Pharm Module 3 Flashcards
the drugs associated with AIN include
- penicillins
- cephalosporins
- ciprofloxacin
- vancomycin
- rifampin
- omeprazole
- lansoprazole
PCC LOVR
the drugs associated with ATN include
- aminoglycosides
- amphotericin B
- radiocontrast dyes (iohexol)
the drugs associated with RTA Type 4 include
- ACE inhibitors
- ARBs
- cyclosporin
- tacrolimus
CATA
the drugs that can induce both AIN and RTA include
- trimethoprim
- NSAIDs
acute kidney injury is characterized by
- sudden loss of kidney function
prerenal AKI is caused by
- reduced blood flow to the kidneys
renal/intrinsic AKI is caused by
- direct damage to the tissues of kidneys themselves
post renal Aki caused by
- urinary tract obstruction downstream of the kidneys
drug induced AKI is almost always of which type
- intrinsic/renal type
damage to the interstitium is called
- acute interstitial nephritis
damage to the glomerulus is called
- glomerulonephritis
damage to the tubular epithelium is called
- acute tubular necrosis
75% of cases of acute interstitial nephritis is caused by
1/3 of it is caused by
the other 2/3 caused by
- adverse reactions to drugs
- antibiotics
- NSAIDs and proton pump inhibitors
how drugs cause inflammatory immune response known as AIN
1) drug is recognized as a distinct antigen that the immune system hasn’t recognized before
2) drug structurally similar to authentic antigen to which immune system has already been exposed
3) non-immunogenic drug may bind to endogenous host protein, creating an immunogenic molecular structure (haptenization)
- activate dendritic cells that patrol kidney which initiates inflammatory response
other immune reactions of AIN
- rash
- fever
- eosinophilia
nephrotoxic ATN causes death of
- epithelial cells in PT and thick ascending limb of LOH
how do ahminoglycosides cause nephrotoxic ATN
- positive charges cause them to bind negative charged lipids in tubular cells
- accumulate in tubular epithelial cells
- disrupt cell processes and kill the cell
example of an ahminoglycoside that causes nephrotoxicin ATN
- gentamicin
the relative renal toxicities of different aminoglycosides correlate with
- their affinity for membrane phospholipids
which aminoglycoside has the highest affinity and highest toxicity
- neomycin
which aminoglycoside has the lowest affinity and lowest toxicity
- streptomycin
how does amphotericin B cause nephrotoxic ATN
- binds to membrane cholesterol instead of ergosterol
- damages renal epithelial cells
how do iodinated radio contrast dyes cause ATN
- concentrates in tubular epithelial cells and can lead to their death
what causes type 4 renal tubular acidodis
- defect in aldosterone signaling to the kidney
type 4 RTA characterized by
- hyperkalemia
- mild acidosis
what is type 4 RTA also called
- hypoaldosteronism
which drugs reduce aldosterone production
- ACE inhibitors
- ARBs
- NSAIDs
which drugs block the effect of aldosterone on the kidneys
- cyclosporin
- tacrolimus
- trimethoprim
role of ACE inhibitors
- block production of AgII
- block AgII vasoconstriction of efferent arteriole
role of ARBs
- block AgII from inducing aldosterone secretion from adrenal cortex
role of NSAIDs
- block secretion of renin and AgII-induced release of aldosterone
- block prostaglandins and cause afferent arteriole vasoconstriction
role of trimethoprim
- directly inhibits ENaC
role of cyclosporin/tacrolimus
- reduce levels of aldosterone receptor
how do ACE inhibitors exacerbate reduction of glomerular BP caused by bilateral renal artery stenosis
- renal blood flow in bilateral renal artery stenosis is low due to atherosclerotic plaques in afferent arterioles
- ACE inhibitors increase efferent dilation which increases blood flow away from glomeruli.
