SIDE EFFECTS - KIDNEY

Question 1

1. Which drug inhibits prostaglandin synthesis by blocking COX-1 and COX-2 isoenzymes?
   a) Metformin
   b) Insulin
   c) NSAIDs
   d) Opioids

Answer 1

c) NSAIDs

Rationale: NSAIDs inhibit prostaglandin synthesis by blocking the cyclooxygenase (COX)-1 and COX-2 isoenzymes, which results in the suppression of inflammation and pain.

Question 2

In the kidneys, COX-1 primarily regulates:
a) Salt and water excretion
b) Renal hemodynamics and GFR
c) Albuminuria
d) Proximal tubular cell injury

Answer 2

b) Renal hemodynamics and GFR

Rationale: In the kidneys, COX-1 regulates the renal hemodynamics and glomerular filtration rate (GFR).

Question 3

Which drug, when used long-term, can lead to albuminuria in CKD patients?
a) Metformin
b) Opioids
c) PPIs
d) Sulfonylureas

Answer 3

b) Opioids

Rationale: Long-term opioid use in patients with CKD may lead to albuminuria. Examples of opioids include natural compounds like morphine and codeine, semisynthetic compounds like diamorphine (heroin) and oxycodone, and synthetic compounds like fentanyl and methadone.

Question 4

4. PPIs are commonly associated with which renal condition?
   a) Albuminuria
   b) Acute interstitial nephritis
   c) Tubular necrosis
   d) Hypoglycemia

Answer 4

b) Acute interstitial nephritis

Rationale: Proton pump inhibitors (PPIs) are considered one of the most common causes of drug-induced acute interstitial nephritis.

Question 5

5. For a patient with an eGFR of 35 mL/min/1.73 m2, what is the recommendation regarding metformin use?
   a) Initiate therapy without dose adjustment
   b) Initiate therapy with dose adjustment
   c) Do not initiate therapy, but continue existing therapy with dose reduction
   d) Contraindicated

Answer 5

c) Do not initiate therapy, but continue existing therapy with dose reduction

Rationale: For patients with an eGFR of 30-45 mL/minute/1.73 m2, the initiation of therapies is not recommended while the continuation of existing therapy may occur at a reduced dose with close monitoring of kidney function.

Question 6

6. Which sulfonylurea drug does not require dose reduction but needs caution against hypoglycemia risk?
   a) Glibenclamide
   b) Glimepiride
   c) Gliclazide
   d) Glipizide

Answer 6

d) Glipizide

Rationale: An adjusted gliclazide dose is permitted in severe CD, but the dose of glipizide does not need to be reduced to be safe, although there is still the need for caution against hypoglycemia risk.

Question 7

7. Which drug is known to cause nephrotoxicity, specifically tubular necrosis at the apical membrane?
   a) Vancomycin
   b) Ciprofloxacin
   c) Gentamycin
   d) Metformin

Answer 7

c) Gentamycin

Rationale: One of the most severe side effects of aminoglycosides is nephrotoxicity. Gentamycin, in particular, has the highest rate of causing tubular necrosis at the apical membrane.

Question 8

8. Which drug can cause allergic interstitial nephritis, presenting with symptoms like fever, skin rashes, and acute arthralgia?
   a) NSAIDs
   b) Opioids
   c) Fluoroquinolones
   d) Insulin

Answer 8

c) Fluoroquinolones

Rationale: Ciprofloxacin, a fluoroquinolone, contributes to nephrotoxicity and can cause allergic interstitial nephritis, a type III hypersensitivity reaction.

Question 9

9. In a patient with an eGFR of 8 mL/min, how should the insulin dose be adjusted?
   a) No adjustment needed
   b) Reduce by 25%
   c) Reduce by 50%
   d) Double the dose

Answer 9

c) Reduce by 50%

Rationale: The dose of insulin should be reduced by 25% if eGFR is 10-50 mL/min, and when eGFR is less than 10 mL/min, the dose should be reduced by 50%.

Question 10

10. Which drug’s nephrotoxicity is significantly correlated with its plasma trough levels, especially at doses of >20 mg/L or >4 g/day?
    a) Metformin
    b) NSAIDs
    c) Vancomycin
    d) Opioids

Answer 10

c) Vancomycin

Rationale: Plasma trough level of vancomycin plays a significant correlation with nephrotoxicity, especially at doses of >20 mg/L or >4 g/day.

Question 11

11. Which drug class is known to enhance NSAID-related renal complications?
    a) PPIs
    b) Opioids
    c) ACE inhibitors
    d) Aminoglycosides

Answer 11

c) ACE inhibitors

Rationale: ACE inhibitors, along with ARBs and B-blockers, can enhance NSAID-related renal complications.

Question 12

12. Which of the following is NOT a natural opioid compound?
    a) Morphine
    b) Codeine
    c) Fentanyl
    d) Diamorphine

Answer 12

c) Fentanyl

Rationale: Fentanyl is a synthetic opioid. Natural opioid compounds include morphine and codeine.

Question 13

13. For a patient with CKD who needs treatment with PPIs, what should be closely monitored?
    a) Blood glucose levels
    b) Creatinine levels
    c) Blood pressure
    d) Heart rate

Answer 13

b) Creatinine levels

Rationale: CKD patients who need to be treated with PPIs should be under creatinine level monitoring.

Question 14

14. In cases of acute kidney injury (AKI), what is the recommendation regarding metformin administration?
    a) Double the dose
    b) Continue without change
    c) Temporarily hold
    d) Permanently discontinue

Answer 14

c) Temporarily hold

Rationale: In AKI, the patient should be instructed to temporarily hold on metformin administration.

