Nephrotoxicity: Assessment of Renal Toxicity (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Okay, now let’s look at something that you’re much more likely to see in your practice—nephrotoxicity.

    00:07 First, let’s break that word down—nephro means kidney, and toxic means, yeah, just what it sounds like (bad news for your kidneys).

    00:14 So, these drugs can be kidney damagers.

    00:17 Well, first up, we’ve got our old friends, the antibiotics.

    00:20 These are 2 specific antibiotics that you want to be aware of—gentamicin and amphotericin B.

    00:27 Now, I want to be careful with drugs that I know can really damage the kidneys.

    00:31 I have to know what my patient’s kidney function is before I give them the medication, while I’m giving any of these medications, and then after the medication because even if I give these at appropriate doses and we think the patient’s doing okay, these can cause significant damage to the kidneys.

    00:47 So, radiocontrast media— that’s the type of dye that they put in when they’re going to take them down and do a test.

    00:53 So, if a patient is on a really common medication like metformin, a medication that we use for type 2 diabetics (it’s an oral medication), if we combine radiocontrast media and that metformin, it could severely damage their kidneys.

    01:07 So, here’s how it rolls.

    01:09 You have to, first of all, make sure that you know all the meds that your patients are on, any patient that’s going to have radiocontrast media (you want to assess them to see if they’re on a medication like metformin and then we’re going to hold that medication for 1 to 2 days before they receive the contrast and 1 to 2 days after they get the contrast).

    01:28 So, let’s break that down.

    01:30 If the test is on Wednesday, we’re going to hold that metformin on Monday and Tuesday.

    01:36 They’re going to have that test on Wednesday and then we’re going to give them a window of Thursday and Friday off of that medication so that they have a real safety net to make sure their kidneys are not impacted.

    01:46 So, what we’ll need to do during that time period is we’ll need to make sure that we do something else to control their blood sugar since they can’t take their metformin.

    01:53 Now, another group of medications, look! There’s another old friend—ACE inhibitors.

    01:58 Remember, we talked about them with angioedema.

    02:01 Also, they can be really hard on kidneys.

    02:04 NSAIDS which are nonsteroidal anti-inflammatories.

    02:08 Okay, you’re like, “What are those and do I take those?” Yeah.

    02:12 I bet if I went around in your house or wherever you are watching this video, and we looked in a purse or a backpack, everyone has these.

    02:20 You might know it as ibuprofen, naproxen, Aleve—that’s what an NSAID is.

    02:26 Now, those are over-the-counter ones.

    02:28 We’ve got stronger, more potent medications that are NSAIDS but know that they can really be hard on kidneys.

    02:35 My own father was really sick.

    02:38 He was vomiting and got dehydrated, but he has really bad arthritis so he took an NSAID because, of course, he is elderly and they always consistently take their medications and he didn’t want to hurt, but the combination of being really dehydrated and already having kidneys that were challenged, he continued to take that medication without flushing out through the kidneys, threw him into acute renal failure that ended up with weeks and weeks in the hospital.

    03:05 Now lithium salts are a psych medication and we use those a lot— it’s a mood stabilizer so we can use that with schizophrenia and we can use it with bipolar disorder, but they can really also be hard on the kidneys and we’ll talk more about that medication in the psych module.

    03:20 The last one is chemotherapy.

    03:21 Wow.

    03:23 Chemotherapy is kind of a necessary evil.

    03:25 It’s a horrible disease to treat cancer but sometimes the chemotherapy gives us bigger problems even than the cancer and cisplantin is another one that can end up with some toxicities.

    03:36 So, what should I do as a nurse if my patient is taking a medication that I know has a possibility of being nephrotoxic? Well, I’m going to watch their serum creatinine—that’s a blood test that you draw, lab will come up and draw the blood for you and these are the normal levels for women and for men.

    03:55 So, what’s your job as a nurse is to make sure to know which meds are nephrotoxic, make sure that you have this data and information on your patients, and know what normal is because if your patient, male or female, already has an elevated creatinine, you’re going to want to stop the medication and notify the healthcare provider immediately.

    04:16 Now, when I say elevated, that means a level greater than 1.1 for women and greater than 1.3 for men.

    04:23 Now, these are just ranges for you to kind of get an idea.

    04:27 When you start working in a hospital or a clinic or an outpatient setting, every lab will have a little bit different values, but they’ll tell you what their normals are.

    04:36 But for now, we’ll use these values.

    04:38 Don’t let it stress you out if every textbook you use or every lab that you see has a little bit different values.

    04:45 Just find the midrange value to memorize, and we think this one’s a pretty good one.

    04:49 Just find the midrange value to memorize and stick with that as you progress through nursing school, and when you get into practice, you’ll see the values printed on every lab report that comes back.

    05:00 So, for kidney function, you’re going to look at creatinine level and you’re going to look at the BUN.

    05:05 Now, normal is 7 to 20 if we’re looking at mg/dL, and if that is elevated, (greater than 20), that tells us the kidneys are in trouble; they’re having problems.

    05:16 So, you want to draw this type of lab work and make sure we have this information before the medication is given, during the administration of the medication, and afterwards just to check and make sure that the kidney function is doing well.

    About the Lecture

    The lecture Nephrotoxicity: Assessment of Renal Toxicity (Nursing) by Rhonda Lawes, PhD, RN is from the course Pharmacology and Implications for Nursing.

    Included Quiz Questions

    1. Metformin
    2. Levothyroxine
    3. Morphine
    4. Lisinopril
    1. Creatinine
    2. BUN
    3. Hemoglobin
    4. Troponin
    5. Potassium
    1. ACE inhibitors
    2. Beta blockers
    3. Calcium channel blockers
    4. Alpha blockers

    Author of lecture Nephrotoxicity: Assessment of Renal Toxicity (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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