RxPrep: Study Guide on Renal Disease Terminology and Pharmacology

diabetes, HTN

What are the 2 most common causes of CKD?

AKI

a sudden loss of kidney function that's often reversible but can be permanent if the precipitating condition isn't corrected

dehydration

What is a common cause of AKI?

>20:1

What BUN:SCr indicates dehydration?

CKD

a progressive loss of kidney function over months or years

CrCl, GFR, urine albumin

What 3 things are used to assess the degree of kidney function in a patient with CKD?

ESRD

total and permanent kidney failure where fluid and waste accumulates; dialysis or transplant is needed to perform the functions of the kidneys

nephron

functional unit of the kidney; primary function is to control the concentration of sodium and water in the blood which regulates blood volume, and in turn, blood pressure

glomerulus

large filtering unit located within the Bowman's capsule

glomerulus

The afferent arteriole delivers blood into the ________.

true

True or False: Most drugs can pass through the glomerular capillaries into the filtrate and are excreted in the urine.

efferent arteriole

If the glomerulus is healthy, large substances, such as proteins and protein-bound drugs, are not filtered and stay in the blood, exiting the nephron via the ________.

some albumin passes into urine

What happens if the glomerulus is damaged?

bicarbonate, hydrogen;

proximal tubule

Blood pH is regulated by the exchange of ________ and ________ ions in the ________.

SGLT2 inhibitors

What is an example of a drug class that works on the proximal tubule of the kidney?

ADH

If ________ is present, water passes through the walls of the ascending limb and is reabsorbed into the blood.

vasopressin

What is another term for ADH?

antidiuretic hormone

What does ADH stand for?

loop diuretics

What is an example of a drug class that works on the Loop of Henle?

inhibits Na-K pump in ascending limb of Loop of Henle

What is the mechanism of action of loop diuretics?

bone density; Ca

Long-term use of loop diuretics can decrease ________ due to ________ depletion.

thiazide diuretics

What is an example of a drug class that works on the distal convoluted tubule of the kidney?

inhibits Na-Cl pump in the distal convoluted tubule of the kidney

What is the mechanism of action of thiazide diuretics?

loop

Which type of diuretic is stronger, loop or thiazide?

Ca

Thiazide diuretics increase ________ reabsorption.

thiazide

The long-term use of (loop/thiazide) diuretics has a protective effect on bones.

potassium-sparing diuretics

What is an example of a drug class that works in the distal convoluted tubule and collecting duct of the kidney?

potassium-sparing

What type of diuretics are aldosterone antagonists?

aldosterone antagonists

Spironolactone and eplerenone are examples of ________.

increase K retention and decrease Na and water reabsorption

What is the mechanism of action of potassium-sparing diuretics?

drug-induced kidney disease

What does DIKD stand for?

DIKD

________ is especially common in the hospital setting and contributes to morbidity and mortality.

multiple nephrotoxic medications

What is the main risk factor for DIKD?

aminoglycosides, amphotericin B, cisplatin, contrast dye, cyclosporine, loop diuretics, NSAIDs, polymyxins, tacrolimus, vancomycin

What are 10 drugs that cause kidney disease?

blood urea nitrogen

What does BUN stand for?

BUN

measures the amount of nitrogen in the blood that comes from urea

urea

waste product of protein metabolism

increase

Dehydration can (decrease/increase) BUN.

creatinine

waste product of muscle metabolism

increases

As kidney function declines, creatinine (decreases/increases).

0.6-1.3

The normal range of SCr is ~________ mg/dL.

Cockcroft-Gault

What is the most common equation used to estimate kidney function when dosing medications?

very low muscle mass

What is a factor that decreases the accuracy of creatinine-based kidney function estimation equations?

low

Low muscle mass means a person will have a (high/low) SCr.

children, kidney failure, unstable renal function

In what 3 populations is the Cockcroft-Gault equation not preferred?

CrCl

Drug dosing recommendations in renal disease are generally based on ________.

metformin, SGLT2 inhibitors

What are 2 drugs that use GFR for dosing recommendations rather than CrCl?

[(140 - age) x weight in kg] / (72 x SCr)

What is the Cockcroft-Gault equation?

multiply answer by 0.85

How is the Cockcroft-Gault equation different for females?

actual

What weight is used in the Cockcroft-Gault equation if actual body weight is less than ideal body weight?

ideal

What weight is used in the Cockcroft-Gault equation if body weight is <120% of the ideal body weight?

adjusted

(BMI >25)

What weight is used in the Cockcroft-Gault equation if body weight is ≥120% of the ideal body weight?

basic metabolic panel

GFR is not commonly calculated by pharmacists, but may be reported with a(n) ________.

degree of albuminuria, GFR

What 2 things are used to stage kidney disease?

