Drug induced renal disease

Question 1

When should nephrotoxic drugs be avoid in patients

Answer 1

already existing renal insufficiency, already on nephrotoxic medications, intravascular volume depletion, elderly

Question 2

What are the two types of drug induced renal disease

Answer 2

pseudo renal disease, drug induced renal disease

Question 3

What are the three sub categories of drug induced renal disease

Answer 3

prerenal, intrinsic, obstructive

Question 4

What is the main cause for pseudo drug induced renal disease

Answer 4

increased SCr due to competitive inhibition of creatinine secretion within the proximal tubule

Question 5

What are two drugs that are known to cause pseudo drug induced renal disease

Answer 5

Trimethoprim and Dronaderone

Question 6

What is the pathophysiology of pre renal AKI

Answer 6

Reduction in renal blood flow

Question 7

What are drugs that can cause pre renal AKI

Answer 7

Loop diuretics, ACEIs and ARBs, NSAIDs, cyclosporine and tacrolimus

Question 8

How can loop diuretics lead to pre renal AKI

Answer 8

Too high of dose can lead to dehydration leading to decreased intravascular volume

Question 9

How can NSAIDs lead to pre renal AKI

Answer 9

NSAIDS block prostaglandin mediated vasodilation leading to afferent arteriolar vasoconstion lead to less blood for the glomerulas

Question 10

What drug class can worsen how NSAIDs cause AKIs

Answer 10

ACEIs and ARBs

Question 11

How do tacrolimus and cyclosporine use lead to pre renal AKI

Answer 11

Vasoconstiction of afferent arterioles can result in chronic ischemia leading to chronic tubulointerstitial nephritis

Question 12

What are the four types of drug induced intrinsic renal diseases

Answer 12

glomerular disease, Acute Tubular Necrosis, Intratubular Obstruction, Acute Interstitial Nephritis

Question 13

What is drug induced glomerular disease, what does it cause, what drugs can bring it about

Answer 13

drug-induced autoimmune disease, causes proteinuria, NSAIDs, lithium, quinolones, bisphosphonates

Question 14

What drugs cause drug induced Acute Tubular Necrosis

Answer 14

Aminoglycosides, contrast media, cisplatin and carboplatin, Amphotericin

Question 15

What drug class has the highest rates of drug-induced AKI,

Answer 15

Aminoglycosides, accumulates in lysosomes of proximal tubules causing autodigestion leading to high output

Question 16

T/F: Contrast increases SCr within 24 to 48 hours and the AKI is usally non-oliguric, with falsely elevated proteinuria

Answer 16

True

Question 17

What patients should avoid contrast

Answer 17

Patients with CKD and CrCl less than 60, reduced renal perfusion

Question 18

What is the ranking for types of contrast that have the most risk for AKI

Answer 18

High osmolar to Low osmolar to Iso-osmolar

Question 19

T/F: If there is no risk factors the risk of AKI from contrast is over 5%

Answer 19

False: If no risk factors, risk of AKI is less than 1%

Question 20

What is a hallmark feature of AKI due to cisplatin, how should the be handled

Answer 20

hypomagnesemia, Use IV hydration to maintain urine output to 3-4 L/day

Question 21

What are the two mechanisms to which amphotericin causes AKI

Answer 21

cause necrosis of proximal tubule, afferent arteriolar vasoconstriction

Question 22

What are common features of amphotericin induced AKI

Answer 22

Non-oliguric, hypokalemia, hypomagnesemia,acidosis

Question 23

What ways to prevent amphotericin induced AKI

Answer 23

use lipid formations, long infusion time over 4-6 hours, pre infusion with 1 liter of normal saline

Question 24

T/F: Intratubular obstruction can be caused by precipitation of drug crystals in the distal tubule

Answer 24

True

Question 25

What drugs can lead to intratubular obstruction

Answer 25

Acyclovir, Foscarnet, methotrexate

Question 26

What drugs can aid in metabolizing methotrexate

Answer 26

glucarpidase

Question 27

What drug drug interaction causes rhabdomyolysis leading to intratubular obstruction

Answer 27

cyclosporine and atorvastatin (increase statin levels 800 to 1000%)

Question 28

What is the clinical presentation of rhabdomylosis

Answer 28

muscle pain, weakness, dark brown or red urine due to myoglobinuria, no RBCs

Question 29

What enzyme will be increased due to rhadomylosis, when the problem is fixed when should this marker reduce

Answer 29

creatinine kinase, 1.5 days

Question 30

How should rhabdomyolysis be managed

Answer 30

agressive fluid resuscitation with normal saline, alkalization of the urine with IV sodium bicarbonate