Acute Kidney Injury

Question 1

General Treatment AKI

Answer 1

Stop nephrotoxic drugs; NSAIDs, ACEs, ARBs, diuretics
Adjust other meds for current renal function, readjust when done
Correct Hypovolemia, electrolyte abnormalities
Perform temporary dialysis prn
Consider corticosteroids and immunosuppression

Question 2

Common Nephrotoxic Drugs

Answer 2

ABX: Piperacillin/Tazobactam (Zosyn), Vanco, Gentamicin, Tobramycin, Amikacin
NSAIDs
Allopurinol
IV Contrast
Ace/Arbs

Question 3

ACE/ARBS

Answer 3

Inhibit angiotensin II mediated vasoconstriction = reduced intraglomerular pressure via efferent arteriole dilation.
CON: Bilat. renal artery stenosis or stenosis in a single remaining kidney

Question 4

Loop Diuretics

Answer 4

BOX: Profound diuresis with water and electrolyte depletion
MOA: Inhibits reabsorption of Na and Cl in the ascending loop. H2O follows the Na = diuresis
CON: Anuria

Question 5

AKI Treatment

Answer 5

Furosemide 40mg IV (Bumetanide 1mg IV) 2x/day
If urine output does not increase to 1mL/kg/hr, increase dose or add THZ OR shorten the interval for loops.
Continuous infusions of loop diuretics: Decreases nursing administration time and lead to fewer adverse drug rxns

Question 6

Rituximab

Answer 6

IND: Nephrotic syndrome and multiple autoimmune and cancer indications. Emerging evidence and off-label usage
MOA: B cell targeted therapy. CD20 antigen on B-lymphocytes
BOX: Infusion related rxns. severe/life threatening, usually within 24 hrs
Mucocutaneous rxns: severe/life threatening
Hep B virus reactivation: opportunistic viral infection
Progressive multifocal Leukoencephalopathy. Opportunistic viral infection
CON:
ADR: A lot. Infusion rxns. Heme abnormalities. Infections

Question 7

Hyperkalemia Causers

Answer 7

ACE, ARB, Spironolactone, Succinylcholine

Question 8

Hyperkalemia Treatment

Answer 8

1. IV Calcium to stabilize cardiac membrane potential
2. Glucose/dextrose: Stabilizes blood sugar for insulin administration
3. Insulin
4. Beta 2 agonists
5. Sodium bicarbonate
6. Loop diuretics
7. K binders
8. Dialysis

Question 9

Sodium Polystyrene Sulfonate (SPS)

Answer 9

IND: Hyperkalemia
MOA: Binds K in the large intestine; exchanges sodium for potassium. (K+ Binder)
BOX: n/a
CON: Hypokalemia, obstructive bowel disease, neonates with reduced gut motility, and sorbitol
ADR: GI and transient hypernatremia

Question 10

Sodium Zirconium Cyclosilicate

Answer 10

IND: Hyperkalemia
MOA: K Binder
BOX: n/a
CON: n/a
ADR: Transient hypernatremia. Edema

Question 11

Patiromer

Answer 11

IND: Chronic Hyperkalemia, not for emergencies d/t delayed onset
MOA: Binds K in intestine. Exchanges a Calcium ion
BOX: n/a
CON: n/a
ADR: None

Question 12

Hypercalcemia

Answer 12

Usually caused by hyperparathyroidism or malignancy
Treatment:
1 Volume expansion
2 Loop: coupled with volume expansion to excrete calcium
3 Zoledronic acid
4 Calcitonin

Question 13

Zoledronic Acid

Answer 13

IND: Hypercalcemia
MOA: Increase elimination of calcium. Long term bone stuff
BOX: n/a
CON: Renal impairment
ADR: Edema, hypotension. Hypophosphatemia, hypokalemia, hypomagnesemia. GI. Fever

Question 14

Calcitonin

Answer 14

IND: Hypercalcemia
MOA: Antagonizes effects of parathyroid hormone, inhibiting bone reabsorption; promotes excretion of Ca and other ions
BOX: n/a
CON: n/a
ADR: Rhinitis if nasal route
Very expensive. Last line.