17 - Tubular Disorders

Question 1

etiologies of tubule and interstitial kidney dz

Answer 1

infections
NSAIDs, other nephrotoxic drugs
sickle cell, myeloma, lymphoprolif
obstruction
heavy metals
PCKD, medullary cystic dz, medullary sponge kidney etc
DM, hyperuricemia, cystinosis, K depletion, oxaluria hypercalcemia
immunologic - SLE, transplanted kidney, cryoglobulinemia, sjogrens, goodpasture

Question 2

drugs causing interstitial kidney inflammation

Answer 2

abx - PCNs, cephalosporins, fluoroquinolones, rifampin
sulfonamides
NSAIDs
phenytoin
thiazides, furosemide
cimetidine, allopurinol, cyclosporine, omeprazole

Question 3

interstitial and tubular kidney dz often present w/

Answer 3

hematuria (can be micro), non-nephrotic proteinuria, flank pain

Question 4

pattern of NSAID nephropathy

Answer 4

starts in medulla and works its way out until its got whole papilla

Question 5

type of patient who gets NSAID nephropathy

Answer 5

female
middle age
personality disorder - anxious/neurotic
addictive behavior - smoking, alcohol, laxatives, sedatives
cause of analgesic use often headache

Question 6

tx of NSAID nephropathy

Answer 6

discontinue analgesics
control BP (ACEIs)
tx urinary infxns
expand vasc volume
psych support
monitor for cancer

Question 7

herbal that causes urothelial carcinoma

Answer 7

aristolochic acid

Question 8

which genetic dz causes papillary necrosis

Answer 8

sickle cell

Question 9

myeloma cast nephropathy

Answer 9

kappa and lambda chains directly toxic to PCT > cast formation
small anion gap

Question 10

1 heavy metal that causes chronic tubulointerstitial nephropathy and 3 that cause acute

Answer 10

chronic - lead

acute - bismuth, mercury, uranium