium bicarbonate therapy?
Slow progression of CKD Prevent bone loss Improve nutritional status
81
When do you initiate sodium bicarbonate therapy?
When plasma HCO3 is less than 15 mEq/mL
82
Titrate sodium bicarbonate to a plasma HCO3 of...
18-20
83
What is the lab test used to measure HCO3 levels?
CO2 on a BMP
84
What is the main adverse effect of sodium bicarbonate?
Bloating
85
What should a provider do if a patient has significant bloating on sodium bicarbonate?
Consider switching to sodium citrate
86
What is used to treat hyperphosphatemia?
Calcium carbonate
87
What is another name for calcium carbonate?
Tums
88
What is the MOA of calcium carbonate?
It binds to phosphate
89
What are the goals of therapy with calcium carbonate?
Keep phosphate levels normal | Reduce mortality
90
What is the main adverse effect of calcium carbonate?
Hypercalcemia
91
Why should a patient take calcium carbonate with meals?
It's so the drug can bind to the phosphate that the patient eats with their meals
92
What is calciferol used to treat?
renal osteodystrophy
93
What is the MOA of calcitrol?
Stimulates intestinal absorption of calcium/phosphate and bone mineralization
94
What is the activated form of Vitamin D?
Calcitrol
95
What are the major adverse effects of calcitrol?
Hypercalcemia | Hyperphosphatemia
96
What are the s/s of calcium toxicity?
GI upset Bone pain Neuro effects - confusion, lethargy, depression Cardiac arrhythmias
97
What is renal dosing?
Medications that are excreted through the kidneys are given in smaller doses
98
What drugs are we particularly concerned about in patients with CKD because they are excreted through the kidneys? (4)
Digoxin Diabetic agents - metformin, glyburide Vancomycin Opioids - morphine
99
What lab would you watch when giving digoxin to a patient with CKD?
Potassium

Pathopharmacology I (33 decks)

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