KIDNEY

Question 1

common types of AKI

Answer 1

70% - hypo-perfusion of the kidneys

20% obstruction to urine flow

10% structural damaged due to ischemia, inflammation, toxins, necrosis

Question 2

CKIDGO criteria for AKI

Answer 2

increased SCR >/ 26.5 mmol/L within 48 hrs or increased SCr >/1.5x baseline known/presumed to have occurred within prior 7days or
Urine volume < 0.5mL/kg/hr for 6 hrs

Question 3

treatment for hyperkalemia

Answer 3

calcium gluconate, sodium bicarbonate, insulin, salbutamol, furosemide, sodium poystyrene sulfonate (exchanges sodium ions for potassium in intestinal cell) dialysis

Question 4

know cockroft gault equation

Answer 4

Question 5

CKIDGO definition of CKD

Answer 5

GFR <60 ml/min for>/3 months with or without signs of kidney damage
OR
presence of markers of kidney damage for >/3 months with or without decreased gfr

Question 6

what factors doe KDIGO used to stage CKD

Answer 6

GFR and albuminuria

Question 7

what stage is considered dialysis

Answer 7

G5

<15ml/min GFR

Question 8

know staging of CKD

Answer 8

G1: >/ 90 GFR 
G2: 60-90 
G3a and G3b: 30-59
G4: 15-29
G5: <15 or dialysis

Question 9

which drug to use for albuminuria or proteinuria

Answer 9

ACEI or ARB

Question 10

complications of CKD that we need to treat

Answer 10

anemia
hyperphosphatemia
secondary hyperparathyroidism ( HPT)

Question 11

BP goal for CKD?

Answer 11

individualized.
<130/80 (BP)

<120 IF meets SPRINT criteria

SPRINT ( >50 years of age, elevated cardiovascular risk without diabetes

Question 12

list the phosphate binder options

Answer 12

1st choice: calcium carbonate

2nd: lanthanum, sevelamer

Question 13

which phosphate binder is preferred in stage 5 CKD

Answer 13

sevelamer

Question 14

treatment for metabolic acidosis

Answer 14

sodium bicarb

Question 15

important counselling points for calcium carb

Answer 15

Oral iron salts, fluoroquinolones, tetracyclines and levothyroxine: absorption reduced. Give 2 h before or 4 h after calcium.

Question 16

unique side efffect of sevelamer

Answer 16

can lower LDL cholesterol by 30%

Question 17

too much vitamin D such as using alfacalcidol can caused what?

Answer 17

hypercalcemia and hyperphosphatemia

Question 18

where is Vitamin D metabolizes

Answer 18

kidney to become active Vitamin D ( calcitriol)

Question 19

how does PTH regulates phosphate

Answer 19

stimulating reabsorption of P from bone

Decreased reabosption of P from the kidneys

Question 20

what is the consequence of CKD on parathyroid hormone

Answer 20

INCREASE PO4, DECREASE CA sensing receptors( high results in higher serum calcium to suppress PTH) AND DECREASE ACTIVE VITAMIN D

Question 21

Treatment of HPT

Answer 21

normalize Ca2+
prevent increased in PO4 ( diet, phosphate binder, dialysis
correct vitamin D deficiency

Question 22

MOA of vitamin D analogues?

Answer 22

stimulate Ca absorption in the intestines
stimulates renal tubular Ca reabsorption
SUPPRESS PTH production

Question 23

what can oversuppression of PTH caused

Answer 23

decreased osteoblast and osteoclast activity
Ca uptake by bone is reduced
INCREASE risk of fractures and calcification

Question 24

indication for VITAMIN D analogues

Answer 24

to correct calcium level and manage hyperparthyroidism

Question 25

what does HPT do the the bones

Answer 25

high turnover bone disease PTH stimulates osteoclasts and osteoblasts increase resorption and bone formation results in abnormal unmineralized osteoid

Question 26

MOA of cinacalcet

Answer 26

binds to Ca receptors to increase sensitivity to Ca and decrease PTH release **not recommended as first line for HPT due to risk of hypocalcemia

Question 27

where erythroietin produce

Answer 27

kidney

Question 28

diagnosis of anemia

Answer 28

Hb < 130 in males | <120 in females

Question 29

what is the target HB when using ESA

Answer 29

<115 g/L ePrex usually initiate when Hb 90-100 g/L

Question 30

what is the major concern with ESA

Answer 30

thromboembolism (with higher Hb targets) hypertension allergic reaction

Question 31

when should we initiate iron supplementatio n

Answer 31

ferritin <500 ng/mL AND Tsat <30%

Question 32

important counselling points of iron supplementation

Answer 32

take on empty stomach to increase absorption take 1 hr before or 2-3 hrs after diary/ Ca supplements warn about darkstools, constipatio, abdominial pian

Question 33

sick day management for insulin

Answer 33

hold bolus | continue basal

Question 34

Where in the nephron does active drug secretion most often occur?

Answer 34

proximal tubule

Question 35

What is the best method for initial testing of proteinuria in a patient with chronic kidney disease risk factors?

Answer 35

Urine albumin : creatinine ratio