QuestionSBA
QuestionChoice
Atorvastatin does not commonly cause renal impairment.
50370
b
Atorvastatin
QuestionChoice
Salmeterol does not commonly cause renal impairment.
50371
c
Salmeterol
QuestionChoice
Paracetamol does not commonly cause renal impairment. It can sometimes cause renal impairment if taken as an overdose, however in this scenario the patient has not taken an overdose.
50373
e
Paracetamol
QuestionChoice
Tiotropium does not commonly cause renal impairment.
50372
d
Tiotropium
QuestionChoice
Losartan is a cause of renal acute kidney injury. It alters the vascular tone of both the afferent and efferent arterioles. In turn, the blood flowing across the glomerulus is altered. This then reduces the glomerular filtration rate which causes a reduction in renal function.
50369
a
Losartan
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3657
The use of losartan is linked to acute kidney injury
Topic
9
Internal Medicine
10128
Case Presentation: A 64-year-old gentleman is admitted to AMU with leg pain.




 **PH** Hypertension, COPD, Hypercholesterolaemia


 **DH** Atorvastatin 20mg PO daily, Losartan 100mg PO daily, Salmeterol 50micrograms INH BD, Tiotropium 5micrograms INH daily, Paracetamol 1g PO QDS


 **On examination**


BP 142/82mmHg, HR 82, RR 12, Weight 80kg


 **Investigation**

||||
|---------------------------|:-------:|--------------------|
|Sodium|138 mmol/L|135 - 145|
|Potassium|4.3 mmol/L|3.5 - 5.3|
|Urea|8.0 mmol/L|2.5 - 7.8|
|Creatinine|182 µmol/L|60 - 120|
|eGFR|48 mL/min/1.73m<sup>2</sup>|> 60|


Question: Select the medication that is most likely to have contributed to the reduction in renal function.
a