Therapeutics: Estimation of Renal Function

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kyleannkelsey
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272314
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Therapeutics: Estimation of Renal Function
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2014-04-28 21:20:19
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Therapeutics Estimation Renal Function
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Therapeutics: Estimation of Renal Function
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Therapeutics: Estimation of Renal Function
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  1. Serum creatinine is a product of creatine metabolism from _________.
    muscle
  2. Serum creatinine is eliminated primarily by ____________.
    glomerular filtration
  3. Thus, SCr and GFR are ________related.
    • Inversely
    • When GFR increases, SCr decreases and vice versa
  4. _________________ alone should NOT be used to assess the level of kidney function.
    SCr concentration
  5. (True/False) SCr can be influenced by many factors.
    True
  6. What factors decrease SCr by Reducing creatinine generation, particularly in children, women, elderly, malnourished pts?
    Reduced muscle mass
  7. What factors increase SCr by transient increase in creatinine generation?
    Ingestion of cooked meat
  8. What factors decrease SCr by reducing creatinine generation through mechanisms of reduced muscle mass and reduced meat intake?
    Malnutrition
  9. What factors can increase SCr by Inhibition of tubular creatinine secretion?
    Use of cimetidine, trimethoprim, probenecid
  10. What factors can increase SCr by interference with assays for creatinine
    Use of flucytosine, some cephalosporins
  11. What factors can increase SCr by interference with assays for creatinine
    Ketoacidosis
  12. What are the reasons you might want to obtain a 24 hour urine sample to obtain a directly measured CrCl value (rather than using prediction equations)?
    • Extremes of age and body size (variable muscle mass)
    • Severe malnutrition or obesity (variable muscle mass)
    • Disease of the skeletal muscle (variable muscle mass)
    • Paraplegia or quadriplegia (variable muscle mass)
    • Vegetarian diet (variable muscle mass)
    • Rapidly changing renal function
    • Prior to dosing drugs with significant toxicity that is excreted by the kidneys
  13. Equations for the estimation of GFR and CrCl (CG, MDRD, CKD-EPI) rely on what patient parameters?
    Individual having stable renal function/steady state
  14. What is the Cockcroft-Gault equation?
    • Men: CLCr =(140-age)ActBW/(SCr x 72)
    • Women: CLCr x 0.85
  15. The CKD-EPI equation was validated inw hat group of patients?
    Those with a GFR over 60
  16. What equations can be used to obtain eCrCl?
    • C-G
    • Jeliffe
    • Brater
    • Salazar-Corcoran
    • Schwartz
  17. What equations can be used to obtain eGFR?
    • MDRD
    • C-G
    • Schwartz
  18. What are the standard units for CrCl?
    mL/min
  19. What is a normal CrCl for a male?
    97 to 137 ml/min
  20. What is a normal CrCl for a Female?
    88 to 128 ml/min
  21. What is a normal CrCl for Newborns (1 day)?
    5-50 mL/min/1.73m2
  22. What is a normal CrCl for a Newborns (6 days)?
    15-90 mL/min/1.73m2
  23. What does the FDA classify as normal renal function?
    > or = to 90
  24. When should you use adjusted body weight instead of actual body weight?
    When a patient weighs more than 20% of their IBW
  25. What is the Ideal Body Weight (IBW) equation for Males
    = 50 kg + 2.3 (inches over 5 ft tall)
  26. What is the Ideal Body Weight (IBW) equation for Females?
    = 45.5 kg + 2.3 (inches over 5 ft tall)
  27. What is the Adjusted Body Weight (AdjBW) equation?
    [0.4 x (ActBW – IBW)] + IBW
  28. Should you round up to 1 when elderly patients have a CrCl of <1?
    No, less biased to use actual number
  29. What does MDRD Stand for?
    Modification of Diet in Renal Disease
  30. FDA currently supports using which equations for estimating renal function for dosing of medications?
    • MDRD or the CG
    • However, the MDRD equation has never been validated in large clinical trials to dose lovenox
  31. What is the Salazar-Corcoran used for?
    Has been validated for morbidly obese
  32. What equation has been validated in patients with CKD and GFR over 60 mL/min/1.73m2?
    CKD-EPI equation
  33. What does CKD-EPI stand for?
    Chronic Kidney Disease Epidemiology Collaboration Equation
  34. CKD-EPI equation is more accurate than ________ for values >60 mL/min/1.73m2
    MDRD
  35. How could you use the CG equation for estimating renal function in a patient with acute kidney injury/rapidly changing function?
    Use the highest possible SCr value you could obtain
  36. Brater and Jelliffe equations use ____________values.
    age, weight, two SCr, the days in between those SCr values
  37. What equation should you use to estimate kidney function in a liver disease patient?
    Equations overestimate = draw a direct measurement of GFR
  38. What equation should you use to estimate kidney function in a pediatric?
    Schwartz (FDA supported)
  39. _________is the primary endogenous biomarker.
    SCr

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