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L35,36,37 CKD Pharmacology, Therapeutics, Labs
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1Three determinants of renin release:
1. Decreased [blank_start]Na+ concentration[blank_end] sensed by kidney
2. Decreased BP or renal [blank_start]blood flow[blank_end]
3. [blank_start]Beta 2[blank_end] receptor activation- ANa+ concentration
- Bblood flow
- CBeta 2
2Angiotensin causes profound vasoconstriction and aldosterone release.
- ATrue
- BFalse
3Both ACEIs and ARBS will decrease systemic vascular resistance and increase renal perfusion.
- ATrue
- BFalse
4Diuretics for CKD:
1. Loop diuretics inhibit the activity of the Na-K-2Cl symporter in the [blank_start]thick ascending loop of Henle[blank_end]. Therefore maximum
effect is ~[blank_start]20-25[blank_end]%.
2. Thiazide diuretics inhibit the activity of the Na-Cl symporter in the [blank_start]distal tubule[blank_end]. Maximum effect is ~[blank_start]5[blank_end]%.
3. K-sparing diuretics inhibit the activity of epithelial Na+ channels in the [blank_start]late distal tubule and collecting duct[blank_end]. Maximum effect is ~[blank_start]2[blank_end]%.
4. Aldosterone antagonists competitively inhibit the binding of [blank_start]aldosterone[blank_end] to the mineralocorticoid receptor. The only class of diuretics that do not enter the tubule cell from the apical ([blank_start]tubular[blank_end]) side, and instead from the basolateral ([blank_start]blood[blank_end]) side.- Athick ascending loop of Henle
- B20-25
- Cdistal tubule
- D5
- Elate distal tubule and collecting duct
- F2
- Galdosterone
- Hblood
- Itubular
5Classification of CKD:
• Normal/ CKD 1: GFR >90 mL/min
• Mild/ CKD 2: GFR [blank_start]60-90[blank_end] mL/min
• Moderate/ CKD 3: GFR [blank_start]30-60[blank_end] mL/min
• Severe/ CKD 4: GFR [blank_start]15-30[blank_end] mL/min
• End-stage/ CKD 5: GFR <15 mL/min- A60-90
- B30-60
- C15-30
6Non-pharmacological treatment of CKD entails dietary sodium restriction, and protein restriction if GFR < 30mL/min.
- ATrue
- BFalse
7When using ACEIs and ARBs in CKD the target is a reduction in urine [blank_start]albumin[blank_end] of 30-50%. Starting can [blank_start]reduce[blank_end] GFR; start at a [blank_start]low[blank_end] dose and titrate the dose slowly to effect. Other Important side effects to consider:
• [blank_start]Hyper[blank_end]kalaemia
• [blank_start]Acute[blank_end] renal impairment
• Dry cough (fairly [blank_start]common[blank_end])
• Angioedema ([blank_start]rare[blank_end], but serious)- Aalbumin
- Breduce
- Clow
- DHyper
- EAcute
- Fcommon
- Grare
8Methods of estimating renal function:
1. Creatinine-based methods (CLcr, eGFR)
• Collection of 24 hour urine samples ([blank_start]creatinine[blank_end] clearance)
• Cockcroft-Gault [blank_start]Equatoin[blank_end] (an estimate of creatinine clearance)
• MDRD
• CKD-EPI
All these are reported by the lab as “[blank_start]eGFR[blank_end]”.
2. Cystatin C clearance
3. Clearance of a [blank_start]xenobiotic[blank_end]: Inulin (NOT insulin), 51Cr EDTA (radioisotope)- Acreatinine
- BEquation
- CeGFR
- Dxenobiotic
9Creatinine is freely filtered by the glomerulus and so its clearance lets us estimate GFR.
- ATrue
- BFalse
10Cockcroft & Gault equation:
CLcr = ( (140 - [blank_start]Age[blank_end]) x [blank_start]ideal body weight[blank_end] x K* ) / [blank_start]serum creatinine[blank_end]
* K = 1.23 for males, 1.04 for females- Aage
- Bideal body weight
- Cserum creatinine
11All creatinine-based methods;
• Are poor predictors of GFR if malnourished or low [blank_start]muscle[blank_end] mass
• Over-estimate GFR in the elderly, [blank_start]obese[blank_end] (using total body weight), severe or end-stage renal disease
• Not for <[blank_start]18[blank_end] years old
• Unreliable when renal function [blank_start]changing[blank_end] rapidly (acute renal failure)
• Drugs [blank_start]inhibiting[blank_end] tubular secretion can raise creatinine conc (e.g. probenecid, trimethoprim, spironolactone)- Amuscle
- B18
- Cchanging
- Dobese
- Einhibiting
12In CKD, K+ secretion is [blank_start]reduced[blank_end] resulting in accumulation. Concentrations above [blank_start]5.5-6[blank_end]mmol/L become symptomatic. Hyperkalaemia is more likely to be observed in CKD 4 or 5, and is exacerbated by [blank_start]ACE-I, ARBs[blank_end] and K-sparing diuretics.
- Areduced
- B5.5-6
- CACE-I, ARBs
13Match the ranges.
- Creatinine (plasma): Adult male: 50-[blank_start]110[blank_end] µmol/L, Adult female: 45-[blank_start]90[blank_end] µmol/L
- Urea (plasma): Adults: [blank_start]3.2-7.7[blank_end] mmol/L
- Sodium (plasma) [blank_start]135-145[blank_end] mmol/L
- Osmolality (plasma) 280-[blank_start]300[blank_end] mmol/kg
- Osmolality (urine) 300-[blank_start]1200[blank_end] mmol/kg- A110
- B90
- C3.2-7.7
- D135-145
- E300
- F1200
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