Part 2 Drug Induced Kidney Disease

Question 1

Mechanisms of Renal susceptibility

Answer 1

Large drug exposure
Renal hemodynamics
Drug accumulation
Metabolism to toxic species
Increased energy requirements
Concentration of drug
Precipitation of drug
Compensatory mechanism

Question 2

Reduced glomerular capillary hydrostatic pressure

Answer 2

ACEi and Ang II receptor blockers effect the RAS system

Question 3

NSAIDs inhibit

Answer 3

COX which reduces PG synthesis from arachidonic acid

Question 4

PGs

Answer 4

Cause vasodilation

Decreased RBF: protect form ischemia and hypoxia by antagonizing vasoconstrictors

Question 5

NSAIDs + Renal ischemia

Answer 5

Increase vasoconstriction, ischemia, and loss of glomerular filtration

Question 6

Calcineurin inhibitors are

Answer 6

Cyclosporine and tacrolimus

Question 7

Calcineurin inhibitors

Answer 7

Effect immunosuppressive agents for solid organ transplant

Question 8

Dose limiting toxicity with Calcineurin inhibitors

Answer 8

Nephrotoxicity involving acute hemodynamically mediated kidney injury

Question 9

Calcineurin inhibitors Nephrotoxicity Pathogenesis

Answer 9

Increased in potent vasoconstrictors (TXA, endothelin, Ang II) and decrease vasodilators (NO, prostacyclin, PGE2)

Question 10

Define Systemic polyarteritis nodosa

Answer 10

Vasculitis with involvement of small and medium sized renal arteries
After methamphetamine abuse

Question 11

Thrombus formation

Answer 11

Has been described with oral contraceptives, cyclosporin, mitomycin C, cisplatin and quinine

Question 12

Anticoagulatns and thrombolytics AE

Answer 12

Embolize cholesterol particles from aortic athersclerotic plaques to small arteries

Question 13

Glomerular Disease

Answer 13

Involves damage to the glomerular capillary filtration surface
Proteinuria > 3.5 g/d with or without renal insufficiency

Question 14

Minimal change Glomerular Disease

Answer 14

NSAID induced nephropathy

T-lymphocytes release lympokines

Question 15

NSAID induced nephropathy

Answer 15

Associated with T-lymphocytic interstitial infiltrate suggesting disordered cell-mediated immunity

Question 16

T-lymphocytes release lympokines

Answer 16

that increase glomerular capillary permeability to proteins

Question 17

Focal Segmental Glomerulosclerosis

Answer 17

Characterized by patchy areas of sclerosis with interstitial inflammation

Question 18

FSGS causes

Answer 18

Chronic heroin abuse
Bisphosphonate pamidronate and zoledronate
AIDS

Question 19

Membranous Nephropathy

Answer 19

Most common drug-induced lesion

Question 20

Membranous Nephropathy Characterized by

Answer 20

Immune complex deposition along the glomerular capillary loops

Question 21

Membranous Nephropathy Causes

Answer 21

Parenterol gold (RA treatment)
Oral gold (less incidence)
Penicillamine, captopril and NSAIDs

Question 22

Acute Tubular Necrosis

Answer 22

MOST COMMON MECHANISMS of DIKD

Damage is localized in the proximal or distal tubular epithelia

Question 23

AG Toxicity Target

Answer 23

Proximal tubular epithelial cells

Question 24

AG cause

Answer 24

obstruction of tubular lumen leading to a backleak of the glomerular filtrate

Question 25

Toxicity of AG is

Answer 25

Directly proportional to the number of their cationic charges

Question 26

AG in cells

Answer 26

Inhibits phospholipase and causes of accumulation of phospholipids

Question 27

Cisplatin

Answer 27

Chemotehrapeutic agent that causes renal tubular damage due to platinum

Question 28

Cisplatin RF

Answer 28

Increased age Renal irradiation Alcohol abuse

Question 29

Cisplatin nephrotoxicity

Answer 29

Reversible

Question 30

Cisplatin can cause

Answer 30

hypomagnesemia which could seizures, neuromuscular irritability and personality changes

Question 31

Cisplatin MOA

Answer 31

Bind platinum to proximal tubular cell with disruption of enzyme activity and uncoupling of oxidative phosphorylation

Question 32

Most common cause of HA renal failure =

Answer 32

IV or intra-arterial administration of radiographic contrast media

Question 33

Radiographic Constrast Renal Failure

Answer 33

Concomitant medical illness and dehydration due to fluid restriction and catartics

Question 34

Prevention of Radiographic Constrast Renal Failure

Answer 34

Prestudy Scr or use alternative imaging procedures

Question 35

Radiographic Constrast MOA

Answer 35

Oxidative stress is development of ATN after contrast exposure

Question 36

Tubulointerstitial Disease

Answer 36

A diffuse or focal interstitial infiltrate of WBC, plasma cells, eosinophils, PMN neutrophils

Question 37

Tubulointerstitial Disease Causes

Answer 37

Penicillin NSAIDs Lithium Cyclosporine and Tacrolimus

Question 38

Lithium

Answer 38

Impairs the ability to concentrate the urine due to dose related decrease in collecting ducts response to ADH

Question 39

Renal Tubular Obstruction

Answer 39

Caused by intratubular precipitation of drugs Acute uric acid nephropathy after chemo Methotrexate

Question 40

Uric acid accumulation can be lessened by

Answer 40

Hydration Urinary alkalinization Allopurinol administration

Question 41

Extrarenal urinary tract obstruction

Answer 41

Lower tract obstruction Tricyclic antidepressants - prostatic hypertrophy Cyclophosphamide or Isosfamide - bladder fibrosis

Question 42

Nephrolithiasis is

Answer 42

Kidney stones

Question 43

Nephrolithiasis is caused by

Answer 43

Triamterene-HCTZ (potassium sparing diuretic) | Laxatives (ammonium urate stones)