Urine Nephrology Now: A Primer for Students in Nephrology
This chapter provides a reference for common medication classes used in nephrology, highlighting their mechanisms, uses, and key considerations.
| Medication Class | Examples | Primary Mechanism & Use | Key Clinical Pearls & Cautions |
|---|---|---|---|
| RAAS Inhibitors (ACEi/ARB) | Lisinopril, Losartan | Block the renin-angiotensin-aldosterone system. Used for hypertension and proteinuria to slow CKD progression. | Monitor for hyperkalemia and acute rise in creatinine (acceptable up to 30%). ACEi can cause a dry cough. |
| SGLT2 Inhibitors | Empagliflozin, Dapagliflozin | Block glucose reabsorption in the proximal tubule. Slows CKD progression and reduces cardiovascular events. | Causes an initial, expected dip in eGFR. Risk of euglycemic DKA and genital mycotic infections. |
| Loop Diuretics | Furosemide, Torsemide, Bumetanide | Inhibit Na-K-2Cl cotransporter in the thick ascending limb. Used for volume overload. | Dose needs to be increased as eGFR declines. Torsemide and bumetanide have better oral bioavailability than furosemide. |
| nsMRAs | Finerenone | Non-steroidal mineralocorticoid receptor antagonist. Reduces albuminuria and cardiovascular risk in diabetic kidney disease. | Lower risk of hyperkalemia compared to steroidal MRAs (spironolactone). |
| Phosphate Binders | Calcium Acetate, Sevelamer, Ferric Citrate | Bind dietary phosphate in the GI tract to treat hyperphosphatemia in CKD. | Must be taken with meals. Choice depends on serum calcium levels and cost (non-calcium binders are more expensive). |
| ESAs | Epoetin alfa, Darbepoetin alfa | Erythropoiesis-Stimulating Agents used to treat anemia of CKD. | Ensure iron stores are adequate before starting. Target hemoglobin is 10-11 g/dL to avoid increased cardiovascular risk. |