Pharmacology of Chronic Kidney Disease

Question 1

eGFR is the preferred measure of what?

Answer 1

renal function

Question 2

what factors are you to calculate/estimate eGFR?

Answer 2

creatinine
age
afro-caribbean ethnicity
gender

Question 3

what treatment should be started > 55 years for hypertension?

Answer 3

amlodipine

Question 4

in a patient hypertension and chronic kidney function, what happens to target blood pressure?

Answer 4

lower than normal

Question 5

what treatment should be started for cardiovascular risk for patient with hypertension and chronic kidney disease?

Answer 5

conservative measures (smoking, salt, exercise)
atorvastatin at risk >10%

Question 6

patient x with chronic kidney disease secondary to hypertension (controlled w/ amlodipine) and now with significant proteinuria. what treatments should be started and stopped?

Answer 6

ACE inhibitors
angiotensin receptor blockers
SGLT-2 inhibitors
salt restriction
stop amlodipine if ACEi reduces his BP too low

Question 7

patient x with chronic kidney disease secondary to hypertension (controlled w/ amlodipine) and now with significant proteinuria. would you treat them with aspirin?

Answer 7

consider prescribing aspirin in people w/ high risk of stroke or MI > limited evidence of benefit even in people with multiple risk factors and there is a risk of harm

Question 8

proteinuria is a marker of?

Answer 8

glomerular dysfunction and it is also damaging in it’s own right

Question 9

what affect does trimethoprim have on GFR?

Answer 9

trimethoprim inhibits the active secretion of creatinine so calculation of GFR is now invalid

Question 10

describe the relationship between creatinine and GFR

Answer 10

inversely proportional

Question 11

patient x is now on amlodipine, gentamicin, ibuprofen. which is contributing to worsening GFR and how?

Answer 11

ibuprofen inhibits PG synthesis and reduces renal blood flow

ACEi reduces perfusion pressure in glomerulus

Question 12

patient x is acutely unwell on amlodipine, gentamicin, ibuprofen. what is the plan for the medication?

Answer 12

ibuprofen - STOP. use alternative
ACEi - pause while acutely unwell
gentamicin - can continue but reduce freq + be guided by blood gentamicin levels

Question 13

what two things should you consider when prescribing for a patient with reduced renal function?

Answer 13

will the drug damage the kidney? (hence worsen kidney injury)
is the drug eliminated by the kidney? (hence will accumulate > lead to side effects)

Question 14

give an example of a drug that would be damaging to a patient with reduced renal function

Answer 14

ibuprofen

Question 15

give an example of a drug that would accumulate in the kidney and lead to side effects in a patient with reduced renal function

Answer 15

morphine

metformin