Kidney Disease

Question 1

What are some common medications that cause kidney disease?

Answer 1

Antibiotics:

• aminoglycosides
• amphoterocin B
• polymixins
• vancomycin (AND vancomycin + pip-tazo)

Transplant meds:

• cyclosporin
• tacrolimus

Others:

• cisplatin
• loop diuretics
• NSAIDs
• contrast dye

Question 2

How does the Cockcroft-Gault equation estimate creatinine clearance in patients with very low muscle mass (under, over, no difference)

Answer 2

Overestimates

Question 3

What are some conditions that can affect serum creatinine and thus creatinine clearance

Answer 3

• Obesity
• Liver disease
• Pregnancy
• High muscle mass or other condition with abnormal muscle turnover

Question 4

When is the Cockcroft-Gault equation not preferred?

Answer 4

• Very young children
• ESRD
• Unstable renal function

Question 5

Most drug-dosing is based on CrCl or eGFR? What are the exceptions?

Answer 5

CrCl

Exceptions are SGLT2-i and metformin

Question 6

What is the formula for CrCl?

Answer 6

[(140 - patient age) x patient weight in kg] / (72 x SCr)

Multiply by 0.85 if female

What weight to use?

• Underweight: actual body weight
• Normal weight: ideal body weight
• Overweight: use adjusted body weight

Question 7

What is the factor measured in the estimation of GFR?

Answer 7

Albumin, which is measured using the MDRD and CKD-EPI equiations

Question 8

What are the factors used to determine staging of renal impairment (per Kidney Disease Improving Gloval Outcomes - KDIGO)

Answer 8

1. GFR
2. Degree of albuminuria

Question 9

What ranges of eGFR and albuminuria indicate CKD?

Answer 9

• eGFR: < 60 mL/min
• Albumin to creatinine ratio: > 30 mg/g or 3 mg/mmol

Question 10

What are the blood pressure goals in CKD?

Answer 10

KDIGO:

<140/90 for patients with no proteinuria

<130/80 for patients with proteinuria

Question 11

What is the role of an ACE/ARB in CKD, diabetes, and/or hypertension?

Answer 11

1. Prevent progression of disease in patients with albuminuria

Question 12

What is the mechanism of an ACE/ARB in CKD?

Answer 12

Inhibition of the renin-antiotensin-aldosterone system which causes efferent arteriolar dilation –> reduces pressure in the glomerulus, decreases albuminuria

Question 13

Monitoring/counseling for ACE/ARB?

Answer 13

1. Keep in mind that starting an ACE/ARB can increase baseline SCr by up to 30%. If >30%, D/C and refer to a nephrologist.
2. Monitor SCr and K 1-2 weeks after initiation
3. Avoid potassium supplements/salt substitutes