Renal Disorders Clinical Pharmacy Practice Flashcards

A set of practice flashcards covering renal disorders including Acute Kidney Injury types, diagnosis, and management, as well as Chronic Kidney Disease complications and pharmacotherapy.

How is acute kidney injury (AKI) primarily described?

A sudden and significant decrease in kidney function.

Which three laboratory parameters change as evidence of AKI?

Serum creatinine, blood urea nitrogen (BUN), and urine output.

What laboratory parameter increases as a marker of AKI?

Serum creatinine.

What parameter representing renal function decreases in AKI?

Glomerular Filtration Rate (GFR).

The diagnosis of AKI is based on a change in serum creatinine (SCr) from baseline and/or what other clinical factor?

Changes in urinary output.

What are the three markers of renal function commonly used in clinical practice?

Serum creatinine, urea, and urine output.

What is the biological source of creatinine?

It is a waste product formed by the normal breakdown of muscle cells.

What volume of urine production defines Anuria?

Less than $50\,mL$ of urine per day.

What volume of urine production defines Oliguria?

$50\text{--}400\,mL$ of urine per day.

Which medical complications are specifically associated with anuria in AKI?

Hyperkalemia, hypertension, and acid-base disorders.

How should a patient producing exactly $30\,mL$ of urine in 24 hours be classified?

Anuria.

How should a patient producing $250\,mL$ of urine per day be classified?

Oliguria.

What are the three common classification systems used for staging AKI severity?

RIFLE, AKIN, and KDIGO.

What does the 'R' stand for in the RIFLE classification system?

Risk.

What does the 'I' stand for in the RIFLE classification system?

Injury.

What does the 'F' stand for in the RIFLE classification system?

Failure.

What does the 'L' stand for in the RIFLE classification system?

Loss of Kidney Function.

What does the 'E' stand for in the RIFLE classification system?

End-Stage Kidney Disease.

What does the acronym AKIN represent?

Acute Kidney Injury Network.

What does the acronym KDIGO represent?

Kidney Disease: Improving Global Outcomes.

On which two criteria are all three major AKI classification systems based?

Serum creatinine and urine output.

How many major clinical types of AKI are recognized based on the location and type of injury?

Three.

What are the three major types of AKI?

Prerenal, Intrinsic, and Postrenal.

Which type of AKI is associated with decreased blood flow to the kidneys?

Prerenal AKI.

Which type of AKI is associated with structural damage inside the kidney?

Intrinsic AKI.

Which type of AKI is associated with an obstruction within the urine collection system?

Postrenal AKI.

Which type of AKI is the most frequently encountered in clinical settings?

Prerenal AKI.

Severe volume depletion is most likely to cause which type of AKI?

Prerenal AKI.

Direct damage to the renal tubules would be classified as which type of AKI?

Intrinsic AKI.

An AKI secondary to a kidney stone (urinary tract obstruction) is classified as which type?

Postrenal AKI.

What three components of the kidney can be involved in Intrinsic AKI?

The glomerulus, the tubules, or the interstitium.

What are three specific examples of conditions that cause Intrinsic AKI?

Glomerulonephritis, acute tubular necrosis, and acute interstitial nephritis.

What mechanism causes glomerulonephritis (GN)?

An immune-mediated process or another precipitating event.

How does acute infection typically cause GN?

By causing inflammation and direct damage to the glomerulus.

What is meant by the term 'acute tubular necrosis' (ATN)?

Death of tubular epithelial cells.

What is the most common form of Intrinsic AKI?

Acute tubular necrosis (ATN).

Which class of antibiotics may cause ATN through a direct toxic effect leading to apoptosis?

Aminoglycosides.

Which specific antineoplastic drug is a well-known cause of ATN?

Cisplatin.

Which imaging-related agent may cause tubular cell apoptosis through a direct toxic effect?

Radiocontrast media.

What is the primary pathological nature of Acute Interstitial Nephritis (AIN)?

A hypersensitivity reaction.

What are the two primary causes of Acute Interstitial Nephritis?

Medications or infections.

Which specific class of antimicrobial agents is most commonly associated with AIN?

Penicillins.

What is the first and most critical step in managing suspected medication-induced AIN?

Discontinue the offending agent.

List three specific factors that can cause postrenal AKI obstruction.

Calculi, precipitation of crystals, or benign/malignant masses.

Which common mechanical urinary tract problem can lead to postrenal AKI?

A misplaced indwelling catheter.

Hypertrophic prostatic disease typically results in which type of AKI?

Postrenal AKI.

What is the first-line treatment approach for all cases of AKI?

Supportive care.

What are three main goals of supportive care in AKI management?

Fluid/electrolyte management, acid-base balance, and kidney protection from further insult.

What is the overall ultimate goal of managing AKI?

Restore kidney function to the pre-AKI baseline.

What should the pharmacist prioritize regarding drug dosing during AKI?

Proper drug dosing and avoidance of unnecessary nephrotoxins.

What is the primary pharmacotherapeutic objective in treating Prerenal AKI?

To improve perfusion to the kidneys.

Management of prerenal AKI involves optimizing what specific kidney pressure?

