Drug-Induced Kidney Disease- General Risk Factors, Prevention, and Monitoring

Question 1

Risk factors for drug-induced kidney disease

Answer 1

Elderly (>65)
CKD
Concomitant nephrotoxins
Renin-dependent state (low effective circulatory volume d/t disease states like cirrhosis, HF)
Known drug allergy
Duration of therapy
DM/HTN

Question 2

General keys to prevention

Answer 2

Direct prevention strategy to underlying mechanism of kidney injury (AKA: do what you need to do to treat the underlying condition)

Avoid nephrotoxic medications (and combos of them) in high-risk patients

Maintain adequate kidney perfusion (hydration)

TDM if available

Question 3

Saline vs. balanced crystalloids

Answer 3

Balanced crystalloids decrease risk of death, need for renal replacement therapy, and persistent renal dysfunction

Question 4

Examples of balanced crystalloids

Answer 4

LR, PlasmaLyte A

Question 5

General prevention of drug-induced kidney disease: proactive monitoring

Answer 5

Kidney function monitoring with an intensity that matches the risk of kidney injury

Question 6

Markers of kidney function

Answer 6

SCr, BUN, eGFR, urinary output

Question 7

Novel biomarkers of kidney function

Answer 7

KIM1
NGAL
IGFBP7
TIMP-2

Question 8

KIM1 tests for what?

Answer 8

ATN

Question 9

NGAL tests for what?

Answer 9

Ischemic injury

Question 10

IGFBP7 and TIMP-2 test for what?

Answer 10

Cell cycle arrest

Question 11

Balanced crystalloids mimic what?

Answer 11

Plasma electrolyte concentrations

Question 12

pH of balanced crystalloids

Answer 12

5.5