Kidney 4 - DIKD Flashcards
Define DIKD
Adverse functional or structural change to kidney after administration of a drug, chemical or biological product
How is DIKD diagnosed?
Changes in SCr or urine output consistent with AKI
- temporally associated with use of a Nephrotoxic drug
Is DIKD part of CKD?
No it is referring to someone who otherwise had a healthy kidney, NOT someone with CKD
- but can happen to someone with CKD
Presentation of DIKD
Metabolic acidosis
Changes to serum electrolytes
Proteinura
Pyuria
Hematuria
Rise in SCr
Decreased urine output
Symptoms of DIKD
Malaise, anorexia, nausea, vomiting, volume overload, SOB
Mechanisms of drug-induced nephrotoxicity
Indirect nephrotoxicity (pre-renal)
Direct kidney injury/damage (intra-renal)
Obstructive uropathy (post-renal)
Common drugs for pre-renal (changes to blood flow)
ACEi/ARB
SGLT2i
NSAIDs
Cyclosporine
Common drugs for intra-renal (acute tubular necrosis)
Aminoglycosides
Radiographic contrast media
Cisplatin
Cyclosporine
Adefovir
Zoledronate
Amphotericin B
Common drugs for intra-renal (acute interstitial nephritis)
Penicillins/cephalosporins
Ciprofloxacin
NSAIDs
PPIs
Loop diuretics
Allopurinol
Phenytoin
Drugs causing intra renal (chronic interstitial nephritis)
Lithium
Calcineurin inhibitors
Common drugs for post renal (obstructive nephropathy)
Sulfonamides
Acyclovir
Methotrexate
Oral phosphate solution
Triamterene
Ciprofloxacin
Drug distribution is impacted by:
Edema
Decreased protein binding
Uremia
Metabolic acidosis
Drug elimination is impacted by:
Decreased filtration
Alterations in tubular secretion and reabsorption
When are dose adjustments required in CKD?
If CrCl falls below 60mL/min
Dose recommended is not always the same for all patients
What are the 8 drug categories that need caution when dosing with CKD?
Antihypertensives (ACE/ARB, BB, digoxin)
Analgesics (NSAIDs, opioids)
Antimicrobial
Hypoglycemics (Metformin, insulin)
Lipid-lowering (statins)
Chemotherapeutic (methotrexate)
Anticoagulants (warfarin, LMWH)
Lithium
