Renal Disease

Question 1

Diuretic effect on bone density

Answer 1

Thiazides diuretics have protective effect (increased Ca reabsoprtion)

Loop diuretics have less Ca reabsorption back into the blood, leading to Ca depletion and decreased bone density

Question 2

Drugs that can cause kidney disease

Answer 2

AGs
Amphotericin B
Cisplatin
Cyclosporine 
Loop diuretics
NSAIDs 
Polymixins
Radiographic Contrast Dye
Tacrolimus
Vancomycin

Question 3

What does BUN measure

Answer 3

The amount of nitrogen in the blood that comes from urea, a waste product of protein
-increased if kidney function is decreased

Question 4

CrCl Equation

Answer 4

ML/min
140-age
——— X kg (X 0.85 if female)
72 x Scr

• use ABW if < IBW
• use IBW if normal BMI
• use AdjBW if overweight

Question 5

Drugs that are CI if <60ml/min

Answer 5

Nitrofurantion

Question 6

Drugs that are CI if <50ml/min

Answer 6

Tenofovir Disoproxil

Voriconazole IV

Question 7

Drugs that are CI if <30ml/min

Answer 7

Metformin
NSAIDs
Tenofovir alafenamide
Rivaroxaban
Dabigatran
SGLT2

Question 8

Drugs that require adjustment in CKD

Answer 8

AGs
Beta lactam antibiotics 
Fluconazole
Quinolones (except Moxifloxacin)
Vancomycin
Rivaroxaban 
LMWHs
H2RAs
Bisphopsphonates
Lithium

Question 9

3 main physiological complications of CKD

Answer 9

1. Decreased renal phosphate clearance, so increased serum plasma phosphate- have to take phosphate binders (Ca) with food
2. Kidneys cannot activate Vit D, so decreased Ca absoption and low Ca - tx with Vit D and/or Calcimimetic to decrease PTH (high PTH pulls Ca from bone)
3. Decreased EPO production, so decreased RBCs so anemia- tx with iron and ESAs (Epoetin Alfa, darbepoetin alfa)

Question 10

Most common cause of hyperkalemia (>5.3)

Answer 10

Kidney failure

-excess potassium is excreted by the kidneys

Question 11

Select drugs that raise potassium levels

Answer 11

ACE/ARBs
Aldosterone receptor antagonists
SMX/TMP
Transplant drugs
Aliskerin
Canagliflozin 
Drospirenone-containing COCs