Renal Disorders

GFR

the rate of blood flow through the kidneys; can be measured by plasma or urinary clearance of creatinine (determination requires both); important to evaluate kidney function.

eGFR

the number calculated to estimate GFR; can be calculated from a single blood test result such as serum creatinine; gives a calculated value of GFR

AKI

abrupt decrease in GFR over a period of hours

- 1.5-2 fold increase in serum creatinine from baseline of 25-50% decrease in GFR; urine output < 0.5 ml/kg/h for 6-12 hours

1. prolonged NSAID use

2. Dehydration

3. Antibiotics: Amphotericin B, Vancomycin, Amikacin, Gentamicin

4. ACE Inhibitors: Captopril

5. Sepsis

6. Trauma

7. blood loss

List some things that can cause AKI.

anuric

urine output < 50ml/day

oliguric

urine output <500 ml/day

nonoliguric

urine output >500 ml/day

1. presence of underlying CKD

2. 65+

3. multisystem organ failure

4. sepsis

5. diabetes

6. drugs

7. infection

8. surgery

9. preexisting chronic diseases

10. malignancy

risk factors for AKI

collect a 24-hour urine sample

how to get a full GFR? (most accurate GFR)

amphotericin, platinum agents, contrast dye (in patients at risk for kidney injury)

agents that require prehydration and post hydration to prevent nephrotoxicity

acute interstitial nephritis

what precedes acute tubular necrosis?

NSAIDs

Allopurinol

Nafcillin, Oxacillin, Methicillin (not used much anymore)

Piperacillin/Tazobactam

what drugs can cause interstitial nephritis?

volume depletion caused by:

- dehydration

- hemorrhage

- pulmonary HTN

- decreased cardiac output

prerenal AKI causes

intrinsic AKI

which category of AKI is described below:

vascular damage

glomerular damage

acute necrosis

postrenal AKI

which category AKI is caused by bladder outlet obstruction (BPH and anticholinergic use), renal calculi, and cancer.

nephritic syndrome

inflammatory injury to the glomeruli that can occur because of antibodies interacting with normally occurring antigens in the glomeruli

- causes: diseases that initiate the inflammatory response

- manifestations: gross hematuria, urinary casts and leukocytes, low GFR, azotemia, oliguria, high BP

- complications: impaired renal function

CKD

gradual loss of renal function that is irreversible

1. diabetes

2. HTN

3. urine obstruction

4. renal diseases

5. renal artery stenosis

6. prolonged exposure to nephrotoxic agents

7. sickle cell disease

8. systemic lupus erythematous

9. smoking

10. advanced age

list some causes of CKD

1. elevated baseline serum creatinine

2. preexisting renal insufficiency

3. underlying diabetic nephropathy

4. CHF

5. high or repetitive doses of contrast media

6. volume depletion and concomitant use of diuretics, ACE inhibitors or ARBs

Risk factors associated with radio contrast media nephrotoxicity.

Metformin; risk of lactic acidosis

What medication should be held prior to administering contrast media? why?

a. Pre-renal kidney injury

A patient, with a past history of hypertension and

diabetes, was admitted with nausea, diarrhea and

vomiting. This patient is most likely to experience which

of the following

a. Pre-renal kidney injury

b. Intrinsic kidney injury

c. Post-renal kidney injury

c. Dehydration

A patient, with a past history of hypertension and

diabetes, was admitted with nausea, diarrhea and

vomiting. This patient is most likely to experience pre-renal AKI. The observed acute kidney injury is a consequence of which of the following:

a. Hemorrhage

b. Hypoalbuminemia

c. Dehydration

d. Existing comorbidities

cause: dehydration

management: fluids

JB is a 25-year-old female with no significant medical history. She presented today with symptoms of diarrhea and vomiting. Scr is 1.5. What is the primary reason for her increased serum creatinine? How do you think this patient should be managed?

nephrolithiasis

drug-induced _____ can be the result of abnormal crystal precipitation in the renal collecting system. This can potentially cause pain, hematuria, infection, or urinary tract obstruction with kidney injury

N-acetylcysteine

what can be given to break down the disulfide bonds in contrast dye?

- restrict dietary phosphate

- administer phosphate binders: Ѕеvеlаmer (Renvela), (Լаոthаոum) Fosrenol

A complication of CKD includes electrolyte imbalances. What is the treatment for hyperphosphatemia?

calcium supplements with or without calcitriol

A complication of CKD includes electrolyte imbalances. What is the treatment for hypocalcemia?

Loop diuretic

Potassium binders:

- Patiromer (Vеltasѕа)

- Sodium zirconium cyclosilicate (Lokelma)

- Sodium polystyrene sulfonate (Kayexalate) [if the two above are not available]

A complication of CKD includes electrolyte imbalances. What is the treatment for hyperkalemia?

Iron

ESA

- Epoetin alfa (Epogen, Procrit,

- Darbepoetin Alfa (Aranesp) [LA]

A complication of CKD includes anemia. List some treatment options.

ACE-I or ARBs

- consider DHP CCB or aldosterone antagonist as second line

If volume overloaded, use diuretics or dialysis

A complication of CKD includes hypertension. How should this be treated? what if they are volume overloaded?

Empagliflozin (Jardiance)

Dapagliflozin (Farxiga)

List the two SGLT-2 inhibitors that are indicated for M.A.C.E. (major adverse cardiovascular events) and CKD as adjunctive therapy