Modification of Diet in Renal Disease

What does MDRD stand for?

Chronic Kidney Disease Epidemiology Collaboration

What does CKD-EPI stand for?

CKD-EPI, MDRD

What are 2 equations that are used to calculate GFR?

albumin

What is the primary protein that's measured in the urine to assess kidney disease?

proteinuria

Albuminuria is sometimes referred to as ________.

Kidney Disease Improving Global Outcomes

What does KDIGO stand for?

KDIGO

Who comes up with the guidelines used to determine the degree/stage of renal impairment?

<60; ≥30; >3 months

The criteria for confirming CKD includes an eGFR of ________ mL/min/1.73 m2, a urine albumin excretion rate or albumin to creatinine ratio of ________, and decreased eGFR or albuminuria occurring for ________ to distinguish from AKI.

albuminuria,

kidney structural abnormalities on imaging,

kidney transplant

What are 3 markers of kidney damaged used in staging kidney disease?

G1, G2, G3a, G3b, G4, G5

What are the 6 GFR categories used in CKD staging?

5

How many CKD stages are there?

normal or high

What kind of kidney function does CKD stage 1, G1 refer to?

mild decrease

What kind of kidney function does CKD stage 2, G2 refer to?

mild to moderate decrease

What kind of kidney function does CKD stage 3, G3a refer to?

moderate to severe decrease

What kind of kidney function does CKD stage 3, G3b refer to?

severe decrease

What kind of kidney function does CKD stage 4, G4 refer to?

kidney failure

What kind of kidney function does CKD stage 5, G5 refer to?

≥90 + kidney damage

What GFR indicates CKD stage 1, G1?

60-89 + kidney damage

What GFR indicates CKD stage 2, G2?

45-59

What GFR indicates CKD stage 3, G3a?

30-44

What GFR indicates CKD stage 3, G3b?

15-29

What GFR indicates CKD stage 4, G4?

<15 or dialysis dependent

What GFR indicates CKD stage 5, G5?

3

How many albuminuria categories are there?

normal to mild increase

What kind of albuminuria is categorized by A1?

moderate increase

What kind of albuminuria is categorized by A2?

severe increase

What kind of albuminuria is categorized by A3?

<30

What albumin to creatinine ratio or albumin excretion rate indicates A1?

30-300

What albumin to creatinine ratio or albumin excretion rate indicates A2?

>300

What albumin to creatinine ratio or albumin excretion rate indicates A3?

<120

The KDIGO Blood Pressure in CKD Guidelines recommend a target SBP of ________ mmHg for those with hypertension and CKD.

ACE inhibitor or ARB

What antihypertensive drug class is first line for patients with CKD and hypertension?

increase; 30

increase is to be expected initially

After starting an ACE inhibitor or ARB, the baseline SCr can (decrease/increase) by up to ________%.

false

(discontinue if increase is >30%)

True or False: If a patient's SCr increases by 20% after starting an ACE inhibitor or ARB, they must discontinue the medication.

true

True or False: ACE inhibitors and ARBs should never be used together.

hyperkalemia

What can occur if an ACE inhibitor and ARB are used together?

potassium supplements, salt substitutes (KCl)

Patients taking an ACE inhibitor or ARB should be counseled to avoid what 2 things?

potassium, SCr

What 2 things should be monitored 2-4 weeks after initiating an ACE inhibitor or ARB?

SGLT2 inhibitor

What drug class does KDIGO recommend for treating diabetes in CKD?

SGLT2 inhibitor

What drug class has demonstrated a reduction in cardiovascular events and CKD progression?

GLP-1 agonist

What drug class is recommended in patients with CKD and diabetes who are unable to use SGLT2 inhibitors or require additional glycemic control?

finerenone

nonsteroidal mineralocorticoid receptor antagonist indicated to reduce CKD progression and cardiovascular risks; can be added to an SGLT2 inhibitor and maximally-tolerated dose of an ACE inhibitor or ARB if eGFR ≥25

<60

Dose adjustments of certain drugs may be necessary when CrCl is ________ mL/min.

≤30

When CrCl is ________ mL/min, additional dose adjustments may be needed or the drug may be contraindicated.

aminoglycosides, beta-lactam antibiotics, fluconazole, quinolones, vancomycin

What 5 anti-infectives require decreased doses or increased dosing intervals in CKD?

antistaphylococcal penicillins, ceftriaxone

What 2 beta-lactam antibiotics don't require decreased doses or increased dosing intervals in CKD?