CKD Flashcards

Question

What drugs should you give for DKD?

Answer 1

- SGLT-2 inhibitors, MRAs, RAAS inhibitors for inflammation - GLP-1RAs for hyperglycemia - ACEis/ARBs/MRAs/SGLT2 inhibitors for hemodynamic dysregulation

Answer 2

- ACEis/ ARBs always 1st line unless contraindicated, then CCB, then hydrochlorothiazide - Loop diuretic (furosemide) over thiazides if you need volume control

Answer 3

- normocytic, normochromic, hypoproliferative (reticulocyte count) - <130 Hgb for men, <120 for women 1. EPO deficiency/ lack of responsiveness to hypoxia (stabilization of HIF) which would normally stimulate EPO production 2. Iron abnormalities (loss, decreased absorption, reticuloendothelial blockade) 3. Decreased RBC survival (due to less EPO and inflammation)

Answer 4

- prevents apoptosis of erythroblasts - made in peritubular capillary cells - loss of healthy cells in CKD leads to less EPO (though still minimal ability to make more in response to hypoxia)

Answer 5

- most iron is stored in Hgb/ as ferritin, main regulation is via absorption in the gut - Loss --> due to frequent sampling, procedures, hemodialysis, coagulopathy, uremic bleeds - Inflammation increases hepcidin which decreases gut absorption of Fe (absolute deficiency) - Hepcidin also blocks Fe transporters which locks ferritin storage (functional deficiency AKA reticuloendothelial iron blockade)

Answer 6

- improved exercise tolerance, improved QoL, receive fewer transfusions which can potentially sensitize someone to a transplant - if ferritin <100 or hemodialysis patient --> IV iron - if ferritin >100 or no response --> EPO or darbopoietin - adjust ESA until Hb is in target range of 11-13 Supplement iron if TSAT <30% and ferritin <500

Answer 7

Transferrin --> form available for erythropoiesis, made in the liver so will increase with inflammation and decrease with malnutrition and cirrhosis - transferrin saturation (TSAT) tells you amount of Fe bound to transferrin Ferritin --> best marker of iron deficiency (under 100) - acute phase reactant so will increase with infxn/ malignancy - tells you if there is enough room to supplement iron without causing an overload

Answer 8

- Do not give iron with active infection - Do not give ESAs with cancer (EPO is anti-apoptotic) - give enough to maintain erythropoiesis and avoid transfusion (target between 95-115) but DO NOT overload (over 130)

Answer 9

- no major impact - may have gut edema leading to decreased absorption - oral iron and PO4 binders may chelate other drugs

Answer 10

- if hypoalbuminemia need to monitor highly protein bound (>80%) drugs i.e. phenytoin, digoxin - will need to halve dose Vd --> theoretical volume of fluid total drug would need to be diluted to produce the concentration in the blood - Low Vd (under 1) --> more water soluble, more likely to be eliminated by dialysis - High Vd (over 2) --> more lipid soluble, less likely to be eliminated by dialysis

Answer 11

Phase I --> functionalization --> loss of activity Phase II --> conjugation with highly polar compounds to aid in rapid excretion

Answer 12

- if non-renal clearance is over 70%, can use normal drug dosing even if there is renal insufficiency - if renal clearance is over 30%, adjust the dose

Answer 13

HD --> smaller and unbound Glomerulus --> bigger proteins *PD is mostly small pores but some larger ones

Answer 14

- beneficence, nonmaleficence, autonomy, justice

Answer 15

- type IV collagen variants, affects the GBM - 2nd most common inherited kidney disease after polycystic - hearing and ocular issues

Answer 16

- metabolic abnormalities (hyperK/PO4, acidemia, severe anemia) - clinical abnormalities (fluid overload, uremic symptoms)

