1: SIM ARF

Question 1

Management of ARF

Answer 1

Some saline + dialysis x3, corticosteroids

Question 2

Categorize as prerenal, intrinsic renal, or postrenal based on labs

Answer 2

BUN:Cr ratio
>20:1 prerenal
Normal with renal disease.

Question 3

3 major types of acute interstitial nephritis

Answer 3

Immune-mediated, infection-mediated, idiopathic

Question 4

Presentation of NSAID-induced acute interstitial nephritis

Answer 4

Rash, eosinophilia (40%), hematuria (40%), pyuria, proteinuria, renal failure, nephrotic syndrome. 1/3 require dialysis

Question 5

Most likely mechanism for drug-induced interstitial nephritis (brief)

Answer 5

CD4+ T cells -> reactivity. CD8+ T cells -> tubular damage

Question 6

Red cells and red cell casts in urine are suggestive of

Answer 6

gomerulonephritis

Question 7

What findings are consistent with a tubulointerstitial process?

Answer 7

Proteinuria, pyuria, casts

Question 8

Interstitial nephritis is characterized by ______

Answer 8

inflammation and scarring of tubules and interstitial spaces. Glomeruli and vasculature are spared.

Question 9

Drugs associated with interstitial nephritis

Answer 9

Abx (inc PCN, cephalosporins, sulfonamides, fluoroquinolones, rifampin, tremethoprim), Diuretics (Lasix, thiazides), NSAIDs, PPIs, lithium

Question 10

What is nephrotic syndrome?

Answer 10

Glomerular damage –> proteinuria. Nephrotic syndrome causes edema, particularly in your feet and ankles, and increases the risk of other health problems.

Question 11

Source of hyponatremia in NSAID-induced interstitial nephritis

Answer 11

NSAIDs-> inhib PG synth. PG play a role in water balance (antagonize ADH)