MEDICATIONS AND ACUTE KIDNEY INJURY Flashcards
What are the drugs covered in the medications and kidney injury overview?
- NSAIDs
- ACE inhibitors and ARBs
- Sodium phosphate
- Pamidronate and zoledronate
- Proton pump inhibitors (PPIs)
- Checkpoint inhibitors (CPI)
- Antiangiogenesis drugs
- Cisplatin
- BRAF inhibitors
- IVIG
- Tenofovir
- Vancomycin + piperacillin/tazobactam
- Ciprofloxacin
- Topiramate
- Crystalline nephropathy
- Metformin
- Bath salts
- Dialyzability
- Contrast agents
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What kidney syndromes can NSAIDs cause?
- Acute kidney injury (AKI)
- Acute interstitial nephritis (AIN)
- Hyponatremia
- Hyperkalemia
- Hypertension
- Edema/CHF
- Minimal change/membranous nephropathy
- Acute papillary necrosis
- Uroepithelial malignancies
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What are the risk factors for NSAID-related kidney injury?
- Preexisting CKD
- Female sex
- Concomitant diuretic or ACE-I use
- Volume depletion
- Older age
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What clinical scenarios can lead to AKI when using ACE inhibitors and ARBs?
- Hypotension
- Decreased blood volume (diuretics, diarrhea, vomiting)
- Decreased effective circulating blood volume (CHF, cirrhosis, nephrotic syndrome)
- Critical renal artery stenosis
- Medications (NSAIDs, calcineurin inhibitors, vasoconstrictors)
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What are the adverse effects of ACE inhibitors and ARBs?
- AKI
- Hyperkalemia
- Rarely, AIN
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What are the risk factors for Sodium Phosphate-induced Acute Phosphate Nephropathy (APN)?
- Preexisting CKD
- Female sex
- Older age
- Volume depletion
- Concomitant diuretic or ACE-I use
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What are the histopathological findings in Sodium Phosphate-induced APN?
- Tubular and interstitial calcium phosphate deposits
- Acute tubular degenerative changes
- Chronic tubulointerstitial nephropathy
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What kidney lesions are associated with Pamidronate?
- Collapsing FSGS
- Minimal change lesion
- Tubular injury
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What kidney lesions are associated with Zoledronate?
- Severe ATN
- Tubular injury
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What kidney syndromes can Proton Pump Inhibitors (PPIs) cause?
- Acute interstitial nephritis (AIN)
- Hyponatremia (SIADH)
- Hypomagnesemia (reduced GI absorption)
- CKD and ESKD (possible association)
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What mechanism is associated with PPIs leading to kidney injury?
Unrecognized AIN leading to chronic interstitial nephritis.
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What types of kidney toxicity are associated with Checkpoint Inhibitors (CPI)?
- Granulomatous AIN (ipilimumab)
- AIN (nivolumab, pembrolizumab)
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What is the mechanism of kidney injury associated with Checkpoint Inhibitors?
Loss of T-cell self-tolerance, leading to autoimmune kidney injury.
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What are the adverse effects of Antiangiogenesis drugs?
- Hypertension
- Proteinuria
- Thrombotic microangiopathy (TMA)
- AIN
- Minimal change disease/collapsing FSGS (tyrosine kinase inhibitors)
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What is the mechanism of Cisplatin-induced nephrotoxicity?
- Uptake by OCT-2 system in proximal tubular cells
- Cellular apoptosis/necrosis via ER stress, mitochondrial injury, and DNA damage
- Reactive oxygen species and oxidative stress
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What clinical effects are associated with Cisplatin nephrotoxicity?
- AKI
- Proximal tubulopathy
- Salt wasting
- Magnesium wasting
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What kidney effects are associated with BRAF inhibitors Vemurafenib and Dabrafenib?
- Vemurafenib: ATN, Fanconi syndrome, Sweet syndrome
- Dabrafenib: Hyponatremia, hypokalemia, hypophosphatemia
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What is the mechanism of nephrotoxicity associated with IVIG and Hydroxyethyl Starch (HES)?
Osmotic nephropathy due to sucrose (IVIG) or HES, leading to tubular obstruction and cell injury.
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What are the risk factors for IVIG and HES-related nephrotoxicity?
- Kidney impairment
- High doses
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What is the mechanism of nephrotoxicity associated with Tenofovir (TDF)?
- Proximal tubule damage via mitochondrial injury
- Fanconi syndrome due to high intracellular TDF concentrations
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How is Tenofovir excreted?
Transported via OAT and MRP-2 efflux transporters.
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What are the AKI risk factors associated with Vancomycin and Piperacillin/Tazobactam?
- Vancomycin: Higher doses, trough levels >20 mg/L, CKD
- Piperacillin-tazobactam: Pseudo-nephrotoxicity (competes with creatinine for OAT), true AKI or AIN
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What crystalline nephropathy risk factors are associated with Ciprofloxacin?
- Alkaline urine (pH >7.3)
- High doses
- Volume depletion
- CKD
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What are the characteristics of crystals associated with Ciprofloxacin-induced crystalline nephropathy?
Needle-shaped, birefringent.
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