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30 Cards in this Set
- Front
- Back
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CrCl
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CrCl=(140-age)IBW/ (SCr x 72)
women x 0.85 use LBW if morbidly obese |
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Complications of CKD and ESRD
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build up of waste products in blood
edema, fluid overload, CV complications metabolic acidosis anemia renal osteodystrophy ( inc. PTH) |
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Uremia effects
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encephalopathy
uremic fetor pulmonary edema sodium retention, volume overload anorexia, NV, constipation, metallic taste renal osteodystrophy and restless leg sydrome EPO deficiency |
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How should you treat CKD or ESRD associated fluid retention
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maintain Na+ intake
avoid large amounts of free water Give diuretic |
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How should you treat diuretic resistance in CKD or ESRD patients
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Long-term: Add a thiazide
(HCTZ 50-100mg daily-mild; 100-200mg daily-severe) Short-term: give dose more often or give continuous infusion |
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Why does diuretic resistance occur?
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Cells in the distal tubule recognize the high Na+ fluid-> try to hypertrophy and take in Na+
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When should ethacrynic acid be used?
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Pt is allergic to loops
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Na+ imbalances
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no salt added diet
use saline IV solutions with caution |
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Treatment of Hyperkalemia in ESRD or CKD
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dialysis
calcium gluconate IV nebulized albuterol insulin + glucose Kayexalate (15-30g between dialysis) sodium bicarb (not for ESRD) |
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Name the three key problems in renal bone disease
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hyperphosphatemia
hypocalcemia dec.Vit D |
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Ca x Phos
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> 55 -> patient at risk for soft tissue calcification
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K+
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4.5-5.5mEq/L
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Treatment of hyperphosphatemia- calcium containing phosphate binders
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Calcium Carbonate (Tums)-500mg elemental calcium, Calcium acetate (PhosLo)-169mg elemental calcium (2-3)...with meals
Do not exceed 1500mg/day elemental calcium |
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Treatment of hyperphosphatemia
non calcium containing phosphate binders |
Aluminum hydroxide- only short term (4 wks); severe cases(phos>7mg/dl); SE constipation, aluminum toxicity
MagCarb- not well studied Sevelamer carbonate (Renvela) Phos 5.5-7.5mg/dL- 800mg TID Phos >7.5mg/dL- 1600mg TID dec. LDL by 15-30% dec. uric acid Lanthanum carbonate (Fosrenol) want acidic stomach does not cross BBB eliminated in feces-no LT accumulation |
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Phosphorous
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3-4.5mg/dL
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Dietary restrictions for hyperphosphatemia
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restrict to 800-1000mg/day if:
Phos> 4.6 CKD stage 3,4 Phos>5.5 CKD stage 5 PTH> target range for CKD 3,4,5 |
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Foods high in phosphorous
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meats
dairy products dried beans nuts colas beer |
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Ergocalciferol (Calciferol)
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inactive vit D
for CKD stage 3,4 50,000IU capsule/month |
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Calcitriol (Rocaltrol and Calcijex)
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For CKD stage 5 and CKD 3,4 with inc. PTH conc
greatest incidence of hypercalcemia and hyperphosphatemia monitor: Ca, Phos, iPTH, Ca x Phos |
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Paricalcitol (Zemplar)
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For CKD stage 5 and CKD 3,4 with inc. PTH conc
less calcemic activity compared to calcitriol >30% reduction in PTH most favorable ADE profile monitor: Ca, Phos, iPTH, Ca x Phos |
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Doxercalciferol
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prohormone, so can't give to liver failure pts
higher incidence of hyperphosphatemia compared to hyperphosphatemia lower incidence of hypercalcemia compared to calcitriol >30% reduction in PTH |
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Sensipar
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Inc. sensitivity of Ca sensing receptors
Dec. PTH, Ca, Phos SE: N/V/D, chest pain, weakness, muscle cramps |
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Serum PTH
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Stage 3: 35-70pg/ml
Stage 4: 70-110pg/ml |
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Monitoring of Stage 3 CKD
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check iPTH every 12 months
Goal iPTH 35-70pg/ml check corrected calcium and phos every 12 months Goal Ca: 9-10mg/dl Goal Phos: 2.7-4.6mg/dl |
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Monitoring of Stage 4 CKD
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check iPTH every 3 months
Goal iPTH 70-110pg/ml check corrected calcium and phos every 3 months Goal Ca:9-10mg/dl Goal Phos: 2.7-4.6mg/dl |
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Monitoring of Stage 5 CKD
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Check iPTH every 3 months
Goal iPTH: 150-300pg/ml Check corrected calcium and phos every month Goal Ca: 8.4-9.5mg/dl Goal Phos:3.5-5.5mg/dl |
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Corrected Ca
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measured Ca + 0.8(4-pt serum alb)
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Hgb
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11-12g/dl
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Recombinant Erythropoietin (Epogen, Procrit)
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SQ or IV dosage
SQ is 2/3 dose of IV |
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Darbepoietin alfa (Aranesp)
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Can be given SC 1x/month if stable Hgb
monitor Hgb weekly during initiation, then monthly Goal: 1-2g/dl rise per month inc. dose by 25% if Hgb not inc. by 1g/dl in 4 weeks dec. dose by 25% if Hgb inc. >2g/dl in 4 wks or Hgb approaches 12 |
