Term
| Definition of Diabetic Kidney Disease |
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Definition
Persistently positive albuminuria in the absence of other kidney disease. Frequently accompanied by the appearance of HTN and declining kidney function.
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Term
| When should you get a urinalysis to determine the presence of protein for type I diabetes vs. type II diabetes? |
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Definition
Type I - w/in 5 years of diagnosis Type II - at time of diagnosis |
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Term
| Methods to Reduce Serum K+ |
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Definition
Calcium gluconate/chloride 1 g IV (if symptomatic) Insulin/Dextrose IV Sodium Polystyrene Sulfonate Albuterol Dialysis |
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Term
When to Measure PTH in CKD |
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Definition
Stage 3 (GFR 30-59) = every 12 months Stage 4 (GFR 15-29) = every 3 months Stage 5 (GFR <15) = every 3 months |
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Term
| When to measure Ca/PO4 in CKD |
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Definition
Stage 3 (GFR 30-59) = every 12 months Stage 4 (GFR 15-29) = every 3 months Stage 5 (GFR <15) = every 1 month |
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Term
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Definition
Stage 3 = 35-70 Stage 4 = 70-110 Stage 5 = 150-300 |
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Term
| Target Phosphorus Levels by CKD Stage |
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Definition
Stage 3 = 2.7 - 4.6 mg/dL Stage 4 = 3.5 - 5.5 mg/dL |
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Term
| Dietary Restrictions for Calcium and Phosporous |
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Definition
Ca = 1500 mg/d of supplement, 2000 mg/d total PO4 = 800 - 1000 mg/d when above normal |
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Term
| When to NOT use calcium-based binders. |
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Definition
High serum calcium levels Dialysis and iPTH < 150 pg/mL x2 measurments Pts w/ soft tissue/vascular calcifications |
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Term
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Definition
| Short-term (4 weeks) and PO4 > 7.0 mg/dL. One course of therapy only. |
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Term
| Normal Serum Calcium Level |
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Definition
8.4-10.2 mg/dL *Remember to correct w/ albumin |
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Term
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Definition
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Term
| When to treat hypocalcemia (<8.4 mg/dL) |
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Definition
signs of hypcalcemia iPTH above normal |
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Term
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Definition
Calcium Carbonate
Ca-based phosphate binder |
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Term
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Definition
Calcium acetate
Ca- based phosphate binder |
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Term
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Definition
Sevelamer HCL
Non-Ca-based phosphate binder
Pearls
-require large doses
-AE same as TUMS
-reduces LDL and increases LDL cholesterol
-some evidence of improved survival compared to ca-based binders |
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Term
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Definition
Lanthanum carbonate
Non-Ca-based phosphate binder
Pearls:
-No effects on plasma lipids
-GI upset most common SE
-Edema also SE
-Chew tablets
-Seems as effective as ca-based binders and sevelamer but concern over long-term toxicities |
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Term
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Definition
| Inactive form of Vitamin D |
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Term
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Definition
Cinacalcet
Calcimimetic
Effect is short, PTH levels flux, Vit D levels gradual and prolonged
Titrate dose, most common is 30 mg qd |
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Term
| Dosing guidelines for ESO in CKD: |
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Definition
-If Ign increasing over time to 12 g/dL OR if Hgb increases by greater than 1 g/dL in a 2 week period --> decrease dose by 25%
-If Hgb has not increased by 1 g/dL w/in a month then increase dose by 25%
-Do not D/C / hold ESA.
-May also increase dosing interval. |
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Term
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Definition
HD:TSAT >20% ;Serrum Ferritin >200, CHr >29 PD, 3, 4: TSAT>20% ;Serrum Ferritin >100;CHr NR |
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Term
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Definition
PD, Stage 3, Stage 4 = Oral first line HD = IV first line (better absorption) |
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Term
Ferrous Sulfate 1) Dosing 2) SE 3) DI 4) Stages of CKD used |
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Definition
1) 325 mg tid (200 mg elemental/d) 2) GI upset, constipation, black stools. 3) Antacids, calcium decrease absorption 4) PD, stages 3 & 4
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