on 26-Apr-2016 (Tue)

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#nephrology

Question

What are tubulo-toxic drugs causing ATN?

Answer

Aminoglycosides Antibiotics (Gentamicin, Tobramycin, Amikacin)
Amphotericin B (antifungal)
Cisplatin (chemo)
IV radiocontrast dye

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Question

6 steps to slowing progression of CKD:

NB: Remember CHD risk equivalent

1. [...] or [...] (slow progression to ESRD with additional advantages over blood pressure lowering alone)
2. Tight blood pressure control
Multiple antihypertensive medications and dietary sodium restriction may be required
Targets: < 140/90 mmHg without DM, < 130/80 mmHg with DM
3. Use of a statin in patients with dyslipidemia (target LDL < 2 mmol/L) - shown to prevent CV events and may slow the rate of decline
4. Recommend smoking cessation (independent risk for development/progression of CKD)
5. glycemic control in patients with diabetes mellitus (HbA1C < 7%)
6. Patients with eGFR <60 ml/min/1.73m2 should avoid NSAIDS, COXIBs and other nephrotoxins such as intravenous contrast if possible

Answer

ACE inhibitor
Angiotensin receptor blocker

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Question

Presentation of hypernatremia

Answer

presentation = confusion, ↓ LOC (brain cell shrinkage)

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Question

6 steps to slowing progression of CKD:

​NB: Remember CHD risk equivalent

1. ACE inhibitor or Angiotensin receptor blocker (slow progression to ESRD with additional advantages over blood pressure lowering alone)
2. Tight [...] control

• Multiple [...] medications and [...] restriction may be required
• Targets: [...] mmHg without DM, [...] mmHg with DM

3. Use of a statin in patients with dyslipidemia (target LDL < 2 mmol/L) - shown to prevent CV events and may slow the rate of decline
4. Recommend smoking cessation (independent risk for development/progression of CKD)
5. glycemic control in patients with diabetes mellitus (HbA1C < 7%)
6. Patients with eGFR <60 ml/min/1.73m2 should avoid NSAIDS, COXIBs and other nephrotoxins such as intravenous contrast if possible

Answer

blood pressure

antihypertensive
dietary sodium

< 140/90
< 130/80

Tags

#nephrology

Question

6 steps to slowing progression of CKD:

​NB: Remember CHD risk equivalent

1. ACE inhibitor or Angiotensin receptor blocker (slow progression to ESRD with additional advantages over blood pressure lowering alone)
2. Tight blood pressure control

• Multiple antihypertensive medications and dietary sodium restriction may be required
• Targets: < 140/90 mmHg without DM, < 130/80 mmHg with DM

3. Use of a [...] in patients with dyslipidemia (target LDL [...] mmol/L) - shown to prevent [...] events and may slow the rate of decline
4. Recommend smoking cessation (independent risk for development/progression of CKD)
5. glycemic control in patients with diabetes mellitus (HbA1C < 7%)
6. Patients with eGFR <60 ml/min/1.73m2 should avoid NSAIDS, COXIBs and other nephrotoxins such as intravenous contrast if possible

Answer

statin
< 2
CV

Tags

#nephrology

Question

6 steps to slowing progression of CKD:

​NB: Remember CHD risk equivalent

1. ACE inhibitor or Angiotensin receptor blocker (slow progression to ESRD with additional advantages over blood pressure lowering alone)
2. Tight blood pressure control

• Multiple antihypertensive medications and dietary sodium restriction may be required
• Targets: < 140/90 mmHg without DM, < 130/80 mmHg with DM

3. Use of a statin in patients with dyslipidemia (target LDL < 2 mmol/L) - shown to prevent CV events and may slow the rate of decline
4. Recommend [...] cessation (independent risk for development/progression of CKD)
5. glycemic control in patients with diabetes mellitus (HbA1C < 7%)
6. Patients with eGFR <60 ml/min/1.73m2 should avoid NSAIDS, COXIBs and other nephrotoxins such as intravenous contrast if possible

Answer

smoking

Tags

#nephrology

Question

6 steps to slowing progression of CKD:

​NB: Remember CHD risk equivalent

1. ACE inhibitor or Angiotensin receptor blocker (slow progression to ESRD with additional advantages over blood pressure lowering alone)
2. Tight blood pressure control

• Multiple antihypertensive medications and dietary sodium restriction may be required
• Targets: < 140/90 mmHg without DM, < 130/80 mmHg with DM

3. Use of a statin in patients with dyslipidemia (target LDL < 2 mmol/L) - shown to prevent CV events and may slow the rate of decline
4. Recommend smoking cessation (independent risk for development/progression of CKD)
5. [...] control in patients with diabetes mellitus ( [which lab value] < [#] %)
6. Patients with eGFR <60 ml/min/1.73m2 should avoid NSAIDS, COXIBs and other nephrotoxins such as intravenous contrast if possible

Answer

glycemic
HbA1C
7

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#nephrology

Question

6 steps to slowing progression of CKD:

​NB: Remember CHD risk equivalent

1. ACE inhibitor or Angiotensin receptor blocker (slow progression to ESRD with additional advantages over blood pressure lowering alone)
2. Tight blood pressure control

• Multiple antihypertensive medications and dietary sodium restriction may be required
• Targets: < 140/90 mmHg without DM, < 130/80 mmHg with DM

3. Use of a statin in patients with dyslipidemia (target LDL < 2 mmol/L) - shown to prevent CV events and may slow the rate of decline
4. Recommend smoking cessation (independent risk for development/progression of CKD)
5. glycemic control in patients with diabetes mellitus (HbA1C < 7%)
6. Patients with eGFR < [...] ml/min/1.73m2 should avoid [...] , [...] and other nephrotoxins such as [...] if possible

Answer

60

NSAIDS
COXIBs
intravenous contrast

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Question

What are CKD complications?

Answer

anemia & bone mineral metabolism
Cardiovascular disease
Volume overload
Electrolyte abnormalities
Uremia

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Question

What causes anemia in CKD?

Answer

peritubular fibroblasts produce EPO in response to ↓ O2 sat but less fibroblasts in CKD

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Question

What causes bone mineral metabolism in CKD?

Answer

2ndary hyperparathyroidism d/t ↓ serum Ca → ↑ PTH

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Question

What are the Cardiovascular diseases seen as a consequence of CKD?

Answer

– CAD
– Hypertension

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Question

What are bone and mineral metabolism consequences seen in CKD?

Answer

– Hypocalcemia
– Hyperphosphatemia

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Question

What are electrolyte abnormalities seen as a consequence of CKD?

Answer

- Hyperkalemia
– Metabolic acidosis

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Question

What are the sx's of uremia seen as a consequence of CKD?

Answer

– Nausea, vomiting
– Pruritus
– Encephalopathy

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Question

Mgmt of hypernatremia

Answer

rx = give H2O, rx underlying cause