WEEK 9 KIDNEY DISEASE Flashcards
ACUTE KIDNEY INJURY IS…
WHICH MEDICATIONS HAVE THE ABILITY TO BE NEPHROTOXIC?
THE ROLE OF DIURETICS IN ACUTE KIDNEY INJURY (AKI) IS…
WHICH DIURETICS ARE MOST BENEFICIAL FOR AKI?
Loop Diuretics
Potential benefits of loop diuretics in AKI:
Loop diuretics might decrease the oxygen consumption of the thick ascending limb of Henle by interfering with its function and thus protect it from ischemia.
Loop diuretics inhibit prostaglandin dehydrogenase, as a result of which there is a decreased breakdown of prostaglandin E2 which is a renal vasodilator. Loop diuretics might therefore increase the renal blood flow.
Maintaining urine flow might prevent tubular obstruction and resultant backflow of glomerular filtrate by flushing out any debris blocking the tubules.
Some studies have concluded that oliguric AKI has a worse prognosis than nonoliguric AKI. Loop diuretics are therefore prescribed to convert an oliguric AKI into a nonoliguric AKI.
Patients in the ICU with AKI and oliguria often receive lots of fluids as carriers for antibiotics, vasopressors, and nutrition and are in danger of developing fluid overload. Diuretics simplify fluid management of such patients.
What are the risks associated with diuretic use in AKI?
Potential harm caused by loop diuretics:
Loop diuretics decrease the effective circulating volume through veno-dilation or diuresis and may cause a decrease in renal blood flow (through renin) and glomerular filtration rate.
Although it is commonly believed that loop diuretics clear tubular obstruction, some studies suggest that loop diuretics acidify the urine and thereby actually increase the aggregation of Tamm-Horsfall protein in the tubules, thus worsening tubular blockage.
Loop diuretics may cause electrolyte abnormalities and metabolic alkalosis. A significant risk of ototoxicity is observed if high doses of loop diuretics are administered to patients with AKI. There is also some evidence that they impair mucociliary clearance in the respiratory tract and may have some immune-suppressive effects.
What are the risk factors for Chronic Kidney Disease (CKD)?
WHAT ARE THE STAGES OF CKD BASED ON GFR?
THE ROLE OF ACE-INHIBITORS AND ARBs FOR CKD…
ROLE OF ACE-INHIBITORS AND ARBs FOR CKD IN PATIENTS WITH DIABETES:
THE ROLE OF ACE-INHIBITORS AND ARBs FOR CKD IN PATIENTS WITH HTN
WHAT ARE SOME POTENTIAL COMPLICATIONS OF CKD?
MINERAL AND BONE DISORDER:
Hyperphosphatemia
Hypocalcemia
Hypercalcemia
Vitamin D deficiency
Parathyroid Hormone (PTH) abnormalities
What is the PATHOPHYSIOLOGY of CKD?
