DIKD Pt 2

Question 1

what drugs cause reduced glomerular capillary hydrostatic pressure?

Answer 1

ACE-I and ANG II receptor blockers (effect the renin-angiotensin system in the kidneys)

Question 2

prostaglandins effect in kidney

Answer 2

prostaglandins primarily cause renal vasodilation (esp prostacyclin and PGE2)
when there is decreased RBF, synthesis of prostaglandins is increased (protects from renal ischemia and hypoxia by antagonizing renal vasoconstrictors)

Question 3

administration of NSAIDS during renal ischemia/ increased prostaglandin activity

Answer 3

could cause renal vasoconstriction/ renal ischemia/ loss of glomerular function

Question 4

acute hemodynamically mediated kidney injury

Answer 4

seen with calcineurin inhibitors (used in kidney transplants)
increase in potent vasoconstrictors and decrease in vasodilators

Question 5

systemic polyarteritis nodosa

Answer 5

seen with meth abuse

vasculitis of small and medium sized renal arteries

Question 6

drugs that cause thrombus formation in the renal vasculature

Answer 6

oral contraceptives, cyclosporin, mitomycin C, cisplatin, quinine

Question 7

anticoag and thrombolytic effect on renal vasculature

Answer 7

esp warfarin

embolize cholesterol particles to renal arteries

Question 8

glomerular disease

Answer 8

damage to glomerular capillary filtration surface

proteinuria >3.5 g/day

Question 9

focal segmental glomerulosclerosis (FSGS)

Answer 9

• characterized by patchy areas of glomerular sclerosis w/ interstitial inflammation
• bisphosphonates (pamidronate and zoledronate) can be assoc with aggressive FSGS
• AIDS

Question 10

most common drug cause of FSGS

Answer 10

chronic heroin abuse

may be due to direct toxicity to heroin or adulterants or bacterial/ viral injury

Question 11

what is the most common drug-induced glomerular lesion?

Answer 11

membranous nephropathy

Question 12

membranous nephropathy

Answer 12

immune-mediated
immune complex deposition along the glomerular capillary loops
parenteral gold= most common cause
penicillamine, captopril, and NSAID use can also be assoc with it

Question 13

what is the most common mechanisms responsible for drug-induced kidney disease?

Answer 13

acute tubular necrosis

damage localizes in the proximal or distal tubular epithelia

Question 14

aminoglycoside toxicity

Answer 14

primary target= proximal tubule
tox is directly proportional to the # of cationic charges since they are reabsorbed by absorptive mediated endocytosis
causes an accumulation of phospholipids
Ca supplementation can help

Question 15

cisplatin toxicity

Answer 15

chemo agent= damage due to platinum
tox is usually reversible
cause hypomagnesemia by the binding of platinum to proximal tubule cells which uncouples oxidative phosphorylation

Question 16

radiographic contrast media toxicity

Answer 16

prevent it by using lower osmolar contrast agents
MOA= oxidative stress
N-acetylcysteine may provide benefit

Question 17

pathology of acute allergic interstitial nephritus

Answer 17

diffuse or focal interstitial infiltrate of lymphocytes, plasma cells, eosinophils, and polymorphonuclear neutrophils
Ex. penicillins (methicllin), NSAID (fenoprofen)

Question 18

drugs that cause chronic interstitial nephritus

Answer 18

lithium (decrease in response to ADH)

cyclosporin and tacrolimus

Question 19

how can you lessen uric acid accumulation following chemotherapy?

Answer 19

hydration, urinary alkalinzation, or allopurinol administration

Question 20

tricyclic antidepressants and extrarenal urinary tract obstruction

Answer 20

prostatic hypertrophy

Question 21

cyclophosphamide/ isofamide therapy and extrarenal urinary tract obstruction

Answer 21

bladder fibrosis

Question 22

nephrolithiasis

Answer 22

kidney stones

Ex. triamterene- HCTZ; laxative abuse