Principles in prescribing in renal disease

What are the three main functions of the kidney?

Filter blood, regulate electrolytes and water, secrete essential hormones.

What defines Chronic Kidney Disease (CKD)?

Reduction in kidney function or structural damage lasting >3 months.

What defines Acute Kidney Injury (AKI)?

An acute drop in kidney function.

Key symptoms associated with CKD complications?

Anaemia, renal bone disease, cardiovascular disease, peripheral neuropathy.

What is eGFR?

Estimated glomerular filtration rate, standardised to 1.73m² body surface area.

What is the role of the albumin:creatinine ratio (ACR)?

Measures protein leakage in urine to assess kidney damage.

What medications should be held in AKI (DAMN)?

Diuretics, ACEi/ARBs, Metformin, NSAIDs.

How is creatinine clearance (CrCl) calculated?

Using the Cockcroft-Gault formula.

When is CrCl inaccurate?

In elderly, bodybuilders, amputees, muscle wasting disorders, and rapid changes in renal function.

How do you manage pre-renal causes of AKI?

Provide IV fluid resuscitation.

How do you manage post-renal causes of AKI?

Relieve obstruction (e.g., insert catheter).

Complications of AKI?

Hyperkalaemia, fluid overload, metabolic acidosis, uraemia.

First-line treatment for hyperkalaemia?

Nebulised salbutamol, IV calcium gluconate, IV insulin and glucose.

Prescribing principle for drugs in renal impairment?

Dose reduction, increase dosing interval, or switch drug.

When should DOAC doses be adjusted?

In patients with impaired renal function, based on weight, age, and serum creatinine.

Why avoid NSAIDs in renal disease?

They inhibit prostaglandin synthesis, impairing renal perfusion.

What is the impact of ACEi/ARBs on renal disease?

May worsen renal function but are beneficial long-term; careful monitoring required.

What was recommended for Mr AK after diagnosing AKI?

Suspend nephrotoxic drugs, amend antibiotic dosing, and monitor renal function.

What anticoagulant adjustment was recommended for Mrs CK?

Dose reduction of rivaroxaban due to CrCl of 25 mL/min.

What medications are recommended for hyperkalaemia management?

Calcium resonium, IV fluids, insulin, glucose, salbutamol, calcium gluconate.