Question 15

15. Which drug from the sulfonylurea class is contraindicated in stage ≥3 CKD (eGFR < 60 mL/min)?
    a) Gliclazide
    b) Glipizide
    c) Glibenclamide
    d) Metformin

Answer 15

c) Glibenclamide

Rationale: Drugs from the sulfonylurea class, especially glibenclamide and glimepiride, are contraindicated in stage ≥3 CKD.

Question 16

16. How is endogenous insulin primarily degraded?
    a) By the kidneys
    b) By the liver
    c) In the gastrointestinal tract
    d) In the lungs

Answer 16

b) By the liver

Rationale: The liver degrades endogenous insulin, while exogenous insulin is eliminated by the renal system.

Question 17

17. Which of the following drugs is associated with nephrotoxicity, specifically causing injury of the proximal tubular cell?
    a) Vancomycin
    b) Metformin
    c) NSAIDs
    d) Insulin

Answer 17

a) Vancomycin

Rationale: Vancomycin-induced nephrotoxicity (VIN) can take several forms, such as injury of the proximal tubular cell with or without necrotic changes.

Question 18

18. Which aminoglycoside is known for the highest rate of tubular necrosis at the apical membrane?
    a) Vancomycin
    b) Ciprofloxacin
    c) Gentamycin
    d) Fentanyl

Answer 18

c) Gentamycin

Rationale: Gentamycin, an aminoglycoside, is known to cause tubular necrosis at the apical membrane.

Question 19

19. Which drug can cause a type III hypersensitivity reaction leading to allergic interstitial nephritis?
    a) Metformin
    b) Insulin
    c) Ciprofloxacin
    d) Glibenclamide

Answer 19

c) Ciprofloxacin

Rationale: Ciprofloxacin, a fluoroquinolone, can cause allergic interstitial nephritis, a type III hypersensitivity reaction.

Question 20

20. Which drug’s plasma trough level plays a significant correlation with nephrotoxicity, especially at doses of >20 mg/L or >4 g/day?
    a) NSAIDs
    b) Opioids
    c) Vancomycin
    d) PPIs

Answer 20

c) Vancomycin

Rationale: Plasma trough level of vancomycin plays a significant correlation with nephrotoxicity, especially at doses of >20 mg/L or >4 g/day.

Question 21

21. Which drug is known for its semisynthetic compound, diamorphine?
    a) NSAIDs
    b) Opioids
    c) PPIs
    d) Sulfonylureas

Answer 21

b) Opioids

Rationale: Diamorphine (heroin) is a semisynthetic compound of opioids.

Question 22

22. Which drug is eliminated primarily by the renal system?
    a) Exogenous insulin
    b) Endogenous insulin
    c) Metformin
    d) NSAIDs

Answer 22

a) Exogenous insulin

Rationale: Exogenous insulin is eliminated by the renal system, while endogenous insulin is degraded by the liver.

Question 23

23. Which drug is associated with nephrotoxicity in the form of tubular dysfunction?
    a) Metformin
    b) NSAIDs
    c) Aminoglycosides
    d) PPIs

Answer 23

c) Aminoglycosides

Rationale: Aminoglycosides are known to cause nephrotoxicity, which can manifest as renal tubular dysfunction.

Question 24

24. Which drug, when used long-term, can lead to chronic interstitial nephritis with interstitial fibrosis?
    a) NSAIDs
    b) Opioids
    c) PPIs
    d) Insulin

Answer 24

a) NSAIDs

Rationale: Long-term use of NSAIDs can lead to chronic interstitial nephritis with interstitial fibrosis.

Question 25

25. Which drug is NOT recommended for initiation if the eGFR is between 30-45 mL/minute/1.73 m2?
    a) Metformin
    b) Insulin
    c) Glibenclamide
    d) Vancomycin

Answer 25

a) Metformin

Rationale: For patients with an eGFR of 30-45 mL/minute/1.73 m2, the initiation of metformin is not recommended.

Question 26

26. Which drug is known to cause a hypersensitivity reaction leading to interstitial nephritis in elderly patients with impaired renal function?
    a) NSAIDs
    b) Opioids
    c) PPIs
    d) Sulfonylureas

Answer 26

a) NSAIDs

Rationale: In elderly patients with impaired renal function, NSAIDs can cause a hypersensitivity reaction leading to interstitial nephritis.

Question 27

27. Which drug is associated with nephrotoxicity, specifically causing injury at the apical membrane of the tubules?
    a) Gentamycin
    b) Ciprofloxacin
    c) Vancomycin
    d) Metformin

Answer 27

a) Gentamycin

Rationale: Gentamycin, an aminoglycoside, is known to cause tubular necrosis at the apical membrane.

Question 28

28. Which drug can cause allergic interstitial nephritis that presents with eosinophilia and proteinuria?
    a) Metformin
    b) NSAIDs
    c) Ciprofloxacin
    d) Insulin

Answer 28

c) Ciprofloxacin

Rationale: Ciprofloxacin, a fluoroquinolone, can cause allergic interstitial nephritis, which clinically presents with symptoms like eosinophilia and proteinuria.

Question 29

29. Which drug’s dose should be reduced by 25% if eGFR is between 10-50 mL/min?
    a) Metformin
    b) Insulin
    c) Glibenclamide
    d) Vancomycin

Answer 29

b) Insulin

Rationale: The dose of insulin should be reduced by 25% if eGFR is between 10-50 mL/min.

Question 30

30. Which drug is associated with nephrotoxicity, especially at doses of >20 mg/L or >4 g/day?
    a) NSAIDs
    b) Opioids
    c) Vancomycin
    d) PPIs

Answer 30

c) Vancomycin

Rationale: Plasma trough level of vancomycin plays a significant correlation with nephrotoxicity, especially at doses of >20 mg/L or >4 g/day.