Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
75 Cards in this Set
- Front
- Back
|
Prostaglandins @ aff and eff
|
aff - vasodialation
efferent arterioles - No effect |
|
|
Angiotensin II
|
aff - vasoCONSTRICT
eff - vasoCONSTRICT |
|
|
what % of Na is normally eliminated?
|
0.5%
|
|
|
What is primarily absorbed in the proximal tubule?
|
Na, K, and HCO3 are 1' absorbed where?
|
|
|
What is primarily absorbed in the loop of henle?
|
magnesium is absorbed where?
|
|
|
Where does aldosterone act?
|
what acts on the collecting duct? This is also where antagonists act.
|
|
|
What acts on the collecting duct?
|
Where does ADH act? antagonists of ADH have a less anti-diuretic effect = diuretic
|
|
|
Where does acetazolamide act?
|
CARBONIC anhydrase inhibitor acting on proximal convuluted tubule. weak diuretic
|
|
|
Where do the thiazides work?
|
inhibit the reabs of Na and Cl in the distal convuluted tubule. Most commonly used
|
|
|
Where do bumetanide, furosemide, and ethacrynic acid act?
|
These diuretics act at the ascending loop of henle, inhibiting the Na/K/2Cl cotransport. Most efficacious
|
|
|
Where do spironolactone, amiloride, and triamterene act?
|
These diuretics act at the collecting duct. These agents prevent the loss of K that occurs w/thiazide or loops.
|
|
|
How do kidneys maintain acid base regulation>?
|
Kidneys regulate NaHCO3 in the PROXIMAL tubule. rate of this abs or H+ secretion is dependent on Pco2 conc.
|
|
|
How can CAinhibs cause metabolic acidosis?
|
Diamox prevents NaHCO3 reabs and is eliminated
|
|
|
What 2 major hormones can be affected in CKD?
|
EPO and vitamin D activation leading to PTH overproduction
|
|
|
When is glucose present in the urine?
|
when the FSBS is >180mg/dL
|
|
|
What products are found in the Urine for people with UTI?
|
leukocyte esterase, nitrite, and some sediment
|
|
|
high / low osmolal mean what?
|
same as specific gravity
high - volume depletion low - inability to conc. urine |
|
|
what are normal albumin levels in the urine?
|
<30 mg/day = normal
30-300 = microalbuminuria >300 = proteinuria |
|
|
What is azotemia?
|
increased BUN
normal BUN=8-20mg/dL |
|
|
what's the normal BUN:Cr
|
normal: 10:1
>20:1 = volume depletion means prerenal azotemia |
|
|
what's normal for Scr?
|
0.5-1.5 with wider range possible related to muscle mass
|
|
|
What is the gold standard of kidney function?
|
GFR! cannot be directly measured
inulin, iothalamate, and iohexol creatinine is most common |
|
|
what's with the cockcroft-gault?
|
male pt w/stable renal function
sick old woman, then CC-G is not a good measure. also not good for special pop |
|
|
What is the definition of CKD?
|
kidney damage for >=3months
w/same or decreased GFR patho abnormal or urine,blood,imaging abnormal OR GFR <60ml/min for >=3months |
|
|
What initiates CKD?
|
Diabetes Mellitus
HTN, drug toxicity autoimmune disease Polycystic kidney disease |
|
|
define stage 1 kidney disease
ClCr? Sympt? urinalysis? signs? Complications? |
>=90ml/min, uncommon to have symptoms; microalbuminuria present
|
|
|
treat stage 1 CKD?
|
ACEi or ARB,
protein restricted to 0.8-1 g/kg/day tx HTN, Smoking, dyslipid |
|
|
define stage 2 kidney disease
ClCr? Sympt? urinalysis? signs? Complications? |
60-89ml/min - mild
proteinuria at risk for increased Na |
|
|
define stage 3 kidney disease
ClCr? Sympt? urinalysis? signs? Complications? |
Moderate = 30-59ml/min
proteinuria and decreased urine output maybe nocturia/edema mild anemia and sHPT present fatigue malaise and nausea |
|
|
define stage 4 kidney disease
ClCr? Sympt? urinalysis? signs? Complications? |
Severe = 15-29ml/min
fatigue malaise and nausea proteinuria and decreased urine output high Na/K low pH in urine anemia/sHPT |
|
|
define stage 5 kidney disease
ClCr? Sympt? urinalysis? signs? Complications? |
<15mL/min or Dialysis
KIDNeY FAILure SOB, confusion, bleeding, itch proteinuria,edema, nocturia Na/K/pH abnormalities anemia/sHPT |
|
|
at what stage does renal dose adjustment begin?
|
stage 3! CrCl<60mL/min
dialysis begins @ stage 5 |
|
|
what about vitD causes sHPT
|
The LOSS of Vit D activation causes sHPT
|
|
|
Absorption in CKD?
|
abs is decreased w/ GI edema in CKD
|
|
|
Distribution in CKD?>
|
decreased albumin in CKD
more available acidic drugs: phy, warf so you would get supratherapeutic levels. |
|
|
elimination in CKD?
|
dose adjustment needed for renally eliminated drugs
NOTE: pt will have more body water |
|
|
What is the preferred adjustment of renal dosing?
|
usual dose, decreased interval
can also do decreased dose @ usual inter. |
|
|
what causes volume overload in CKD?
|
decreased GFR results in
dec Na and inc Na retained along w/ total body water so normal Na, but w/edema |
|
|
Normal vs. CKD change urine concentrations
|
normal urine conc/dilutes urine 50-1500.
