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Questions and Answers
What is a common consequence of using chemotherapeutic agents?
Which chemotherapeutic agent is known to have nephrotoxic side effects?
How does amphotericin B affect renal tubular cells?
Which form of amphotericin B is known for having a better renal safety profile?
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What is a potential adverse effect of using foscarnet?
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Which of the following antivirals has nephrotoxic effects due to crystal precipitation?
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What is a common mechanism by which chemotherapeutic agents induce nephrotoxicity?
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Which of the following is NOT a nephrotoxic chemotherapeutic agent?
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Which of the following complications are associated with the use of chemotherapeutic agents?
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In patients receiving nephrotoxic drugs, what is a predictive factor for renal tubular damage?
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Which class of drugs is NOT typically associated with nephrotoxicity?
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What characteristic of aminoglycosides contributes to their nephrotoxic effects?
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Which of the following statements about antifungal agents is true regarding their renal effects?
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Which of the following is a strategy to prevent nephrotoxicity in patients taking aminoglycosides?
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Which of the following populations is at a higher risk for drug-induced renal injury due to the use of nephrotoxic agents?
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What is the reported incidence of nephrotoxicity with aminoglycosides even at therapeutic doses?
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What cumulative dose of doxorubicin is reported to be safe when used in combination with taxoids?
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Which symptom is NOT associated with cardiotoxicity from 5-fluorouracil?
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Which mechanism is thought to contribute to the cardiotoxicity of cyclophosphamide and ifosfamide?
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What is the estimated incidence range of cardiotoxicity associated with high-dose cyclophosphamide?
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What factor is NOT suggested to be involved in cisplatin-related acute myocardial infarction?
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Which complication is typically associated with the continuous infusion of 5-fluorouracil?
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Which of the following is a proposed pathophysiological mechanism for 5-FU cardiotoxicity?
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What is a common risk factor for the cardiotoxic effects of 5-fluorouracil?
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Study Notes
Angiotensin II and renal autoregulation
- Angiotensin II increases intra-glomerular pressure.
- ACE inhibitors and ARBs antagonize the activity of angiotensin II.
- This can interfere with renal autoregulation of GFR.
- Loss of autoregulation could lead to acute kidney injury.
Antiviral Agents
- Acyclovir -- High-dose IV acyclovir can cause acute kidney injury from crystal precipitation in the renal tubules. Lower doses and slower infusion rates can prevent nephrotoxicity.
- Foscarnet -- Foscarnet is nephrotoxic, causing acute kidney injury and electrolyte abnormalities.
- Tenofovir (nucleoside reverse transcriptase inhibitor) -- This antiretroviral can cause acute kidney injury with or without proximal tubulopathy.
- Protease inhibitors -- Indinavir can crystallize in renal tubules leading to kidney injury.
Antifungal Agents
- Amphotericin B (AmB) -- Used to treat life-threatening fungal infections. Liposomal AmB has an improved renal safety profile over conventional AmB.
- AmB -- alters membrane permeability of fungal cells, leading to death. This can also damage renal tubular cells.
Chemotherapeutic Agents
- Commonly used chemotherapeutic agents associated with nephrotoxicity include: cisplatin, ifosfamide, and methotrexate.
- Patients with hepatic failure are susceptible to drug-induced renal injury. Hyperbilirubinemia can also be a risk factor.
- Neonates are at risk for drug-induced renal injury, especially those requiring multiple nephrotoxic agents.
### Antibacterial Agents
- Aminoglycosides -- Well known nephrotoxic and ototoxic agents. Despite risks, they are often used to treat Gram-negative bacterial infections.
- Aminoglycosides -- Risk of nephrotoxicity is higher with prolonged treatment. Neomycin is the most toxic, followed by gentamicin, tobramycin, amikacin, and streptomycin.
- Sulfamethoxazole–trimethoprim and sulfa-based antibiotics -- Sulfamethoxazole is a widely used sulfa-based antibiotic. It is often combined with trimethoprim to increase its effectiveness.
### Cardiotoxic Drugs
- Anthracyclines -- Can cause cardiotoxicity.
- Taxoids -- Can cause cardiotoxicity when combined with anthracyclines, leading to lower cumulative anthracycline doses.
- 5-fluorouracil (5-FU) -- Associated with myelosuppression, diarrhea, mucositis, dermatitis, and possibly cardiotoxicity. Cardiotoxicity is more likely with continuous infusion.
- Cyclophosphamide and ifosfamide -- High dose cyclophosphamide is associated with acute cardiotoxicity. The exact mechanism is unknown, but increased free oxygen radicals may play a role.
- Cisplatin -- A number of cases of acute myocardial infarction have been reported after cisplatin treatment. Factors involved may include vascular damage, alterations in platelet aggregation, hypomagnesemia, and activation of an arachidonic pathway in platelets.
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Description
Explore the relationship between angiotensin II and renal autoregulation, as well as the nephrotoxic effects of various antiviral and antifungal agents. This quiz covers key concepts including the impact of ACE inhibitors, acyclovir, foscarnet, and amphotericin B on kidney function. Understand how these agents can contribute to acute kidney injury and their clinical implications.
