Renal Disease and Drug Handling

Question 1

What is the definition of clearance?

Answer 1

The volume of plasma cleared entirely of drug per unit time (ml/min).

Question 2

What (in terms of renal function) decreases with age?

Answer 2

Renal Blood Flow
Renal Blood Filtration
Renal Mass

Question 3

What is Acute Kidney Injury (AKI)?

Answer 3

Sudden episode of kidney failure which happens within a few hours // days.
Lasts for 7 days or less.

Question 4

What is Chronic Kidney Disease (CKD)?

Answer 4

Deteriorating kidney function over a long period of time.

Lasts for >90 days.

Question 5

What are the 3 stages in AKI?

Answer 5

Pre - Renal
Intrinsic
Post - Renal

Question 6

Out of AKI and CKD, which one is reversible?

Answer 6

AKI is reversible.

Question 7

What are the 3 main causes of CKD?

Answer 7

Glomerular Disease
Hypertension
Diabetes

Question 8

What are the risk factors for kidney disease?

Answer 8

Age 
Obesity 
Smoking
Heart Disease
African - American ethnicity 
Hypertension 
Diabetes

Question 9

What are the outcomes for kidney disease?

Answer 9

Cardiovascular Disease
Kidney Events
Disability
Death

Question 10

What is glomerular disease?

Answer 10

Autoimmune Disease in which the glomeruli is damaged.

Question 11

What are the main causes of glomerular disease?

Answer 11

• Immunologically mediated inflammatory injury.
• Secondary mechanisms ( fibrin // deposition // platelet aggregation ).
• Haemodynamic Changes.
• Generalised Disease. (Lupus // Diabetes)

Question 12

What is Lupus?

Answer 12

A long term autoimmune disease in which healthy tissue is attacked.

Question 13

What does haemodynamic changes mean?

Answer 13

Changes to the dynamics of blood flow.

Question 14

What are 2 terms used to describe glomerular disease?

Answer 14

Nephrotic

Nephritic

Question 15

What is nephrotic kidney disease?

Answer 15

Kidney disease which causes body to pass TOO MUCH protein in your urine.

Question 16

What is nephritic kidney disease?

Answer 16

Kidney disease which causes body to pass BLOOD in the urine due to inflammation.

Question 17

How can hypertension affect kidney functioning?

Answer 17

There is narrowing in the arteries which delivers blood to the kidney -> Causes damage and thus, weakens the kidney vessels.

Question 18

Why does hypertension damage the kidney?

Answer 18

The waste and extra fluids CAN’T be removed and therefore, they build up in the vessels = damaging them.

Question 19

How can diabetes affect the kidney?

Answer 19

Damage the kidney.

Damage the nerves in the kidney.

Question 20

Explain further regarding the damage done to the kidney.

Answer 20

Waste and fluids build up in the blood instead of leaving the blood.
The body retains more SALT and WATER -> leads to weight gain alongside swelling of the ankles.

Question 21

Explain further regarding the damage done to the kidney nerves.

Answer 21

Leads to difficulty in emptying the bladder and thus, pressure builds up -> injuring the kidney.

Question 22

How can you measure kidney function?

Answer 22

Serum Urea
Serum Creatinine 
Albumin to Creatinine ratio 
Creatinine Clearance 
Insulin Clearance

Question 23

What is an indicator of severe risk of disease progression?

Answer 23

As kidney failure progress and the urine protein levels increase -> High risk of disease progression.

Question 24

What are the ways of measuring GFR?

Answer 24

Cockcroft - Gault Equation.

Measuring amount of creatinine present in sample of urine collected over 24hrs.

Question 25

What is the normal creatinine clearance?

Answer 25

``` MEN = 97 / 123 mL / min WOMEN = 88 / 128 mL / min ```

Question 26

What factors are taken into consideration when using the Cockcroft - Gault equation?

Answer 26

Sex // Age // Height // Creatinine // Height

Question 27

What is an eGFR?

Answer 27

This is a calculated estimate of the actual glomerular filtration rate. This is based on blood creatinine level with age // sex // race.

Question 28

What are the issues with impaired renal function and drugs?

Answer 28

Causes toxicity. Side effects are poorly tolerated. Effectivity is reduced. Sensitivity is reduced.

Question 29

Why should nephrotoxic drugs be avoided in pattens with renal impairment?

Answer 29

Can cause renal damage -> as it can cause acute kidney injury due to renal under - perfusion : known as PRERENAL AZOTEMIA.

Question 30

What is Prerenal Azotemia?

Answer 30

This is when little // no urine is produced despite the kidney working.

Question 31

What are the 2 classes of drugs which can damage the kidney?

Answer 31

NSAIDS. | ACE Inhibitors.

Question 32

How can NSAIDS damage the kidney?

Answer 32

They block the synthesis of afferent arteriole vasodilation = Causes vasoconstriction and thus, reduces GFR.

Question 33

How can ACE Inhibitors damage the kidney?

Answer 33

They block efferent vasoconstriction -> can cause acute renal failure.