CKD has constant 300mosmol/L |
|
|
Tx for volume overload?>
|
Na restricted to 2 grams/day
loop diuretics |
|
|
How does hyperkalemia occur in CKD?
|
less GFR, then less K filtered
more tube secretion and more GI elimination is not enough to compensate K buildup ACEi are also risk for hyperK |
|
|
CKD hyperK prevent?
|
loop diuretics
low K diet prevent constipation AVOID NSAIDs |
|
|
How does hyperkalemia occur in CKD?
|
less GFR, then less K filtered
more tube secretion and more GI elimination is not enough to compensate K buildup ACEi are also risk for hyperK |
|
|
CKD hyperK prevent?
|
loop diuretics
low K diet prevent constipation AVOID NSAIDs |
|
|
Metabolic acidosis values and complications?
|
dec buffer sys, then dec acid secretion
occurs @ bicarb levels of 12-20meq/L presents w/ <30ml/min causes bone disease, less albumin, hyperK, arrhythmias |
|
|
Goals of tx for MA?
|
serum CO2 = 22 mEq/L
prevent hypokalemia that occurs w/tx maintain fluid balance - tx may cause Na retent |
|
|
Metabolic acidosis values and complications?
|
dec buffer sys, then dec acid secretion
occurs @ bicarb levels of 12-20meq/L presents w/ <30ml/min causes bone disease, less albumin, hyperK, arrhythmias |
|
|
Goals of tx for MA?
|
serum CO2 = 22 mEq/L
prevent hypokalemia that occurs w/tx maintain fluid balance - tx may cause Na retent |
|
|
chronic MA tx?
|
divide sodium citrate or Na/K citrate bid-tid
after meals refridge and dilute 1:1 to inc palate n/v/diarrhea |
|
|
chronic MA tx?
|
divide sodium citrate or Na/K citrate bid-tid
after meals refridge and dilute 1:1 to inc palate n/v/diarrhea |
|
|
How does hyperkalemia occur in CKD?
|
less GFR, then less K filtered
more tube secretion and more GI elimination is not enough to compensate K buildup ACEi are also risk for hyperK |
|
|
CKD hyperK prevent?
|
loop diuretics
low K diet prevent constipation AVOID NSAIDs |
|
|
Metabolic acidosis values and complications?
|
dec buffer sys, then dec acid secretion
occurs @ bicarb levels of 12-20meq/L presents w/ <30ml/min causes bone disease, less albumin, hyperK, arrhythmias |
|
|
Goals of tx for MA?
|
serum CO2 = 22 mEq/L
prevent hypokalemia that occurs w/tx maintain fluid balance - tx may cause Na retent |
|
|
chronic MA tx?
|
divide sodium citrate or Na/K citrate bid-tid
after meals refridge and dilute 1:1 to inc palate n/v/diarrhea |
|
|
Pathophys of anemia in CKD
|
normocytic normochromic anemia
due to dec kidney EPO produce low Fe stores, low protein, low abs of Fe, inc blood loss |
|
|
What Tsat indicates anemia?
|
measure of Fe for making RBC
<20% means iron deficient normal is 20-50% t=transferrin |
|
|
What ferritin level indicates anemia?
|
measure of Fe storage
normal= 100-800ng/mL <100 means low Fe store low TsatANDferritin=ABS Fe def! |
|
|
Citrate products are CI with what?
|
Al containing P binders are CI with what?
|
|
|
EPO or iron 1st?
|
replace Fe def before EPO admin
|
|
|
What is oral place in therapy
|
early CKD w/o IV access: 1-4
patients w/o abs Fe def 200mg elemental in divided doses AE GI upset/constipation |
|
|
ferrous sulfate
ferrous gluconate ferrous fumarate polysaccharide Fe |
feosol
fergon hemocyte Fe-tinic, Nu-iron |
|
|
what oral salt requires 17 tabs/day
|
heme Fe polypeptide
(Proferrin-ES) |
|
|
what is IV place in therapy
|
patients wit Abs Fe Def
generally used w/IV access 1000mg Abs Fe Def in div dose 50mg q weekly |
|
|
Iron dextran - BBW test dose
Ferric Gluconate iron sucrose |
InFeD
Ferrlecit Venofer |
|
|
Epoetin alpha
|
epogen, procrit
4-13 hour t1/2 titrate for 1 month do not give SC! |
|
|
when to decrease dose by 25%?
|
Hgb>12
increased>1g/dL in any 1 week withholding dose is not recommen |
|
|
increase dose by 25%
|
Hgb increase of <2 after 8 weeks
patients requiring transfusions at ANY level |
|
|
Dose of Procrit?
|
50-100 units/kg IV! 3x week
give q 2-4 weeks in stages 3-4 |
|
|
Darbepoetin alfa
|
Aranesp
Much longer IV halflife of 21h regardless of EPO therapy, pt must be on Fe replacement |
|
|
what is aranesp dose?
|
0.45mg/kg q weekly IV
consider q 3-4 weeks in stage3-4 |
|
|
1st line therapy for sHPT?
|
P restriction
<800mg/day instead of 1200 recommend nutrition counseling |
|
|
what is the corrected Ca formula?
|
=((4-alb)x0.8) + Measured Ca
|
|
|
What should the CaxP product be?
|
<55
|
|
|
Ca intake NTE?
|
2000mg/day total
1500 mg/day from supplements |
