Sweatman: kidney toxicity Flashcards
this focuses on treatment and effects of drugs, not kidney physiology
There are a number of ways in which medications can cause toxicity to the kidney…what are they
pre-renal toxicities vasoconstriction crystalluria tubular toxicity endothelial injuries glomerulopathy interstitial nephritis
what class of drugs most commonly leads to pre-renal issues (i.e. a reduced blood supply to kidney)?
diuretics
What class of drugs causes vasoconstriction?
NSAIDs
What class of drugs can lead to crystalluria?
sulfonamides
what class of drugs can lead to tubular toxicity?
aminoglycosides
what drug can lead to endothelial injuries?
cyclosporine
what drug can lead to glomerulopathy?
penicillamine
what class of drugs can lead to interstitial nephritis?
antibiotics
What are some methods you could use to assess kidney function?
- measure inulin or creatinine clearance to directly determine GFR
- measure serum BUN or creatinine for indirect assessment of renal function
- examine urine osmolality and content
What does high molecular weight proteins (e.g. albumin) in the urine suggest? low mol weight?
glomerular damage
proximal tubular damage
What are effects of acetaminopehn on the kidney?
proximal tubular necrosis
increased BUN and serum creatinine–> decreased GFR
What are the effects of NSAIDs on the kidney?
- inhibit prostaglandin synthesis –>vasoconstriction –> decreased RBF –> ischemia
- analgesic nephropathy: chronic interstitial nephritis and papillary necrosis
- interstital nephritis (rare)
What are the effects of aminoglycosides on the kidney?
they cause an increase in the number and size of lysosomes via inhibition of sphingomyelinase and phospholipases. rupture of these lysosomes is toxic
What are the effects of amphotericin B on the kidney?
vasoconstriction: impairs functional integrity of the glomerulus, PCT and DCT –> decreased RBF and GFR
What are the effects of cyclosporine on the kidney?
endothelial injuries: acute reversible renal dysfunction and acute vasculopathy
