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PHM 702 DIKD > Drug - Induced KD > Flashcards

Drug - Induced KD Flashcards

1
Q

What drugs cause Hemodynamic Renal Injury

A

NSAIDs
SGLT2 inhibitors
ACE inhibitors/ARBs
Calcineurin inhibitors

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1
Q

What drugs cause Pre-Renal injury?

A

Diuretics

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2
Q

What injuries happen to the kidney intrinsically?

A

Glomerulonephritis
Acute Tubular Necrosis
Acute Interstitial Nephritis
Vasculitis

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3
Q

What drugs can cause Glomerulonephritis?

A

Gold
Allopurinol

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4
Q

What drugs can cause Acute Tubular Necrosis?

A

IV Contrast Media
Amphotericin B
Aminiglycosides

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5
Q

What drugs can cause Acute Interstitial Nephritis?

A

Peniciilin
NSAIDs
PPIs
Sulfa drugs

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6
Q

What drugs can cause Vasculitis?

A

PTU
Allopurinol
Levamisole(coke)
Phenytoin

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7
Q

What is a Post-Renal injury?

A

Nephrolithiasis
Rhabdomyolysis
Lithium-Induced CKD

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8
Q

What drugs can cause Post-Renal Nephrolithiasis?

A

*Topiramate
*Sulfonamides
*Furosemide
Allopurinol
Acyclovir

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9
Q

What are risks factors for Drug - induced Kidney Disease?

A

Age > 65
CKD
Concomitant nephrotoxins
Known allergy
Duration of Therapy
Diabetes
HTN
Renin dependent state (eg HF, cirrhosis)

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10
Q

How do you prevent DIKD?

A

Direct prevention to undelying mechanism
Avoid neohrotoxic meds and combos
Maintain adequate kidney perfusion with hydration
Therapeutic Drug Monitoring

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11
Q

What traditional markers are used to monitor kidney function?

A

BUN
SCr
eGFR
UO

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12
Q

What novel biomarkers are used to monitor kidney function?

A

KIM1 - ATN
NGAL - Ischemic injury
IGFBP7 & TIMP2 - cellular arrest

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13
Q

What type of fluids do you give to someone with kidney injury?

A

Balanced crystalloids

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14
Q

Why are balanced crystalloids preferred over normal saline?

A

Mimic normal plasma Electrolyte concentration
Closer to neutral pH
Decreased risk of death
Decreased risk of RRT
Decreased risk of renal dysfunction

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15
Q

What are the types of balanced crystalloids?

A

Lactated Ringers
Plasma - Lyte A

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16
Q

Constituents of Lactated Ringers?

A

Na
Cl
Lactate
K
Ca

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17
Q

Constituents of Plasma - Lyte A?

A

Na
Cl
K
Mg
Acetate
Gluconate

18
Q

How do NSAIDs cause Pre- Renal Injury?

A

block afferent arteriole dilation by reducing PGE2 production

19
Q

How do SGLT2 inhibitors cause Pre - Renal Injury?

A

stimulate afferent arteriole constriction via tubuloglomerular feedback

20
Q

How do ACEi/ARBs cause Pre- Renal Injury?

A

block efferent arteriole constriction via decrease in Angiotensin II

21
Q

How does a decrease in angiotensin II cause Pre- Renal Injury?

A

There will be loss of autoregulation followed by increase risk of intraglomerular hydrostatic pressure which leads to decrease in GFR

22
Q

How does Tubuloglomerular Feedback work?

A

Macula densa cells sense high Na concentration in distal tubule
Relays info to afferent arteriole to constrict
Decrease intraglomerular hydrostatic pressure

23
Q

True or False. Tubuloglomerular Feedback is never protective.

A

False. It is protective with a decrease in albuminuria

24
Q

True or False. Contrast Media injures the kidney only via direct toxicty.

A

False. Via Multiple mechanisms

25
Q

What are the risk factors for Contrast Media induced Kidney Disease?

A

Diabetes
Large or High volume
High osmolal contrast
Ionic contrast
Short interval between doses

26
Q

How to prevent Contrast Media Renal Injury?

A

Give Saline Hydration
- 0.9% NaCl 1 - 1.5 mL/kg/hr 12 hours before and after
Give NAC (add if higher risk)
Low/Iso-osmol Contrast
- Not Diatrizoate or Metrizoate
Sodium bicarb has potential harm

27
Q

How should you monitor Contrast Media?

A

SCr and BUN Q12H for 2 days then Q24H for 5 - 7 days
UO with strict ins and outs for 4 days
Medication regimen review
Check Elytes if pt develops kidney injury

28
Q

How does AIN occur?

A

Immune activation/hypersensitivity > Leukocyte infiltration > Inflammation

29
Q

What is the treatment for AIN?

A

Stop offending agent
Avoid cross reactors
Supportive Care
Steroids - large bolus

*Earlier you stop offender ans start steroids - the better

30
Q

What other drug can cause AIN aside from Beta Lactams, PPIs, Sulfas and NSAIDs?

A

Vancomycin

31
Q

What paramters show Vancomyin induced AIN?

A

Elevated trough concentration
24 HR AUC > 600
Daily dose > 4g
>7 days duration of therapy
High severity of illness
High weight (>101.4 kg)
Concomitant nephrotoxins

32
Q

How to prevent Drug Induced AIN?

A

Antibiotic Stewardship
Avoid Concomitant Drugs
Monitoring

33
Q

How does Nephrolithiasis cause renal injury?

A

Backup of fluid into kidneys

34
Q

True OR False. Most stones are made of Calcium so Ca supplementation may increase risk of Nephrolithiaisis.

A

True

35
Q

How to prevent Nephrolithiasis?

A

Hydration (2 -3 L of water/day; UO > 2.5L/DAY)
Ca in urine? > thiazide

36
Q

Treatment of Nephrolithiasis

A

Pain management
Lithotripsy - passage/stone removal

37
Q

What is Rhabdomyolysis and how can it cause kidney injury?

A

It is muscle breakdown and can cause intratubular obstruction

38
Q

What drugs can cause rhabdomyolysis?

A

Stains and statin-fibrate combos

39
Q

How to prevent rhabdomyolysis?

A

Avoid statin DDI
Counsel pt on symptoms
Check urine color

40
Q

How to manage rhabdomyolysis?

A

D/C drug
Treat with aggressive fluids
Urinary alkalization (solubilize myoglobin)
Target a UO of 3 ml/kg/h

41
Q

How does Lithium cause kidney injury?

A

Chronic interstritial nephritis
It is related to duration of use
CUMULATIVE DRUG EXPOSURE

42
Q

How to prevent Lithium-Induced CKD?

A

Routine TDM
Avoid Dehydration
Monitor renal function
Avoid DDIs (HCTZ)

43
Q

How to treat Lithium-Induced CKD?

A

D/C Lithium
Hydration
Amiloride
Avoid other nephrotoxins

PHM 702 DIKD (1 decks)

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