Drug induced renal disease Flashcards
When should nephrotoxic drugs be avoid in patients
already existing renal insufficiency, already on nephrotoxic medications, intravascular volume depletion, elderly
What are the two types of drug induced renal disease
pseudo renal disease, drug induced renal disease
What are the three sub categories of drug induced renal disease
prerenal, intrinsic, obstructive
What is the main cause for pseudo drug induced renal disease
increased SCr due to competitive inhibition of creatinine secretion within the proximal tubule
What are two drugs that are known to cause pseudo drug induced renal disease
Trimethoprim and Dronaderone
What is the pathophysiology of pre renal AKI
Reduction in renal blood flow
What are drugs that can cause pre renal AKI
Loop diuretics, ACEIs and ARBs, NSAIDs, cyclosporine and tacrolimus
How can loop diuretics lead to pre renal AKI
Too high of dose can lead to dehydration leading to decreased intravascular volume
How can NSAIDs lead to pre renal AKI
NSAIDS block prostaglandin mediated vasodilation leading to afferent arteriolar vasoconstion lead to less blood for the glomerulas
What drug class can worsen how NSAIDs cause AKIs
ACEIs and ARBs
How do tacrolimus and cyclosporine use lead to pre renal AKI
Vasoconstiction of afferent arterioles can result in chronic ischemia leading to chronic tubulointerstitial nephritis
What are the four types of drug induced intrinsic renal diseases
glomerular disease, Acute Tubular Necrosis, Intratubular Obstruction, Acute Interstitial Nephritis
What is drug induced glomerular disease, what does it cause, what drugs can bring it about
drug-induced autoimmune disease, causes proteinuria, NSAIDs, lithium, quinolones, bisphosphonates
What drugs cause drug induced Acute Tubular Necrosis
Aminoglycosides, contrast media, cisplatin and carboplatin, Amphotericin
What drug class has the highest rates of drug-induced AKI,
Aminoglycosides, accumulates in lysosomes of proximal tubules causing autodigestion leading to high output
T/F: Contrast increases SCr within 24 to 48 hours and the AKI is usally non-oliguric, with falsely elevated proteinuria
True
What patients should avoid contrast
Patients with CKD and CrCl less than 60, reduced renal perfusion
What is the ranking for types of contrast that have the most risk for AKI
High osmolar to Low osmolar to Iso-osmolar
T/F: If there is no risk factors the risk of AKI from contrast is over 5%
False: If no risk factors, risk of AKI is less than 1%
What is a hallmark feature of AKI due to cisplatin, how should the be handled
hypomagnesemia, Use IV hydration to maintain urine output to 3-4 L/day
What are the two mechanisms to which amphotericin causes AKI
cause necrosis of proximal tubule, afferent arteriolar vasoconstriction
What are common features of amphotericin induced AKI
Non-oliguric, hypokalemia, hypomagnesemia,acidosis
What ways to prevent amphotericin induced AKI
use lipid formations, long infusion time over 4-6 hours, pre infusion with 1 liter of normal saline
T/F: Intratubular obstruction can be caused by precipitation of drug crystals in the distal tubule
True