Answer 17

- uremic blood (K, PO4, toxins) is run against diasylate (purified water w individualized electrolytes and dextrose) Diffusion --> passive movement of solutes down a concentration gradient, affected by size of solute/pores, SA of membrane, gradient, and flow rate - more for small molecules (K, Na, urea) Convection --> active movement of solutes dragged by water movement/ pressure gradient, affected by the same factors as diffusion plus amount of H20 removed - more for medium/ large molecules (B12, glucose, PO4, uric acid, cretainine) - Av Fistula/graft --> preferred - Tunneled IJ catheter --> tip in RA, risk of infection/ endocarditis, cannot shower/ swim - Can be done in facilities (3x week for 4h or 8h nocturnal) - Can be done at home (trained, no cost, travel)

Answer 18

- peritoneal lining acts as the membrane - fill bag, tubing, drainage bag (cannot get wet) - similar mechanisms as HD except also ONCOTIC pressure (convection) for larger molecules as diasylate is glucose based - Continuous Ambulatory - 3-4 exchanges a day with last fill at night with icodextrin, drained in the morning - only free inbetween exchanges - Continuous Cycler - hooks up to machine that does 4-8 exchanges while asleep, last fill in the morning with icodextrin and drain at night - ambulatory and free during the whole day *HD and PD outcomes are similar and you can switch between the two

Answer 19

Diagnostic --> symptomatic patients who need a diagnosis Carrier --> asymptomatic patients who are not at risk of disease, inform risk for future kids Screening --> asymptomatic patients at risk for a treatable genetic condition based on general population (CF) Predictive --> asymptomatic patients at risk for an inherited disease based on family history (Huntingtons, BRCA1/2) - most common in 20-30s and 55-60s

Answer 20

Positive - asymptomatic but will LIKELY develop condition Negative - asymptomatic but not at risk of developing condition

Answer 21

too young, anticipated negative psychological effects, no preventative therapy, potential for discrimination *most will have decreased anxiety and depression regardless of the outcome a year later, but will have worse outcomes for (+) eventually (depression is most common)

Answer 22

- secondary glomerulonephritis - caused by ANCA vasculitis (ANCA MPO will be (+))

Answer 23

- plant based diet, unsaturated fats, nuts, avoid processed meats/ refined carbs/ sweetened drinks - increase protein intake if on dialysis, but avoid excess protein and malnutrition (protein energy wasting common in late stage CKD) - avoid restaurants as they have a lot of excess sodium - less than 2300mg Na per day

Answer 24

transplant - no fluid restriction PKD - at least 3 L HD - 750ml - 1L plus urine output PD - 1.5 - 2L or to thirst Stage 3-5 - 0.8-1.5 Stage 5 Dialysis - 1.1 - 1.8 *PO4 is more bioavailable in processed foods than legumes/grains, want to avoid hyperPO4

Answer 25

- inadequate fiber, excess proteins, lots of coffee, juice

Answer 26

- active infection/ malignancy/ psych illness, high peri-operative risk, high comorbidity burden (dementia) - even Hep C/ HIV patients have been able to donate kidneys - pigs can! (zenotransplantation)

Answer 27

- living is better --> shorter time, decreased perioperative risk, better graft longevity

Answer 28

- T cell and B cell mediated graft rejection - APC presents Ag to T cell via MHC/TCR and B7/CD28 connections (CTLA4 inactivates T cells) - ABO blood group and HLA Abs - Ab-mediated rejection is the #1 cause of graft failure - Acute rejection is becoming less common but long term outcomes are still relatively the same

Answer 29

- belatacept - better renal toxicity outcomes comapred to cyclosporine - anti-thymocyte globulins ( get slow recovery of CD4/8 cells)

Answer 30

Group A --> Anti B Abs, A antigen Group B --> Anti A Abs, B antigen Group AB --> no Abs, A and B antigens Group O --> Anti A and B Abs, no antigens *AB group most likely to receive transplants

Answer 31

- HLA Abs are present on all nucleated cells - They are formed in pregnancy, blood transfusions, transplantation, infection (all sensitizing events) - Less important for liver transplant

Answer 32

Made organ trafficking illegal (except Iran)

Answer 33

- neurologic death --> coma with no responsiveness, absence of brainstem reflexes, apnea test, must be no reversible cause - if irreversible but doesnt meet the above criteria, can donate after cardiac death (heart stops for more than 5 minutes)

CKD Flashcards

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