Drug-Induced Kidney Disease

Question 1

General Risk Factors

Answer 1

age > 65
pre-existing kidney disease
HF, cirrhosis
known allergy
longer duration of therapy
DM, HTN

Question 2

Pre-Renal & Hemodynamic Injury - Drugs Involved

Answer 2

NSAIDs
ACE inhibitors / ARBs

Question 3

Pre-Renal & Hemodynamic Injury - Treatment

Answer 3

stop offending agent
fluids
monitoring

Question 4

Intrinsic Renal Injury - Types

Answer 4

acute tubular necrosis
acute interstitial nephritis

Question 5

Acute Tubular Necrosis - Drugs

Answer 5

aminoglycosides
amphotericin B (conventional)
IV contrast media (iodinated)

Question 6

Acute Tubular Necrosis - Signs & Symptoms

Answer 6

proteinuria
muddy brown casts
metabolic acidosis
hyperkalemia

Question 7

Acute Tubular Necrosis - Treatment

Answer 7

stop offending drug
hydration & electrolytes
hemodialysis (if severe)

Question 8

Contrast Media Injury - Risk Factors

Answer 8

CKD, DM
HF, cirrhosis
large volume of media
highly osmolal media
ionic contrast
short time between administrations
concomitant nephrotoxic drugs

Question 9

Contrast Media Injury - Treatment

Answer 9

saline hydration 1-1.5 ml/kg/hr
sodium bicarbonate (conflicting evidence)
NAC 1200 mg PO BID x 4 doses

Question 10

Acute Interstitial Nephritis - Drugs

Answer 10

beta-lactams
NSAIDs
sulfa-containing drugs
PPIs

Question 11

Acute Interstitial Nephritis - Pathophysiology

Answer 11

immune activation -> leukocyte infiltration -> inflammation

Question 12

Acute Interstitial Nephritis - Treatment

Answer 12

stop offending drug
consider cross-reactivity
supportive care
steroids (methylprednisolone 250-500 mg IV QD x 3-5 days or prednisone 1 mg/kg/day tapered off x 8-12 wks)

Question 13

Vancomycin-Associated AKI - Risk Factors

Answer 13

elevated troughs
24-hr AUC > 600
daily dose > 4 g
duration > 7 days
severity of illness
weight > 100 kg
concomitant nephrotoxic drugs

Question 14

Vanco-Associated AKI - Prevention

Answer 14

stewardship
avoid w/ aminoglycosides, amphotericin B, contrast
monitoring
avoid trough > 15-20 and AUC > 600

Question 15

Post-Renal Injury - Types

Answer 15

nephrolithiasis
rhabdomyolysis

Question 16

Nephrolithiasis - Drugs

Answer 16

topiramate
furosemide
sulfonamides

Question 17

Nephrolithiasis - Prevention

Answer 17

maintain adequate hydration
thiazide if high urinary Ca

Question 18

Rhabdomyolysis - Pathophysiology

Answer 18

intra-tubular precipitation of myoglobin from muscle breakdown

Question 19

Rhabdomyolysis - Drugs

Answer 19

statins

Question 20

Rhabdomyolysis - Treatment

Answer 20

stop offending drug
aggressive IV fluids
alternate sodium chloride & sodium bicarbonate if urine pH < 6.5

Question 21

CKD - Drugs

Answer 21

lithium

Question 22

Lithium-Induced CKD - Pathophysiology

Answer 22

chronic interstitial nephritis
nephrogenic diabetes insipidus
distal tubular acidosis

Question 23

Lithium-Induced CKD - Risk Factors

Answer 23

duration of therapy
episodes of acute toxicity
cumulative lithium exposure
DDI with HCTZ

Question 24

Lithium-Induced CKD - Treatment

Answer 24

stop lithium
hydration
amiloride 5-20 mg QD
avoid other nephrotoxic drugs
monitoring