Renal Drug metabolism/Nephrotoxicity

Question 1

Which enzyme processes 25-hyroxy-vitamin D

Answer 1

CYP27B1

Question 2

What is the role of Renal UGT? Where is it located?

Answer 2

• glucuronidation of aldosterone + Fatty acids

- Expressed in proximal/distal tubule, loop of Henle, macula densa, + collecting ducts

Question 3

Role of CES?

Answer 3

Hydolyzing anti-cancer frug irinotecan

Question 4

DHP-1

Answer 4

Enzyme in Proximal tubule which activates Imipenam (B-lactam Abx)

Question 5

Prevention of Imipenem nephrotoxicity

Answer 5

Given in combo w/ Cilastatin

Question 6

Dolutegravir–metformin interaction

Answer 6

• Dolutegravir inhibits OCT2 transporter

- OCT2/MATE transports Metformin

Question 7

Pyrimethamine–metformin interaction

Answer 7

• Pyrimethamine inhibits hMATE1/2-k

- Metformin eliminated via OCT2/MATE

Question 8

Affects of Probenicid

Answer 8

• Blocks absorption of uric acid into cell f/ urine
• Blocks absorption of uric acid into cell f/ blood
• Blocks absorption of Abx (Penicillan, cephalosporins, methotrexate) into renal cell f/ blood

Question 9

DIKD LabDx

Answer 9

• INC serum Creatinine
• INC BUN
• DEC GFR
• Excretion of enzymes (NABG, y-GTP, glutathion ST, IL-18)
• NGAL Protein
• IGFBP7 + TIMP-2 Excretion

Question 10

Pathogenic Mechanisms of DIKD

Answer 10

1. Acute Tubular Necrosis (Aminoglycodise,Radiocontrast, Cisplatin, Mannitol)
2. Hemodynamically-mediated (ACEi/NSAIDs, Calcineurin inh)
3. Acute Allergic interstitial Nephritis (Diuretics, NSAIDSm PPIs)

Question 11

Tetracycline can exacerbate _____

Answer 11

Uremia

Question 12

Hyperglycemic control for Diabetic individuals with CKD

Answer 12

Linbagliptin: DPP4i does NOT req dose-adjustment;

Question 13

Common meds req reduction in CKD

Answer 13

• Allopurinol (gout)
• Gabapentin (seizures/shingles)
• Reglan (Metoclopramide - GI)
• Narcotics (methadone/fentanyl)