Renal disease and drug handling Flashcards
State the definition of clearance.
The volume of plasma cleared entirely of drug per unit time (ml/min)
clearance is a rate constant
What decreases with age? (renal function)
Renal blood flow
Renal blood filtration
Renal mass
What is acute kidney injury (AKI)?
A sudden episode of kidney failure which happens over hours or days
What is chronic kidney disease (CKD)?
Deteriorating kidney function (any underlying cause). A progressive impairment in renal function, more than 3 months.
Is AKI or CKD reversible?
AKI is reversible
CKD is irreverisble
Give examples of the main causes of CKD
Diabetes
Hypertension
Glomerular disease
What is glomerular disease?
Immunologically mediated inflammatory injury. the normal function of the kidney is disturbed and the chemical balance isn’t maintained in the blood and urine.
What are the possible causes of glomerular disease?
Generalised disease (eg lupus, diabetes) Haemodynamic changes Immunologically mediated inflammatory injury
What are the 2 classifications of glomerular disease?
Nephritic syndrome
Nephrotic syndrome
What are some risk factors of kidney disease?
Hypertension
Diabetes
Age
Race/ethnicity - Afro-Caribbean
List a few outcomes of kidney disease.
Cardiovascular events
Kidney events
Disability
Death (from kidney failure)
What does haemodynamic changes mean?
Changes to the dynamics of blood flow.
What is nephrotic kidney disease?
What condition is more likely to cause this?
Protein in urine.
Proteinuria
Diabetes
What is nephritic kidney disease?
What condition is more likely to cause this?
Blood in urine
Haematuria
Small vessel vasculitis
How does hypertension affect kidney function?
Narrowing of renal arteries (stenosis) causing damage and weakening the kidney vessels.
How does hypertension damage the kidney?
Fluid and waste are not excreted creating a build-up in the vessels.
How can diabetes affect the kidney?
diabetes progression - hypertension - Glomerular hypertension = kidney damage and nephrotic kidney damage
How can kidney function be measured?
Serum urea Serum creatinine Urine albumin to creatinine ratio (ACR) Creatinine clearance (GFR) Insulin clearance (GFR)
What indicates a risk of disease progression?
As kidney failure progresses the urine protein levels increase = higher risk of disease progression
What is the average creatinine clearance?
Men = 97 / 123 mL / min Women = 88 / 128 mL / min
What is the eGFR?
A calculated estimate of the glomerular filtration rate
What are the issues with impaired renal function and drugs?
Toxicity
The Side effects are poorly tolerated
Effectivity is reduced
Sensitivity is Increased
What are the 2 classes of drugs which can damage the kidney?
NSAIDs
ACE inhibitors
How do NSAIDs damage the kidneys?
They block the synthesis of afferent arteriole vasodilation = Causes vasoconstriction and thus, reduces GFR.
How do ACEi damage the kidneys?
They block the efferent arteriole = vasoconstriction.
Can cause acute renal failure.
