Exam 2 - D-I Kidney

Question 1

What are risk factors for DIRD? (8)

Answer 1

DM, HTN, elderly, CKD, nephrotoxins, renin-dependent state (heart failure, cirrhosis), allergy to drug, duration of therapy

Question 2

What are the kidney function biomarkers? (4)

Answer 2

SCr, BUN, eGFR, urinary ouput

Question 3

What are the kidney damage biomarkers? (3)

Answer 3

KIM1, NGAL, IGFBP7

Question 4

What are the two balanced crystalloids?

Answer 4

lactated ringers and Plasma-Lyte A

Question 5

How does hemodynamic mediated renal injury occur, and what drugs can cause it? (5)

Answer 5

reduction in glomerular pressure due to alterations in arteriole tone; ACEi, ARBs, NSAIDs, SGLT2i, calcineurin inhibitors

Question 6

How does pre-renal injury occur, and what drugs can cause it? (1)

Answer 6

Reduced blood flow, diuretics

Question 7

What are the treatments for hemodynamic mediated and pre-renal injury? (3)

Answer 7

discontinue offending agent, provide sufficient fluids, monitor kidney function and electrolytes

Question 8

What is the number one cause of community-based drug-induced AKI?

Answer 8

NSAIDs

Question 9

What drugs can cause acute tubular necrosis (ATN)? (3)

Answer 9

aminoglycosides (gentamicin/tobramycin/amikacin), amphotericin B, iodinated IV contrast media

Question 10

What is nephrotoxicity related to for aminoglycosides?

Answer 10

trough concentrations

Question 11

What are the goal troughs for the aminoglycosides? (3)

Answer 11

gentamicin and tobramycin = 2 or less mg/L, amikacin = less than 8 mg/L

Question 12

What are the treatments for ATN? (3)

Answer 12

discontinue offending agent, provide sufficient fluids, monitor kidney function and electrolytes

Question 13

What are risk factors for contrast-induced nephropathy (CIN)? (5)

Answer 13

DM, large-dose iodinated contrast, high osmolal contrast, ionic contrast, short time interval between contrast administrations

Question 14

What are the treatments for preventing CIN? (2)

Answer 14

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

Question 15

What is NOT a treatment for preventing CIN?

Answer 15

sodium bicarbonate

Question 16

Which contrast media has a high osmolality? Iso?

Answer 16

iohexol; iodixanol

Question 17

Electrolytes should only be monitored/checked when there is evidence of?

Answer 17

kidney injury

Question 18

What drugs can cause acute interstitial nephritis (AIN)? (4)

Answer 18

beta-lactams (penicillins), NSAIDs, sulfa-containing drugs, proton pump inhibitors

Question 19

What are the treatments for drug-induced AIN? (4)

Answer 19

discontinue offending agent, avoid cross-reacting drugs, supportive care, steroids

Question 20

What are examples of AIN steroid protocols? (2)

Answer 20

methylprednisolone 250-500 mg IV daily 3-5 days, prednisone 1 mg/kg/day tapered

Question 21

What are risk factors for vancomycin associated AKI? (7)

Answer 21

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

Question 22

What drugs can cause nephrolithiasis? (3)

Answer 22

topiramate, sulfonamides, furosemide

Question 23

What are the treatments for nephrolithiasis? (4)

Answer 23

provide sufficient fluids (goal urine ouput 2.5 L/day or more, give thiazide diuretic if high urinary calcium), pain management, lithortripsy

Question 24

What drugs can cause rhabdomyolysis? (2)

Answer 24

statins and statin-fibrate combinations

Question 25

What are the treatments for rhabdomyolysis? (3)

Answer 25

discontinue offending agent, provide sufficient fluids, attempt urinary alkalinization if urine pH<6.5 with NaCO3 IV fluids

Question 26

What is the main risk factor for lithium-induced CKD?

Answer 26

cumulative lithum exposure

Question 27

What drug can increase lithium exposure?

Answer 27

HCTZ

Question 28

What are the treatments for lithium-induced CKD? (3)

Answer 28

discontinue offending agent, provide sufficient fluids, amiloride 5-20 mg daily for polydipsia/uria symptoms