Exam 2 - D-I Kidney Flashcards
What are risk factors for DIRD? (8)
DM, HTN, elderly, CKD, nephrotoxins, renin-dependent state (heart failure, cirrhosis), allergy to drug, duration of therapy
What are the kidney function biomarkers? (4)
SCr, BUN, eGFR, urinary ouput
What are the kidney damage biomarkers? (3)
KIM1, NGAL, IGFBP7
What are the two balanced crystalloids?
lactated ringers and Plasma-Lyte A
How does hemodynamic mediated renal injury occur, and what drugs can cause it? (5)
reduction in glomerular pressure due to alterations in arteriole tone; ACEi, ARBs, NSAIDs, SGLT2i, calcineurin inhibitors
How does pre-renal injury occur, and what drugs can cause it? (1)
Reduced blood flow, diuretics
What are the treatments for hemodynamic mediated and pre-renal injury? (3)
discontinue offending agent, provide sufficient fluids, monitor kidney function and electrolytes
What is the number one cause of community-based drug-induced AKI?
NSAIDs
What drugs can cause acute tubular necrosis (ATN)? (3)
aminoglycosides (gentamicin/tobramycin/amikacin), amphotericin B, iodinated IV contrast media
What is nephrotoxicity related to for aminoglycosides?
trough concentrations
What are the goal troughs for the aminoglycosides? (3)
gentamicin and tobramycin = 2 or less mg/L, amikacin = less than 8 mg/L
What are the treatments for ATN? (3)
discontinue offending agent, provide sufficient fluids, monitor kidney function and electrolytes
What are risk factors for contrast-induced nephropathy (CIN)? (5)
DM, large-dose iodinated contrast, high osmolal contrast, ionic contrast, short time interval between contrast administrations
What are the treatments for preventing CIN? (2)
0.9% NaCl 1.5 mL/kg/hr 12 hrs prior and 12 hrs after, N-acetylcysteine 600-1200 mg PO bid x 4 doses
What is NOT a treatment for preventing CIN?
sodium bicarbonate
Which contrast media has a high osmolality? Iso?
iohexol; iodixanol
Electrolytes should only be monitored/checked when there is evidence of?
kidney injury
What drugs can cause acute interstitial nephritis (AIN)? (4)
beta-lactams (penicillins), NSAIDs, sulfa-containing drugs, proton pump inhibitors
What are the treatments for drug-induced AIN? (4)
discontinue offending agent, avoid cross-reacting drugs, supportive care, steroids
What are examples of AIN steroid protocols? (2)
methylprednisolone 250-500 mg IV daily 3-5 days, prednisone 1 mg/kg/day tapered
What are risk factors for vancomycin associated AKI? (7)
trough >15-20 mg/L, 24-hr AUC over 600 mcg/mL, daily dose > 4g, duration of therapy >7 days, severity of illness, weight > 101.4 kg, concomitant nephrotoxic agents
What drugs can cause nephrolithiasis? (3)
topiramate, sulfonamides, furosemide
What are the treatments for nephrolithiasis? (4)
provide sufficient fluids (goal urine ouput 2.5 L/day or more, give thiazide diuretic if high urinary calcium), pain management, lithortripsy
What drugs can cause rhabdomyolysis? (2)
statins and statin-fibrate combinations
