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Renal Exam 1 > Part 1 Drug Induced Kidney Disease > Flashcards

Part 1 Drug Induced Kidney Disease Flashcards

1
Q

Drug Induced Kidney Disease Diagnosis

A

Elevated SCr and BUN

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2
Q

DIKD Renal Insufficiency

A

Often reversible upon discontinuation but may lead to ESRD

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3
Q

DIKD + hospital admissions

A

20%

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4
Q

Drug induced AKI + hospital

A

60%

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5
Q

Drugs frequently involved

A 
AG
Radiocontrast media
NSAIDs
COX2 inhibitors
Amp B
ACEI
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6
Q

Nephrotoxicity evidenced

A

Early sign of renal tubular function without loss of GFR and as markers of proximal tubular injury

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7
Q

Outpaint Setting Nephrotoxicity

A

NSAIDs = most common and best defined

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8
Q

NSAIDs

A

Prescribed and OTX therapy has be associated with a 4-fold increased risk of acute RF

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9
Q

NSAID RF

A 
Male greater than 65
HD drugs
CVD
Recent hospitalization for non-renal
In combo with nephrotoxic drugs
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10
Q

NSAIDs + >70 y.o.

A

2 fold increased risk for hospitalization

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11
Q

Hemodynamically mediated Acute renal failure

A 
Due to NSAIDs and ACEi
RF: Preexisting insufficiency
Decreased RBF due to volume depletion
HF
Liver disease
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12
Q

Glomerular Filtration

A

Monitor SCr and BUN

Measure urine output (esp with radiographic contrast media, NSAIDs and ACEi)

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13
Q

Outpatient setting, nephrotoxicity is recognized with

A

Uremia (malaise, anorexia and vomiting) or volume overload (edema)

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14
Q

What may quantify the loss of glomerular filtration?

A

SCr or BUN + urine collection

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15
Q

Renal Tubular function can be altered without

A

Loss of glomerular filtration

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16
Q

General indicators of proximal tubular injury are

A

Metabolic acidosis with bicarbonatura
Glycosuria without hyperglycemia
Hypophosphatemia and hypouricemia due to increased urine loss

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17
Q

Indicators of distal tubular injury are

A

Polyuria (inability to concentrate urine)
Metabolic acidosis
Hyperkalemia (can’t excrete K)

18
Q

KIM-1

A

Used for early detection of AKI

Upregulated in the urine within 12 hours of ischemic acute tubular necrosis

19
Q

NGAL

A

May be detected in the urine within 3 hours of ischemic injury

20
Q

Drug Induced Nephrotoxicity

A

Highly heterogeneous with respect to the drugs involved and the lesions produced

21
Q

Renal Susceptibility

A

Kidneys are more sensitive to drug toxicity compared to other organs
Both immunological and non mechanisms can contribute

22
Q

High blood flow

A

Enhanced kidney’s exposure to circulating drugs

23
Q

Within each nephron

A

BF and prssure are regulated by glomerular afferent and efferent arterioles

24
Q

Specialized BF regulated by interrelations

A

Between renal, PGs, atrial natruiretic factors, sympathetic nervous system, RAG, and the macula densa response to distal tubular solute delivery

25
Q

BB and NSAIDs

A

decrease total RBF

26
Q

Radiographic contrast media

A

May shut intrarenal BF away from superficial nephron

27
Q

ACEi

A

Dilate glomerular efferent arterioles leading to decrease glomerular filtration pressure in the presence of ischemic RVD

28
Q

Dietary salt restriction

A

Activate neurohumoral renal hemodynamic control systems that increase renal susceptibility to drug nephrotoxicities

29
Q

Drugs or metabolites can accumulate

A

In areas of active tubular secretion and reabsorption (proximal tubule)

30
Q

What plays a role in the eliminatio of drugs

A

OCT1
OAT1
P-gp

31
Q

AG and cyclosporines

A

Appear to mediate nephrotoxicity through intracellular accumulation

32
Q

Gentamycin

A

Increases intracellular and superoxide ion, H2O2, and hydroxyl radicals

33
Q

Cyclosporine

A

Increase H2O2 which contributes to oxidative stress and nephrotoxicity

34
Q

Methoxyfluorane

A

Metabolized to fluoride which acts in the ascending limb of the loop of Henle and collecting ducts

35
Q

High energy requirements by renal tubular cells

A

Medullary tubular epithelial cells are sensitive to drugs that exacerbate the already hypoxic environment by decrease energy production or oxygen delivery

36
Q

AmpB

A

Damge due to imbalance between increased cellular energy requirements and inadequate O2 delivery

37
Q

Concentration of solute in the tubular lumen

A

Luminal surface of the proximal tubular is exposed to high concentrations of drugs due to increase water reabsorption

38
Q

Urine acidication

A

Solutes can precipitate and obstruct the tubular lumen at a pH of 4.5

39
Q

Age + Renal =

A

Age-related decline in renal function

40
Q

Prevention of drug nephrotoxicity

A

Avoid nephrotoxic agents

Renal Exam 1 (8 decks)

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