Nephrotoxicity

Question 1

Name two forms of kidney impairment

Answer 1

Acute kidney injury (AKI) and chronic kidney disease (CKD)

Question 2

CKD - age

Answer 2

aging can be a cause of renal impairment

Question 3

What is the prognosis for CKD

Answer 3

Check both GFR and ACR - and find on the scale

Question 4

What is the prognosis for CKD

Answer 4

Check both GFR and ACR - and find on the scale

Question 5

AKI - what is the definition

Answer 5

abrupt decrease in kidney function that includes but is not limited to acute renal failure.
This is why we don’t use GFR for AKI 0 it needs to be in a steady state (there is a dramatic change)

Question 6

List the criteria of AKI

Answer 6

Increase in serum creatinine
Increase in SCr
Urine volume is lower than normal
Decrease in eGFR

Question 7

What is KDIGO classification

Answer 7

General markers for the stage of AKI - assesses serum creatinine and urine output
Does depend on drug, exposure and time etc.

Question 8

List biomarkers for kidney toxicology

Answer 8

Urinary proteins w enzymatic activity 
Proteinuria 
Kidney injury molecule 1 (KIM-1)
Neutrophil gelatinase-associated lipocalin 
Cytokines
Clusterin 
Type IV collagen 
Osteopontin

Question 9

Give examples of pre-renal toxicology

Answer 9

Reduced perfusion
Volume depletion
Altered renal haemodynamics

Question 10

Give examples of intrinsic nephrotoxicity

Answer 10

Glomerulonephritis
actue tubular necrosis
actue interstitial nephritis

Question 11

Post-renal (obstructive) nephrotoxicity

Answer 11

Ureteric/retroperitoneal fibrosis
renal calculi
thrombotic microangiopathy

Question 12

Vasoconstriction and dilation - drugs with renal impairment

Answer 12

ACE, NSAIDs, loop diuretics