Intraglomerular pressure.

Which three common medication classes should be monitored or discontinued in Prerenal AKI?

Diuretics, ACEIs, and ARBs.

Which immunosuppressive class requires monitoring or discontinuation in Prerenal AKI?

Calcineurin inhibitors.

Which class of over-the-counter pain relievers is specifically mentioned for monitoring in AKI?

NSAIDs (Nonsteroidal Anti-inflammatory Drugs).

Which fluids are recommended to optimize renal perfusion in volume-depleted AKI patients?

Isotonic crystalloid fluids.

Name two types of drug therapy besides fluids used to support perfusion in appropriate AKI patients.

Inotropes and vasopressors.

On what does the treatment of glomerulonephritis primarily depend?

The cause and the specific type of GN.

Which pharmacologic therapy is commonly helpful in certain GN situations?

Corticosteroids.

Beside corticosteroids, what other drug class is mentioned for treating GN?

Other immunosuppressive agents.

What does standard treatment for ATN primarily involve?

Supportive care and protecting the kidneys from additional insults.

Regarding comorbid diseases like infection or diabetes in ATN, what is the recommendation?

Treating these underlying disease states should be considered.

What should be prioritized once a urinary tract obstruction is identified in AKI?

Remove the cause of the obstruction.

Name three treatment objectives in the management of AKI.

Correct reversible causes, maintain fluid/electrolyte balance, and treat body chemistry alterations.

How is treating an underlying infection classified in AKI management?

As part of correcting reversible causes.

Which specific electrolyte disturbance is a high-priority 'body chemistry alteration' in AKI?

Hyperkalemia.

Which acid-base disturbance is a high-priority 'body chemistry alteration' in AKI?

Metabolic acidosis.

Improving which output parameter is a key AKI treatment objective?

Urine output.

What is the recommended fluid intake volume in conservative AKI management?

Less than $1\,L/day$.

What is the dietary protein recommendation for conservative management of AKI?

$0.6\,g/kg/day$.

Which nutrient's excessive intake should be avoided in conservative AKI management?

Carbohydrates.

What is the recommended sodium intake in conservative AKI management?

$1\text{--}2\,g/day$.

What is the recommended potassium intake for conservative AKI management?

Less than $40\,mmol/day$.

Why is hyperkalemia considered clinically urgent in AKI?

It is common and potentially life-threatening.

What test should be performed immediately if hyperkalemia is suspected?

Electrocardiogram (ECG).

A 'peaked T wave' on an ECG indicates what condition in AKI?

Hyperkalemia.

Besides peaked T waves, what other ECG abnormality indicates severe hyperkalemia?

Widened QRS complexes.

What is the purpose of administering IV calcium in severe hyperkalemia?

To stabilize the cardiac membrane.

What are the two forms of IV calcium used for cardiac stabilization?

Calcium chloride and calcium gluconate.

What concentration is recommended for IV calcium preparations in hyperkalemia?

$10\%$.

What is the recommended dose and administration time for IV calcium chloride/gluconate $10\%$?

$10\text{--}30\,mL$ over $5\text{--}10\,\text{minutes}$.

What specific dose of IV calcium is listed as the 'first agent' for severe hyperkalemia?

$1\,g$ IV calcium.

Over what time frame should the $1\,g$ of IV calcium be administered?

Approximately $2\text{--}5\,\text{minutes}$.

Which drug combination is used to shift potassium intracellularly?

Regular human insulin with dextrose.

How many units of regular human insulin are typically used in the hyperkalemia shift regimen?

$10\,\text{units}$.

What amount and concentration of dextrose is given with $10\,\text{units}$ of insulin?

$25\,g$ of $50\%$ dextrose.

By what route is the insulin/dextrose combination administered?

IV push.

What is the administration duration for the insulin/dextrose combo for hyperkalemia?

$2\text{--}5\,\text{minutes}$.

Besides insulin, which other IV medication can cause an intracellular shift of potassium?

Sodium bicarbonate.

Which therapy is used when potassium actually needs to be removed from the body in severe AKI?

Dialysis (Renal Replacement Therapy).

What is the primary concern for a patient with severe hyperkalemia and widened QRS?

Potential cardiac arrest/life-threatening cardiac effects.

Which oral agent is used as a potassium-lowering therapy?

Calcium polystyrene sulfonate (SPS).

What medication is used to treat metabolic acidosis in AKI?

Sodium bicarbonate.

What is the oral dose range for sodium bicarbonate in metabolic acidosis treatment?

$1\text{--}6\,g/day$, given in divided doses.

Why is sevelamer used in AKI and CKD?

As a phosphate binder to treat hyperphosphatemia.

Which non-calcium phosphate binder is specifically mentioned for kidney disorders?

Sevelamer.

Name an aluminum-containing medication used for hyperphosphatemia.

Aluminum hydroxide.

Which oral calcium salts are used as phosphate binders?

Calcium acetate and calcium carbonate.

Which dietary strategy helps manage hyperphosphatemia in CKD?

Restrict dietary phosphate intake.

Which medications are used to treat hypocalcemia?

Oral calcium salts (like calcium carbonate) or IV calcium gluconate.