4/3 Nephrology ASSESSMENT OF KIDNEY FUNCTION
QUESTIONS WITH COMPLETE SOLUTIONS
(decrease in UOP usually < 400 mL/day)
(AKI with normal UOP > 400 mL/day)
(no UOP < 20 mL/day)
(excess nitrogenous products in blood)
(signs of increased nitrogenous products)
Hypovolemia vs Hypervolemia vs Euvolemia Correct Answers
oliguria
non oliguria
anuria
azotemia
uremia
•GFR < 60,
•Hgb < 10:
•Check Ferritin, TSat Correct Answers Ferritin < 500 and TSat
< 30%
•Iron replacement
Ferritin > 500 and TSat > 30%
•Initiate ESA
*** If anemia uncorrected with iron --> ESA
,24 urine collection
May lead to inaccurate collections
Smaller collections have been studied; an _____ collection has
been found to be somewhat reliable
Tedious to collect urine for 24 hours; not typically done unless
patient is _____ Correct Answers 8 hour
starting dialysis, changing kidney function, extremes of muscle
mass
3 y.o. is 100 cm in height and weighs 21 kg. Recent lab work
shows a Scr of 1.3 mg/dL.
Calculate the patient's Clcr using the Schwartz equation Correct
Answers 31.8 ml/min
35 y.o. male patient is 5'10 inches and weighs 80 kg
His most recent blood work shows a Scr of 0.9 mg/dL
Calculate his Clcr using the Cockcroft & Gault Equation
Correct Answers 118 mL/min
43 year old female, 5'3",weight 188 lbs
What is her IBW?
Does she weigh more than 120% of her IBW?
Calculate her adjusted body weight. Correct Answers 45.5
+2.3(3) = 52.4 kg IBW
88.5 kg/52.4 kg x 100 = 163%
(85.5 - 52.4) (0.4) + 52.4 kg = 65.6 kg
Accumulation of Metabolites
,Category ____ CKD
Metabolites may possess pharmacologic or toxicologic
properties
- Pharmacologic: oxypurinol, morphine-6-glucuronide,
benzodiazepine metabolites
- Toxicologic: norhydrocodone (metabolite of hydrocodone)
- Caution with opiates and benzos in CKD and AKI Correct
Answers G4 and G5
** Most metabolites are more water soluble and may
accumulate
ACEI/ARB for Proteinuria
ACEI/ARBs preferentially vasodilate ____ to reduce ____
Correct Answers efferent arteriole
IGP
ACEI/ARBs
Can _____
Rise in Scr expected
> ____ increase in 1-2 weeks problematic
Start with a short-acting ACEI at a low dose and titrate up
Monitor kidney function and serum K
Typically reverses upon discontinuation Correct Answers
reduce GFR
30%
ACEI/ARBs
Prevent progression of CKD in ____ (good effect)
, Can cause AKI in certain situations (bad effect) Correct
Answers diabetes
ACEI/ARB for Proteinuria (Good Effect)
*** SLIDE 13
ACEI/ARBs
Prevention of ____, yet ____
Risk factors
-Volume depletion
-Renal artery stenosis
-Heart failure
-Pre-existing kidney disease
-Other nephrotoxic drugs, such as NSAID Correct Answers
progression of CKD, yet can cause AKI
Additive Effects of Multiple Medications
Renal ischemia (Hemodynamically mediated AKI)
Afferent arteriolar constriction + total volume depletion
Efferent arteriolar dilation + total volume depletion
Afferent arteriolar constriction + efferent arteriolar dilation +
total volume depletion Correct Answers NSAIDS + Diuretics
ACEI/ARBs + Diuretics
NSAIDS + ACEI/ARBs + Diuetics
Adjusted Body Weight (ABW)
lOverweight
QUESTIONS WITH COMPLETE SOLUTIONS
(decrease in UOP usually < 400 mL/day)
(AKI with normal UOP > 400 mL/day)
(no UOP < 20 mL/day)
(excess nitrogenous products in blood)
(signs of increased nitrogenous products)
Hypovolemia vs Hypervolemia vs Euvolemia Correct Answers
oliguria
non oliguria
anuria
azotemia
uremia
•GFR < 60,
•Hgb < 10:
•Check Ferritin, TSat Correct Answers Ferritin < 500 and TSat
< 30%
•Iron replacement
Ferritin > 500 and TSat > 30%
•Initiate ESA
*** If anemia uncorrected with iron --> ESA
,24 urine collection
May lead to inaccurate collections
Smaller collections have been studied; an _____ collection has
been found to be somewhat reliable
Tedious to collect urine for 24 hours; not typically done unless
patient is _____ Correct Answers 8 hour
starting dialysis, changing kidney function, extremes of muscle
mass
3 y.o. is 100 cm in height and weighs 21 kg. Recent lab work
shows a Scr of 1.3 mg/dL.
Calculate the patient's Clcr using the Schwartz equation Correct
Answers 31.8 ml/min
35 y.o. male patient is 5'10 inches and weighs 80 kg
His most recent blood work shows a Scr of 0.9 mg/dL
Calculate his Clcr using the Cockcroft & Gault Equation
Correct Answers 118 mL/min
43 year old female, 5'3",weight 188 lbs
What is her IBW?
Does she weigh more than 120% of her IBW?
Calculate her adjusted body weight. Correct Answers 45.5
+2.3(3) = 52.4 kg IBW
88.5 kg/52.4 kg x 100 = 163%
(85.5 - 52.4) (0.4) + 52.4 kg = 65.6 kg
Accumulation of Metabolites
,Category ____ CKD
Metabolites may possess pharmacologic or toxicologic
properties
- Pharmacologic: oxypurinol, morphine-6-glucuronide,
benzodiazepine metabolites
- Toxicologic: norhydrocodone (metabolite of hydrocodone)
- Caution with opiates and benzos in CKD and AKI Correct
Answers G4 and G5
** Most metabolites are more water soluble and may
accumulate
ACEI/ARB for Proteinuria
ACEI/ARBs preferentially vasodilate ____ to reduce ____
Correct Answers efferent arteriole
IGP
ACEI/ARBs
Can _____
Rise in Scr expected
> ____ increase in 1-2 weeks problematic
Start with a short-acting ACEI at a low dose and titrate up
Monitor kidney function and serum K
Typically reverses upon discontinuation Correct Answers
reduce GFR
30%
ACEI/ARBs
Prevent progression of CKD in ____ (good effect)
, Can cause AKI in certain situations (bad effect) Correct
Answers diabetes
ACEI/ARB for Proteinuria (Good Effect)
*** SLIDE 13
ACEI/ARBs
Prevention of ____, yet ____
Risk factors
-Volume depletion
-Renal artery stenosis
-Heart failure
-Pre-existing kidney disease
-Other nephrotoxic drugs, such as NSAID Correct Answers
progression of CKD, yet can cause AKI
Additive Effects of Multiple Medications
Renal ischemia (Hemodynamically mediated AKI)
Afferent arteriolar constriction + total volume depletion
Efferent arteriolar dilation + total volume depletion
Afferent arteriolar constriction + efferent arteriolar dilation +
total volume depletion Correct Answers NSAIDS + Diuretics
ACEI/ARBs + Diuretics
NSAIDS + ACEI/ARBs + Diuetics
Adjusted Body Weight (ABW)
lOverweight
