renal disease

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Anonymous
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303016
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renal disease
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2015-05-20 14:30:50
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renal disease
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renal disease
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  1. most common causes of CKD
    • diabetes
    • hypertension
  2. what is the marker that gauges severity of kidney damage
    albumin in the urine - watch for drugs that are highly bound
  3. loop diuretics in ckd
    • ascending loop of henle
    • ↓ Na ↓ Ca ↓K
    • ↑ glycemia ↑ uric acid
  4. thiazide diuretics in ckd
    • distal convoluted tubule
    • ↑ Ca ⇣K
  5. goal blood pressures in ckd
    • no proteinuria = < 140/90
    • proteinuria = < 130/80
  6. ACEIs & ARBs in ckd
    • renal protective
    • increase SCr initially 30%
    • ↑K
    • monitor SCr & K 1-2 weeks ofter initiating
  7. anemia and ckd
    • ↓ erythorpoietin = anemia
    • Tx = erythropoiesis stimulating agents (ESAs) (epogen, procrit, aranesp) + iron
  8. hyperphosphatemia in ckd
    • 1. diet restriction
    • 2. phosphate binders
    •   a. aluminum based - short term if at all
    •   b. calcium based - 1st line, dose limiting effect
    •       is hypercalcemia (problem when taking vitD
    •   c. iron based - 
    •   d. Al & Ca free - expensive
  9. aluminum and calcium free agent for hyperphosphatemia
    Lanthanum carbonate (fosrenol) - chewable, CI bowel obstruction, ileus, fecal impaction
  10. sevelamer (renvela) for hyperphosphatemia
    • 1. not systemically absorbed
    • 2. ↓ TC and LDL (15-30%)
    • 3. taken with meals
    • 4. CI - bowel obstruction
  11. Calcitriol (Rocaltrol)
    • 1. vitamin D analog
    • 2. Treats 2ndary hyperparathyroidism
    • 3. active form of D3
    • 4. CI - hypercalcemia
  12. Cinacalcet (Sensipar)
    • 1. calcimimetic
    • 2.Treats 2ndary hyperparathyroidism
    • 3. ↓ Ca, PTH, Phos
    • 4. CI hypocalcemia
  13. vitamin D2 dosing in ckd
    • <5 = 50,000 units QW X12W then QM
    • 5-15 = 50,000 units QW X 4W then QM
    • 16-30 = 50,000 units QM

    Duration is 6 months, then measure levels of serum 25 (OH)
  14. drugs that increase potassium
    • BINGO CAP
    • Bactrim
    • Immunosuppressants
    • NSAIDS
    • Glycopyrrolate
    • OC's (drosperinone)
    • Canaglifozin
    • ACE/ARB, aliskren, aldosterone antagonists
    • Pentamidine
  15. Tx of hyperkalemia
    • 1. remove sources of K
    • 2. IV calcium gluconate (stabilizes heart)
    • 3. loop diuretic (excretion)
    • 4. insulin
    • 5. glucose
    • 6. beta agonist (albuterol) 
    • 7. if metabolic acidosis then sodium bicarb
    • 8. kayexalate
    • 9. Dialysis

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