NSAIDS and Renal Failure

Question 1

Only unbound drug is filtered?

Answer 1

True

Question 2

Three conditions exacerbated by NSAID use?

Answer 2

HTN, CHF, Renal insufficiency

Question 3

What do prostaglandins do in the kidney under physiologic circumstances?

Answer 3

Induce vasodilation in the interlobular arteries, afferent and efferent arterioles, and glomeruli

Question 4

In healthy ppl, is PG production high or low?

Answer 4

Low

Question 5

Main role of prostaglandins in the kidney>

Answer 5

Antagonize the effects of angiotensin II, endothelin, vasopressin, and catecholamines that sacrifice renal blood flow for systemic blood pressure. Prostaglandins ares stimulated to optimize renal blood flow.

Question 6

In a pt with a condition that drives the systemic preservation of blood pressure, the delivery of a prostaglandin can be harmful to the kidney why?

Answer 6

B/c the kidney has now lost its ability to counteract the body’s method of preserving systemic bp over renal blood flow. You suddenly lose RBF, then GFR, and then you get acute onset of kidney injury

Question 7

Can NSAIDs be harmful in chronic kidney disease?

Answer 7

You betcha. PG production is up in CKD in order to preserve perfusion to the few remaining nephrons

Question 8

What kinds of drugs increase the risk of ARF when issued with NSAIDS

Answer 8

ACE and ARB

Question 9

Prostaglandins do what in the Thick asc loop

Answer 9

decrease cellular sodium transport leading to inc sodium excretion and medullary tonicity

Question 10

Net effect of NSAIDS?

Answer 10

can lead to a mild increase in BP, this can be dangerous in pts with pre-exisitng hypertension, NSAIDS can also lead to acute toxicity in the form of tubular necrosis, Also associated with allergic interstitial nephritis.