Medication Appropriation/ Nephritic Nephrotic

Question 1

Which part of the kidney is damaged in a Nephrotic or Nephritic Syndrome?

Answer 1

glomerular capillary membrane

Question 2

What type of kidney injury are Nephrotic and Nephritic syndrome referred to?

Answer 2

AKI
-can be permanent

Question 3

What is the result of the glomerular capillary membrane being damaged?

Answer 3

-Loss of albumin
-Stimulation of hepatic protein synthesis
-RBC and WBC escape the glomerulus

Question 4

What is the consequence of losing Albumin?

Answer 4

due to leaky blood vessels

-decrease in oncotic pressure in the blood vessel -> leakage of serous fluid -> third spacing edema

-loss of Albumin and low oncotic pressure stimulates the RAAS system -> Na/water retention

Question 5

What is the consequence of hepatic protein synthesis?

Answer 5

Hyperlipidemia
-since the liver produces cholesterol

Question 6

What is the consequence of RBC and WBC escaping the glomerulus?

Answer 6

-Bloody urine
-Pyuria: WBC in the urine
due to leaky blood vessels

Question 7

Signs of Nephritic Syndrome

Answer 7

-Hematuria
-Pyuria
-Proteinuria (<3g of albumin/24h) !!

Question 8

Signs of Nephrotic Syndrome

Answer 8

-Proteinuria (>3g of albumin/24h)
-Hypoalbuminemia
-Hyperlipidemia
-Edema

Question 9

Causes of Nephrotic Syndrome

Answer 9

-Diabetes
-minimal change disease (no abnormalities in the kidney when biopsied)

-focal segmental Glomerulosclerosis (glomerular scarring, can be genetic or drug-induced (steroids) or due to a disease (HIV))

-membranous Nephropathy (thickened glomerular membrane)

-systemic lupus Erythematosus (autoimmune disorder, can be nephrotic or nephritic)

-Amyloidosis (build of abnormal proteins)

Question 10

What may cause FGS (focal segmental Glomerulosclerosis)?

Answer 10

-drugs (steroids)
-HIV
-genetics

Question 11

What may cause membranous Nephropathy (MN)?

Answer 11

-lupus
-malaria

Question 12

Causes of Nephritic Syndrome

Answer 12

-systemic lupus Erythematosus
-IGA Nephropathy

Question 13

What is the IGA Nephropathy?

Answer 13

-also called Berger’s disease
-build-up of IgA causing renal damage

Question 14

Symptoms of Nephritic Syndrome

Answer 14

-Hematuria
-HTN
-Edema

Question 15

Symptoms of Nephrotic Syndrome

Answer 15

-Edema
-Weight gain (due to edema)
-Hyperlipidemia
-Hypercoagulable states (due to stress on the liver, the liver produces clotting factors, and proteins for CNS?)
-Fatigue

Question 16

Nephrotic Syndrome Treatment Nonpahrm

Answer 16

-Sodium restriction (50 mEq/day)
-protein restriction (0.8-1g per day)
-low-fat diet (less than 200mg cholesterol and less than 30% of total daily calories)
-smoking cessation

Question 17

Pharmacologic Treatment for Nephrotic Syndrome

Answer 17

-immunosuppressants for auto-immune disorders (steroids, cyclophosphamide, cyclosporine)

-loop diuretics +/- metolazone for edema
-albumin infusion for hypoalbuminemia
-ACEi/ARBs for HTN
-Statins for hyperlipidemia

-Anticoagulants (controversial, only used when there is another indication)

Question 18

How are doses adjusted differently in CKD and acute kidney injury?

Answer 18

more aggressively downregulated in AKI bc the injury is acute and not predictable whereas in CKD the renal function is impaired but stable

Question 19

What are the pharmacokinetic changes in kidney disease?

Answer 19

-excretion of drugs is decreased
-Vd is increased due to volume overload
-reduction in serum albumin -> increase in free fraction drugs
-minimal impact on metabolism and absorption

Question 20

What are the pharmacokinetic changes in dialysis?

Answer 20

-extensive excretion for 3 days (time of dialysis)
-increased Vd and increased free fraction drugs (similar to acute kidney disease)
-minimal impact on metabolism and absorption