Renal Pharmacotherapy & Laboratory Values – Exam Review

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Flashcards covering laboratory terminology, chemistry panels, CKD and AKI pathophysiology, clinical presentations, treatment goals, dialysis, and key drug considerations for exam preparation.

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58 Terms

1
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What is a "critical value" in laboratory testing?

A result significantly above or below the reference range that is associated with impending morbidity or mortality.

2
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Define "reference range".

The range of normally accepted values for a given laboratory test.

3
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What is a false-negative laboratory result?

A test result that incorrectly indicates a condition is absent.

4
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What is a false-positive laboratory result?

A test result that incorrectly indicates the presence of a condition.

5
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What does test "sensitivity" measure?

The ability of a test to correctly identify individuals who have a disease (true positives).

6
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What does test "specificity" measure?

The ability of a test to correctly identify individuals who do not have the disease (true negatives).

7
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Define positive predictive value (PPV).

The percentage of positive test results that truly indicate the presence of the condition.

8
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Define negative predictive value (NPV).

The percentage of negative test results that truly indicate absence of the condition.

9
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List the seven components of a Basic Metabolic Panel (BMP or "Chem-7").

Sodium, Potassium, Chloride, Bicarbonate (CO2), Blood Urea Nitrogen (BUN), Serum Creatinine (SCr), Blood Glucose.

10
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What additional analyte is included in a Chem-8 panel that is not in a Chem-7?

Calcium.

11
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Which three extra tests distinguish a Complete Metabolic Panel (CMP) from a Chem-8?

Albumin, additional Calcium report, and a hepatic (liver) panel.

12
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Normal reference range for sodium (Na⁺).

135–145 mEq/L.

13
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Normal reference range for potassium (K⁺).

3.5–5.0 mEq/L.

14
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Normal reference range for chloride (Cl⁻).

97–110 mEq/L.

15
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Normal reference range for bicarbonate/CO₂.

22–26 mEq/L.

16
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Normal reference range for BUN.

8–20 mg/dL.

17
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Normal reference range for serum creatinine (adult).

0.7–1.3 mg/dL.

18
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Normal fasting blood glucose range.

65–109 mg/dL.

19
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Normal magnesium range.

1.3–2.2 mEq/L.

20
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Normal total calcium range.

8.6–10.3 mg/dL.

21
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Normal ionized calcium range.

1.1–1.35 mmol/L.

22
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Normal serum phosphate range.

2.5–4.5 mg/dL.

23
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Three key pathophysiologic processes in chronic kidney disease (CKD).

Loss of nephrons, glomerular capillary hypertension (proteinuria), and progressive protein-mediated nephron injury.

24
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Which hormone mediates intraglomerular hypertension in CKD?

Angiotensin II.

25
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Give two susceptibility (correlative) risk factors for CKD per K/DOQI.

Any two of: advanced age, low birth weight/reduced kidney mass, family history, low income/education, dyslipidemia, systemic inflammation.

26
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Name two initiation factors that directly cause kidney damage leading to CKD.

Any two: Diabetes mellitus, hypertension, glomerulonephritis, drug toxicity, urinary tract infection, urinary stones.

27
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Name two progression factors that worsen existing CKD.

Any two: Hyperglycemia, uncontrolled hypertension, smoking, proteinuria, obesity.

28
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What form of metabolic disturbance is common in advanced CKD?

Metabolic acidosis due to reduced ability to produce ammonia and excrete H⁺.

29
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Why can CKD lead to hyperkalemia?

Loss of the kidney's ability to effectively excrete potassium; risk rises in advanced CKD and with K-raising drugs.

30
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List four medications that can increase serum potassium.

ACE inhibitors, angiotensin-receptor blockers (ARBs), aldosterone antagonists, potassium-sparing diuretics (or K⁺ supplements).

31
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Give two medications that can cause fluid retention and worsen edema in CKD.

Any two: Corticosteroids, NSAIDs, androgens/estrogens, thiazolidinediones, dihydropyridine calcium-channel blockers.

32
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Primary goals of CKD therapy.

Delay progression of CKD and minimize complications.

33
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Recommended dietary protein intake for CKD patients with GFR <30 mL/min (KDIGO).

≈0.8 g/kg/day.

34
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KDIGO blood pressure goal for CKD patients if tolerated.

< 120/80 mmHg.
35
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First-line antihypertensive classes to reduce proteinuria in CKD.

ACE inhibitors or ARBs.

36
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When titrating ACEi/ARB in CKD, what makes you increase the dose even if BP is controlled?

Failure to reduce proteinuria by 30–50% from baseline.

37
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Which calcium-channel blocker class can supplement ACEi/ARB to further reduce proteinuria?

Non-DHP CCBs (e.g., verapamil, diltiazem).

38
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Two common complications of hemodialysis.

Any two: Hypotension, muscle cramps, nausea/vomiting, pruritus, headache, chest/back pain, thrombosis, infection.

39
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Most common form of peritoneal dialysis.

Continuous ambulatory peritoneal dialysis (CAPD).

40
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Define azotemia.

Elevation of nitrogenous waste products (e.g., BUN, SCr) in the blood.

41
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Define uremia.

Clinical syndrome from azotemia marked by anorexia, nausea/vomiting, and altered mental status.

42
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Urine output threshold for oliguria.

< 500 mL/day.
43
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Urine output threshold for anuria.

< 50 mL/day.
44
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Give the three broad etiologic categories of acute kidney injury (AKI).

Prerenal, intrinsic (intrinsic renal), and postrenal.

45
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Key feature distinguishing prerenal AKI pathophysiology.

Decreased renal perfusion with otherwise undamaged renal tissue.

46
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Most common structure damaged in intrinsic AKI.

Renal tubules (acute tubular necrosis).

47
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Classic BUN:SCr ratio suggestive of prerenal AKI.

20:1.

48
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Typical fractional excretion of sodium (FeNa) in prerenal AKI.

< 1 %.
49
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Name one drug class that can cause prerenal AKI by efferent arteriolar dilation.

ACE inhibitors or ARBs.

50
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Why can NSAIDs precipitate prerenal AKI?

They block prostaglandin-mediated afferent arteriolar dilation, reducing renal blood flow.

51
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Define the RIFLE acronym for AKI staging.

Risk, Injury, Failure, Loss, End-stage renal disease.

52
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Two supportive (non-pharmacologic) measures to prevent AKI in high-risk patients receiving IV contrast.

IV isotonic saline hydration and use of antioxidants such as N-acetylcysteine or vitamin C.

53
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List two interventions NOT recommended for AKI prevention.

Any two: Prophylactic renal replacement therapy, routine diuretics, dopamine, theophylline, erythropoiesis-stimulating agents, natriuretic peptides.

54
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Four classic urgent indications for initiating renal replacement therapy in AKI.

Uremia (BUN >100 mg/dL), volume overload unresponsive to diuretics, life-threatening electrolyte imbalance (e.g., hyperkalemia), refractory metabolic acidosis, or encephalopathy (any four).

55
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Standard bolus (intermittent) IV furosemide dosing for AKI patients needing diuresis.

40–80 mg IV every 6–12 hours or equivalent loop dose.

56
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Continuous IV furosemide infusion starting rate.

10–20 mg/hour IV.

57
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Formula most commonly used in adults to estimate creatinine clearance.

Cockcroft–Gault equation.

58
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What physical exam finding often suggests postrenal AKI?

Distended bladder or enlarged prostate indicating urinary obstruction.