Renal disease and drug handling

Question 1

State the definition of clearance.

Answer 1

The volume of plasma cleared entirely of drug per unit time (ml/min)
clearance is a rate constant

Question 2

What decreases with age? (renal function)

Answer 2

Renal blood flow
Renal blood filtration
Renal mass

Question 3

What is acute kidney injury (AKI)?

Answer 3

A sudden episode of kidney failure which happens over hours or days

Question 4

What is chronic kidney disease (CKD)?

Answer 4

Deteriorating kidney function (any underlying cause). A progressive impairment in renal function, more than 3 months.

Question 5

Is AKI or CKD reversible?

Answer 5

AKI is reversible

CKD is irreverisble

Question 6

Give examples of the main causes of CKD

Answer 6

Diabetes
Hypertension
Glomerular disease

Question 7

What is glomerular disease?

Answer 7

Immunologically mediated inflammatory injury. the normal function of the kidney is disturbed and the chemical balance isn’t maintained in the blood and urine.

Question 8

What are the possible causes of glomerular disease?

Answer 8

Generalised disease (eg lupus, diabetes)
Haemodynamic changes 
Immunologically mediated inflammatory injury

Question 9

What are the 2 classifications of glomerular disease?

Answer 9

Nephritic syndrome

Nephrotic syndrome

Question 10

What are some risk factors of kidney disease?

Answer 10

Hypertension
Diabetes
Age
Race/ethnicity - Afro-Caribbean

Question 11

List a few outcomes of kidney disease.

Answer 11

Cardiovascular events
Kidney events
Disability
Death (from kidney failure)

Question 12

What does haemodynamic changes mean?

Answer 12

Changes to the dynamics of blood flow.

Question 13

What is nephrotic kidney disease?

What condition is more likely to cause this?

Answer 13

Protein in urine.
Proteinuria

Diabetes

Question 14

What is nephritic kidney disease?

What condition is more likely to cause this?

Answer 14

Blood in urine
Haematuria

Small vessel vasculitis

Question 15

How does hypertension affect kidney function?

Answer 15

Narrowing of renal arteries (stenosis) causing damage and weakening the kidney vessels.

Question 16

How does hypertension damage the kidney?

Answer 16

Fluid and waste are not excreted creating a build-up in the vessels.

Question 17

How can diabetes affect the kidney?

Answer 17

diabetes progression - hypertension - Glomerular hypertension = kidney damage and nephrotic kidney damage

Question 18

How can kidney function be measured?

Answer 18

Serum urea 
Serum creatinine 
Urine albumin to creatinine ratio (ACR)
Creatinine clearance (GFR)
Insulin clearance (GFR)

Question 19

What indicates a risk of disease progression?

Answer 19

As kidney failure progresses the urine protein levels increase = higher risk of disease progression

Question 20

What is the average creatinine clearance?

Answer 20

Men = 97 / 123 mL / min 
Women = 88 / 128 mL / min

Question 21

What is the eGFR?

Answer 21

A calculated estimate of the glomerular filtration rate

Question 22

What are the issues with impaired renal function and drugs?

Answer 22

Toxicity
The Side effects are poorly tolerated
Effectivity is reduced
Sensitivity is Increased

Question 23

What are the 2 classes of drugs which can damage the kidney?

Answer 23

NSAIDs

ACE inhibitors

Question 24

How do NSAIDs damage the kidneys?

Answer 24

They block the synthesis of afferent arteriole vasodilation = Causes vasoconstriction and thus, reduces GFR.

Question 25

How do ACEi damage the kidneys?

Answer 25

They block the efferent arteriole = vasoconstriction.

Can cause acute renal failure.