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Renal Exam 1 > Part 2 Drug Induced Kidney Disease > Flashcards

Part 2 Drug Induced Kidney Disease Flashcards

1
Q

Mechanisms of Renal susceptibility

A 
Large drug exposure
Renal hemodynamics
Drug accumulation
Metabolism to toxic species
Increased energy requirements
Concentration of drug
Precipitation of drug
Compensatory mechanism
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2
Q

Reduced glomerular capillary hydrostatic pressure

A

ACEi and Ang II receptor blockers effect the RAS system

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3
Q

NSAIDs inhibit

A

COX which reduces PG synthesis from arachidonic acid

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4
Q

PGs

A

Cause vasodilation

Decreased RBF: protect form ischemia and hypoxia by antagonizing vasoconstrictors

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5
Q

NSAIDs + Renal ischemia

A

Increase vasoconstriction, ischemia, and loss of glomerular filtration

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6
Q

Calcineurin inhibitors are

A

Cyclosporine and tacrolimus

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7
Q

Calcineurin inhibitors

A

Effect immunosuppressive agents for solid organ transplant

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8
Q

Dose limiting toxicity with Calcineurin inhibitors

A

Nephrotoxicity involving acute hemodynamically mediated kidney injury

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9
Q

Calcineurin inhibitors Nephrotoxicity Pathogenesis

A

Increased in potent vasoconstrictors (TXA, endothelin, Ang II) and decrease vasodilators (NO, prostacyclin, PGE2)

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10
Q

Define Systemic polyarteritis nodosa

A

Vasculitis with involvement of small and medium sized renal arteries
After methamphetamine abuse

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11
Q

Thrombus formation

A

Has been described with oral contraceptives, cyclosporin, mitomycin C, cisplatin and quinine

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12
Q

Anticoagulatns and thrombolytics AE

A

Embolize cholesterol particles from aortic athersclerotic plaques to small arteries

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13
Q

Glomerular Disease

A

Involves damage to the glomerular capillary filtration surface
Proteinuria > 3.5 g/d with or without renal insufficiency

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14
Q

Minimal change Glomerular Disease

A

NSAID induced nephropathy

T-lymphocytes release lympokines

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15
Q

NSAID induced nephropathy

A

Associated with T-lymphocytic interstitial infiltrate suggesting disordered cell-mediated immunity

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16
Q

T-lymphocytes release lympokines

A

that increase glomerular capillary permeability to proteins

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17
Q

Focal Segmental Glomerulosclerosis

A

Characterized by patchy areas of sclerosis with interstitial inflammation

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18
Q

FSGS causes

A

Chronic heroin abuse
Bisphosphonate pamidronate and zoledronate
AIDS

19
Q

Membranous Nephropathy

A

Most common drug-induced lesion

20
Q

Membranous Nephropathy Characterized by

A

Immune complex deposition along the glomerular capillary loops

21
Q

Membranous Nephropathy Causes

A 
Parenterol gold (RA treatment)
Oral gold (less incidence)
Penicillamine, captopril and NSAIDs
22
Q

Acute Tubular Necrosis

A

MOST COMMON MECHANISMS of DIKD

Damage is localized in the proximal or distal tubular epithelia

23
Q

AG Toxicity Target

A

Proximal tubular epithelial cells

24
Q

AG cause

A

obstruction of tubular lumen leading to a backleak of the glomerular filtrate

25
Q

Toxicity of AG is

A

Directly proportional to the number of their cationic charges

26
Q

AG in cells

A

Inhibits phospholipase and causes of accumulation of phospholipids

27
Q

Cisplatin

A

Chemotehrapeutic agent that causes renal tubular damage due to platinum

28
Q

Cisplatin RF

A

Increased age
Renal irradiation
Alcohol abuse

29
Q

Cisplatin nephrotoxicity

A

Reversible

30
Q

Cisplatin can cause

A

hypomagnesemia which could seizures, neuromuscular irritability and personality changes

31
Q

Cisplatin MOA

A

Bind platinum to proximal tubular cell with disruption of enzyme activity and uncoupling of oxidative phosphorylation

32
Q

Most common cause of HA renal failure =

A

IV or intra-arterial administration of radiographic contrast media

33
Q

Radiographic Constrast Renal Failure

A

Concomitant medical illness and dehydration due to fluid restriction and catartics

34
Q

Prevention of Radiographic Constrast Renal Failure

A

Prestudy Scr or use alternative imaging procedures

35
Q

Radiographic Constrast MOA

A

Oxidative stress is development of ATN after contrast exposure

36
Q

Tubulointerstitial Disease

A

A diffuse or focal interstitial infiltrate of WBC, plasma cells, eosinophils, PMN neutrophils

37
Q

Tubulointerstitial Disease Causes

A

Penicillin
NSAIDs
Lithium
Cyclosporine and Tacrolimus

38
Q

Lithium

A

Impairs the ability to concentrate the urine due to dose related decrease in collecting ducts response to ADH

39
Q

Renal Tubular Obstruction

A

Caused by intratubular precipitation of drugs
Acute uric acid nephropathy after chemo
Methotrexate

40
Q

Uric acid accumulation can be lessened by

A

Hydration
Urinary alkalinization
Allopurinol administration

41
Q

Extrarenal urinary tract obstruction

A

Lower tract obstruction
Tricyclic antidepressants - prostatic hypertrophy
Cyclophosphamide or Isosfamide - bladder fibrosis

42
Q

Nephrolithiasis is

A

Kidney stones

43
Q

Nephrolithiasis is caused by

A

Triamterene-HCTZ (potassium sparing diuretic)

Laxatives (ammonium urate stones)

Renal Exam 1 (8 decks)

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