The document discusses causes, management, and treatment of acute kidney injury (AKI) and chronic kidney disease (CKD). It covers topics like medications that can cause AKI, management of electrolyte abnormalities, anemia management, and factors that affect CKD progression.
The document discusses causes, management, and treatment of acute kidney injury (AKI) and chronic kidney disease (CKD). It covers topics like medications that can cause AKI, management of electrolyte abnormalities, anemia management, and factors that affect CKD progression.
The document discusses causes, management, and treatment of acute kidney injury (AKI) and chronic kidney disease (CKD). It covers topics like medications that can cause AKI, management of electrolyte abnormalities, anemia management, and factors that affect CKD progression.
The document discusses causes, management, and treatment of acute kidney injury (AKI) and chronic kidney disease (CKD). It covers topics like medications that can cause AKI, management of electrolyte abnormalities, anemia management, and factors that affect CKD progression.
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Renal review:
Possible causes of AKI:
Pre-renal: hypoperfusion of the kidney (most common cause of an AKI)
Intrinsic AKI: damage or impairment within the kidney Post-renal AKI: sever blockage beyond the kidney (i.e. in the ureter) causes waste buildup in the kidney
Meds can cause AKI view several mechanisms:
- Change the blood flow rate within the glomerulus o NSAIDs, ACEi, ARBs - Inflammation within the glomerululs: NSAIDs, propylthiouracil - Acute interstitial nephritis due to drug binding to antigens in the kidneys – fluoroquinolones, diuretics - Drug crystalized and causes a urinary outflow bloackage – cliprofloxacin, methotrexate - Rhabdomyolysis: statins, BZDs - Inducing clots within small vessels of the kidney – clopidogrel, cyclosporine
Which med increases risk of hyperkalemia? spironolactone
Which condition is most likely to cause acute AKI? HF (hypoperfusion) – lead to acute AKI How does insulin treat hyperkalemia? shifts potassium intracellularly Kidney fxs: - optimize acid base balance - regulate electrolyte levels + calcium and phosphate levels - Vitamin D activation - optimize RBC production - regulate BP
Which is associated wth post-renal AKI? BPH (involved with ureter – constrict the urethra severely, which can result in urine build up and limit renal emptying)
Sick day management = SADMANS (sulfonylureas, ACEi, diuretics, metformin, ARBS, NSAIDs, SGLT2i) not statin – does not need to be help for AKI
What may cause hematuria? interstitial nephritis, kidney tumor, kidney stones
Which drugs can cause an AKI? 1. Rampiril 2. Dapagliflozin 3. Furosemide 4. Lithium
If edema is not severe enough to be life threatening – don’t do dialysis. Other options= sodium restriction, furosemide, bumetanide.
Most likely cause of low Hgb: decreased erythropoietin
As CKD progresses, the kidneys production of erythropoietin decreases and results in dec Hgb
Uncontrolled HTN can cause and worsen CKD and lead to kidney failure
Which sx can present in both CKD and AKI?
- Hyperkalemia
Life threatening cardiac arrythmias are treated with: Calcium gluconate IV
IV calcium gluconate is used to treat potassium-induced cardiac arrythmias.
Calcium carbonate is used to treat hyperphosphatemia associated with CKD. This can cause the following s/e: - Hypophosphateia - Abdominal discomfort - Hypoparathyroidism - DOES NOT CAUSE FLUID RETENTION
A pt with CKD and CrCl of 25 ml/min requires a diuretic. Which is the most effective and safe? 1. HCTZ 2. Furosemide 3. Spironolactone 4. Acetazolamide - Thiazide diuretics less effective when CrCl <30 - As hyperkalemia is a common complication of CKD, potassium-sparing diuretics should not be used if there are safer alternatives (spironolactone) - Loop diuretic woll be safe and effective - Acetazolamide can lead to metabolic acidosis as it increases sodium bicarb excretion and is not the safest option
ESAs – most likely reason for inadequate response to ESA tx in pts with CKD? - Pts serum iron level is depleted. Lack of iron stores will not allow RBC formation, even if there is sufficient erythropoietin in the blood
Risk factors for CKD: low body wt is not a risk factor
Actual risk factors: fam history of kidney disease, certain ethnic groups, autoimmune disorder.
All of the following should be monitored except:
1. SBP < 120 2. Albuminuria <3 -- this is the healthy albuminuria target 3. A1c <7 for diabetic pts 4. Serum sodium levels bw 135-145 -- serum sodium levels are not closely monitored but above 3 parameters are.
oral iron supplement:
- heme iron polypeptides were originally thought to be better tolerated than ferrous salts (now we know that they are not well tolerated) – these are animal sourced iron. - Iron supplements may be taken with vit C - Ferrous fumarate is more likely to cause constipation than ferrous sulphate
Which warrants IV iron supplementation?
- pt unresponsive to ESA agent - NOT pregnant woman with iron deficiency – still trial supplement then IV iron
Which parameter has the earliest response to iron therapy? absolute reticulocyte count
Smoking and CKD progression – smoking can inc the speed of CKD progression
pt with gout episode – GFR = 19. give prednisone 25mg po daily.
NSAIDs are not recommended in CKD as they can inc the risk of kidney failure.
Morphine metabolites accumulated in chronic kidney dysfunction.
Drug administraton times may need to be adjusted around hemodialysis tx. HD can remove certain drugs abruptly from the body, so administration imes are imp.
Which of the following drugs do not commonly cause nausea?
1. Calcium carbonate 2. Sodium polystyrene sulfonate 3. Calcitriol 4. Ferrous fumarate ESA: - Hgb should be <100 in order to qualify for ESA tx
Which agent is most likely to cause AKI in pts with underlying CKD? - gentamicin – aminoglycosides are commonly associated with nephrotoxicity In pts receiving ESA, the risk of stroke increases with higher Hgb levels
First line tx for anemia = oral iron supplements and folate/B12 if needed. If oral supplements are insufficient, then IV iron is second line ESA is recommended if Hgb <100 and iron is ineffective in raising Hb level While on ESA, Hb should ideally inc by 10-20 each month, target Hgb: 115.
Hyperkalemia and subsequent arrythmia most likely cause: - perindopril and septra inc serum potassium
