The Renal Horror Story
What is the gold standard for chronic renal function assessment?
What is mGFR?
*not eGFR
*CrCl is the gold standard for renal dosing adjustment, not renal function assessment!
CKD is officially defined as abnormalities of kidney function or structure present for this minimum duration of time
What is 3 months or longer?
According to KDIGO criteria, a rise in SCr by greater than or equal to 0.3 mg/dL must occur within this specific timeframe to indicate AKI
What is within 48 hours?
This type of allograft rejection occurs within minutes after transplantation due to preformed recipient antibodies completely mismatched against donor antigens
What is hyperacute rejection?
Renal replacement therapy is typically indicated for patients with chronic kidney disease when their GFR drops below this specific number of mL/min
What is 15 mL/min?
Which is less affected by muscle mass/diet and more sensitive for early CKD detection, serum creatinine or cystatin C?
What is cystatin C?
A UACR of greater than this specific value (in mg/g) indicates albuminuria
What is >30?
The primary cause of anemia in chronic kidney disease patients is a decreased production of this hormone that regulates RBC production
What is erythropoietin (EPO)?
Typically manifesting within the first 6 months post-transplant, acute rejection is primarily mediated by the cellular activation of these lymphocytes
What are T-cells?
This type of hemodialysis is often used for critically ill patients in renal failure thay will not tolerate hypotension or volume loss
What is continuous RRT (CRRT)?
This drug class is the mainstay treatment for hypervolemic prerenal acute kidney injury in heart failure
What are loop diuretics? (must say LOOP diuretics, not just diuretics)
These 2 underlying conditions account for most chronic kidney disease cases
What is diabetes and hypertension?
As kidney function decreases, what happens to SCr?
increases (because can't be cleared)
Basiliximab is a chimeric monoclonal antibody that specifically targets and binds to the alpha chain of this specific receptor complex on activated T-cells
What is IL2 receptor?
True or false- patients with CKD Or undergoing dialysis require specialized dose adjustments or altered schedules for the Tdap vaccines compared to the general population
False- standard immunization recommendations apply for Tdap in patients with kidney disease
A BUN:Cr ratio of what suggests dehydration?
What kind of AKI would this be- prerenal, intrinsic, or postrenal?
* must get both right for points- ratio and type of AKI
Prerenal AKI
You should not target a hemoglobin greater than this specific value (in g/dL) when giving ESAs due to increasing CV risk
What is >11?
NSAIDs can cause AKI by doing what to which arteriole?
What is constricting the afferent arteriole?
Belatacept blocks T-cell co-stimulation by binding to CD80 and CD86 on APCs, preventing their interaction with this specific costimulatory receptor on T-cells.
What is CD28?
This type of HD access is preferred, as it has the longest survival, lowest infection risk, & is cost-effective
What is arteriovenous (AV) fistula?
ACEi/ARBs can cause prerenal AKI by dilating or constricting the afferent or efferent arteriole?
* must get both parts right for points
What is dilating the efferent arteriole?
A patient has a GFR of 73 with a history of kidney transplant and albuminuria. What CKD stage are they in?
What is G2?
G2: GFR of 60-89 with at least 1 marker of kidney damage
When mean arterial pressure drops, carotid baroreceptors detect the change and trigger SNS activation, releasing this NT that causes vasoconstriction of the afferent arteriole
What is norepinephrine?
Drugs that interfere with the production/action of IL2 are divided into 3 main classes. Name 2 of them
*only list 2, must get both right for points
calcineurin pathway inhibitors
costimulation blockers
mTOR inhibitors
The "AEIOU" mnemonic for RRT indications stands for these five complications.
*must get all 5 right for points