Renal

Question 1

Mannitol

Answer 1

Works in proximal tubule and loop of henle
Osmotic diuretic
Increases tubular fluid osmolarity
DECREASES INTRACRANIAL AND INTRAOCULAR PRESSURE

Clinical: drug overdose, increased intracranial/intraocular pressure

Toxicity: pulmonary edema, dehydration
Overaggressive treatment can lead to hypernatremia

Contraindicated in anuria and CHF

Question 2

Ehancrynic acid

Answer 2

MOA: phenyoxyacetic acid derivative (same action as loop diuretics)

Clinical: diuresis in patients with sulfa allergy

Toxicity: Hyperuricemia
Great risk of ototoxicity especially with high doses, rapid IV administration, or in combo with aminoglycosides, salicylates, and cisplatin

Question 3

Loop Diuretics

Furosemide, torsemide, bumetanide

Answer 3

MOA: Inhibits co-transport of (Na/K/2 Cl) of thick ascending limb of loop of Henle
Prevents concentration of urine
Stimulates PGE release (inhibited by NSAIDS)
increase Ca excretion

Clinical: USED ACUTELY edematous states (CHF, cirrhosis, nephrotic syndrome, pulmonary edema) hypertension, hypercalcemia

Toxicity: OH DANG
Ototoxicity, hypokalemia, dehydration, allergy (sulfa), Nephritis (interstitial), Gout

Question 4

Hydrochlorothiazide, chlorothiazide, indapamide, metolazone

Answer 4

MOA: inhibits NaCl reabsorption in distal tubule
Decreases Ca2 excretion

Clinical: hypertension, CHF, idiopathic hypercalciuria, nephrogenic diabetes insipidus, osteoporosis, prevention of kidney stones

Toxicity: hypokalemic metabolic alkalosis, hyponatremia,
HYperglycemia, hyperipidemia, Hyperurecemia (gout), hypercalcemia
Sulfa allergy

Question 5

Tramterene adn amiloride

Answer 5

MOA: block Na channels in collecting duct

Clinical: hyperaldosteronism, K+ depletion, CHF
DECREASE MORBIDITY AND MORTALITY IN CLASS III AND IV HEART FAILURE

Toxicity: hyperkalemia (arrhythmias),

Question 6

Spironolactone and eplerenone

Answer 6

MOA: competitive aldosterone receptor antagonists in the collecting tubule

Clinical: hyperaldosteronism, K+ depletion, CHF
DECREASE MORBIDITY AND MORTALITY IN CLASS III AND IV HEART FAILURE

Toxicity: hyperkalemia (arrhythmias),
SPIRONOLACTONE: GYNECOMASTIA, decreased libido, impotence
Mild metabolic acidosis

Question 7

Acetozolamide

Answer 7

MOA: carbonic anhydrase inhibitor
Decreases total-body HCO3- stores

Clinical: GLAUCOMA, urinary alkalinzation, metabolic alkalosis, altitude sickness, pseudotumor cerebri

Toxicity: hyperchloremic metabolic acidosis, parasthesias, NH3 toxicity, sulfa allergy
hypokalemia and hyponatremia, somnolence

Question 8

ACE inhibitors

Captopril, enalapril, lisnopril

Answer 8

MOA: inhibit ACE leading to decreased Angiotensin II and decreased GFR by preventing constriction of efferent arteriole
Also prevents inactivation of bradykinin a vasodilator

Clinical: hypertension, CHF, proteinuria, diabetic nephropathy,
Prevent heart remodeling as a result of chronic hypertension

Toxicity: cough, angioedema, teratogen (fetal renal malformations), hyperkalemia, and first dose hypotension (avoid with diuretics)

Avoid in bilateral renal artery stenosis because decreased GFR leads to renal failure

Question 9

Rasburicase

Answer 9

Recombinant urate oxidase

Catalyzes conversion of Uric acid to allantoin (more soluble than Uric acid)

Prevents and treats hyperuricemia is and the resulting renal manifestations of tumor lysis syndrome

Question 10

Hemodialysis

Answer 10

Temporary access: central catheter placed in subclavian or jugular vein
Permanent dialysis: arteriovenous fistula between radial or brachial artery and forearm veins
hemodynamically unstable: continuous areriovenous hemodialysis, and continuous venovenous hemodialysis-ICU with AKI

Advantages: more efficient and initiated more quickly for emergencies

Disadvantages: can lead to hypotension-MI fatigue
hyposmolality-n and V, headache, sometimes seizures and coma
First use syndrome: chest pain, back pan and rarely anaphylaxis
Must be anticoagulated-bleeding, hemorrhage, hematoma
infection of sites-sepsis
Hemodialysis associated amyloidosis and B2 microglobulin in bones and joints

Question 11

Peritoneal dialysis

Answer 11

Hyperosmolar solution infused into peritoneal cavity and then fluid and solutes diffuse into capillaries and drained from abdomen

Advantages: patient can perform on their own
Mimics normal kidney function

Disadvantages: high glucose leads o hyperglycemia and hypertirglyceridemia
Peritonitis
Patient must be highly motivated
Increased abdominal girth 
Abdominal/inguinal hernia
Protein malnutrition