NSAIDs and the Kidney

Question 1

A 35 year old man goes for a weekend fast food binge with lots of salt (he’s “lovin’ it”). What does the kidney do to accommodate?
A) Constrict both the afferent arteriole and the efferent arterioles
B) Constrict the afferent and dilate the efferent arterioles
C) Dilate the both the afferent and efferent arterioles
D) Dilate the afferent and constrict the efferent arterioles

Answer 1

B) Constrict the afferent and dilate the efferent arterioles

The EABV will increase, there will be more blood flow to the kidneys and the body will want to protect against that blood flow so it will constrict the afferent and dilate the efferent arterioles.

Question 2

A 75 year old man present to the ER with urosepsis and a blood pressure of 77/35mmHg. He is taking ibuprofen and presents with AKI. Which of the following is correct about the effect of ibuprofen?
A) It will dilate his afferent arteriole
B) It will increase renin secretion
C) It will increase ADH action
D) It will increase prostaglandin action

Answer 2

c) It will increase ADH action

Question 3

Which of the following medications will worsen the risk for papillary necrosis in combination with NSAIDs?
A) Amlodipine
B) Olmesartan 
C) Indapamide 
D) Metoprolol

Answer 3

B) Olmesartan

Question 4

Given the effects of NSAIDs on the kidney, how will NSAIDs affect excretion of potassium?
A) Increase Renin and Increase Excretion
B) Decrease Renin and Increase Excretion
C) Increase Renin and Decrease Excretion
D) Decrease Renin and Decrease Excretion

Answer 4

D) Decrease renin and decrease excretion

Question 5

A 84 year old woman comes to your office with a gout flare. You prescribe her indomethacin for the pain. Based on the effects of NSAIDs, which of the following can occur?
A) Hypophosphatemia 
B) Hyponatremia
C) Hypotension
D) Hypokalemia

Answer 5

B) Hyponatremia

Question 6

A 65 year old woman presents with nephrotic syndrome after having taken NSAIDs. Which of the following pathologies may be the cause?
A) Membranoproliferative 
B) Membranous
C) IgA Nephropathy
D) Amyloidosis

Answer 6

B) Membranous GN

NSAIDs can cause Membranous GN and Minimal Change Disease but the pathogenesis is unknown.

Question 7

A 45 year old with stage 4 CKD from diabetes on ASA, enalapril and atorvastatin presents to the emergency department after feeling unwell for three days. Which of the following electrolyte abnormalities in the most likely?
A) Hyponatremia 
B) Hypokalemia 
C) Hyperkalemia 
D) Hypernatremia

Answer 7

C) Hyperkalemia

Hyponatremia may occur but it is rare.