Term
| What is the role of the kidney? How does it accomplish this? |
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Definition
- Maintains body composition through balacing of water, electrolytes, pH, nutrients, excretion of foreign substance and secretion of hormones.
- There are approximately 1 million nephrons per kidney that each filter, secrete and absorb
Components: Glomerulus, Proximal tubule, Loop of henle, Distal Tubule, Collecting duct
Glomerulus: Free permeable to water and small solutes. Retains blood, particles, large molecules. Filtration dependent upon size and charge (-charge of basement membrane), particles >4nm are not filtered |
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Term
| What is GFR? What is a normal GFR and how do we measure this? |
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Definition
- Rate at which fluid is filtered past the basement membrane of the glomerulus into the renal tubules
- Sum of all nephrons in the kidney
- Diseases can reduct nephrons but GFR can be preserved
- Men --> 120 ml/min/1.73m2
- Women --> 100 ml/min/1.73m2
- Determined by measuring a substance that is neither absorbed nor secreted, freely filterable, not metabolized or produced by the kidneys (Exogenous: Inulin, Iothalamate, Iohexol; Endogenous: Creatinine, Cystatin C)
- Scr is most common, range 0.5-1.5mg/dL
- GFR and Scr are inversely related |
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Term
| What are the limitations of the Cockcroft-Gault equation? |
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Definition
- Formula systematically overestimates CrCl in patients who are edematous or overweight
- Since formula predicts CrCl it is an overestimate of GFR |
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Term
| What is the MDRD equation? |
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Definition
- Modification of Diet in Renal Disease Equation
- Estimates GFR
eGFR = 186 x [Scr in mg/dL]-1.154 x [age in yrs]-0.203
x 0.742 if female x 1.210 if African American
- If lab uses standardized Cr by IDMS then 186 is changed to 175
Limitations: Underestimates GFR in populations that should have higher levels of GFR, can't compute for special groups (ethnics) |
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Term
| What is the definition of CKD? |
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Definition
| - GFR < 60ml/min/1.73m2 for > 3 months, or kidney damage for > 3 months, with or without changed GFR, that can LEAD to decreased GFR, manifested by pathologic abnormalities, or markers of kidney damage including abnormalities in the composition of blood or urine, or abnormalities in imaging rests (proteinuria, albuminuria, Hematuria, abnormalities in blood/urine chemistry or urine sediment, or just a plain ol' history of kidney transplant) |
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Term
| What is the etiology of CKD? |
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Definition
Diabetes - 45%
Hypertension - 27%
Glomerulonephritis - 8%
Other - 20% |
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Term
| What are comorbidities of CKD? |
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Definition
- Malnutrition
- CVD
- Mineral and bone disorder
- Anemia
- Neuropathy
- Metabolic Acidosis
- Fluid and electrolyte abnormalities
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Term
| What are the stages of CKD? |
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Definition
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CKD Stage
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Description
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GFR
(ml/min/1.73m2)
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Action*
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1
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Kidney damage with normal or GFR
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≥90
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Diagnosis and treatment
Treatment of comorbid conditions
Slowing progression
CVD risk reduction
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2
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Kidney damage with mild GFR
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60-89
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Estimating Progression
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3
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Moderate GFR
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30-59
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Evaluating and treating complications
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4
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Severe GFR
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15-29
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Preparation for renal replacement therapy
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5
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Kidney failure
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<15 or dialysis
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Renal replacement
(if uremia present)
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Term
| What is the best pharmacist approach to CKD? |
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Definition
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Step 1
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Obtain hx and relevant demographic/clinical information
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Record demographic information
Obtain PMH including hx of renal dx
Record current lab information
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Step 2
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Estimate CrCl
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Use Cockrcoft-Gault to estimate CrCl (for dosing)
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Step 3
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Review current medications
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Identify drugs for which individualization of treatment regimen will be necessary
Identify other drug related problems
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Step 4
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Calculate individualized treatment regimen
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Determine treatment goals (based upon guidelines)
Calculate/adjust drug regimen based on PK characteristics of the drug and renal function
Make recommendations to solve DRPs
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Step 5
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Monitor
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Monitor parameters of drug response and toxicity
Monitor drug levels if applicable
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Step 6
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Revise regimen
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Adjust regimen based on drug response or change in patient status as warranted
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