Renal Imapirment

Question 1

Reduced renal secretion of drugs

Answer 1

Can cause toxicity
Reduce dose based on severity, maintenance decrease dose or increase interval
Plasma t1/2 prolonged
Reduced renal clearance in elderly - excrete drug slowly highly susceptible nephrotoxic drug

Question 2

Signs of acute kidney injury

Answer 2

Decreased urine output
Fluid retention
Dehydration
Nausea and vomiting
Fatigue
High blood pressure
Confusion

Question 3

Lab results in renal impairment

Answer 3

Reduced eGFR and CrCl
High serum creatinine

Question 4

Sick day rules

Answer 4

List medication to stop temporarily during illness = dehydration is sig risk factor
Restart when well 24 to 48 hours after normal and drinking
Diuretics (exacerbate dehydration and electrolyte disturbance)
ACEi/ARBs (nephrotoxic and reduced eGFR)
Metformin (increase risk lactic acidosis)
NSAIDs (nephrotoxic, decreased eGFR and sodium and water retention)

Question 5

Nephrotoxic drugs

Answer 5

ACEi
Aciclovir
Tetracyclines
Quinolones
NSAIDs
Lithium
Ciclosporin
Methotrexate
Vancomycin
Aminogycosides