Acute Allergic Interstitial Nephritis Flashcards

1
Q

• Usually occurs within 2 weeks of therapy

A

Acute Allergic Interstitial Nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

the prototype

A

Methicillin-induced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

presentation of Acute Allergic Interstitial Nephritis

A

Fever, maculopapular rash, eosinophilia, arthralgia, and
oliguria.
– Tubular dysfunction may be manifested by acidosis,
hyperkalemia, salt wasting, and concentrating defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

NSAID induced AIN

A

6-months, 70% have nephrotic

syndrome (proteinuria >3.5 g/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

the most definitive method for diagnosis For AIN

A

Renal biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pathogenesis of Acute Allergic Interstitial Nephritis

A

allergic sensitivity response,
granulomas and tubular epithelial cell necrosis are
common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

• Risk factors:

Acute Allergic Interstitial Nephritis

A

No specific risk factors (idiosyncratic hypersensitivity
reactions)
– Individuals with other drug allergies may have increased
risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Prevention of Acute Allergic Interstitial Nephritis

A

: monitor patient carefully, discontinuing the

offending drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Managment of AIN

A

corticosteroid (prednisolone), monitor

kidney function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Chronic Interstitial Nephritis

A
  1. Lithium:
  2. Cyclosporine & Tacrolimus
  3. Aristolochic acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Usually occurs after 10 to 20 years of treatment

A

lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

– Nephrogenic diabetes insipidus is seen in up to 87% of patients

A

lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Presentation of lithium

A

Polydipsia
polyuria
20%, fibrosis in the first 5 years of therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pathogenesis of lithium

A

Impaired ability to concentrate urine is a result of a
decrease in collecting duct response to antidiuretic hormone, which
may be related to downregulation of aquaporin 2 water channel
expression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

risk factors of lithium

A

: long term therapy, age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Prevention of lithium CKD

A

Maintaining lithium concentrations as low as
therapeutically possible, avoiding dehydration, and
monitoring kidney function.
– Amiloride: prevention and treatment of nephrogenic diabetes
insipidus, since it blocks epithelial sodium transport of lithium into the
cortical collecting duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of lithium

A

Discontinuation of lithium therapy or start with amiloride 5
to 10 mg daily during lithium therapy
– Monitor kidney function and lithium serum concentrations

18
Q

– Delayed nephritis after several months of therapy and can

result in irreversible kidney disease

A
  1. Cyclosporine & Tacrolimus
19
Q

– ESRD develops within 6 to 24 months of exposure

A

. Aristolochic acid

20
Q

Can use chromic & acute Interstitial Nephritis & DI

A

lithium

21
Q

Presentation of 3. Aristolochic acid

A

: hypertension, mild proteinuria, glucosuria, high

Scr, anemia

22
Q

Pathogenesis of . Aristolochic acid

A

metabolites bind to DNA and cause direct DNA
damage and may lead to proximal tubular atrophy and
apoptosis

23
Q

• Implies inflammation of the vessel wall, capillaries, or
glomeruli and is typically classified according to vessel
size

A

Renal Vasculitis

24
Q

presentation of renal vasculitis

A

Patients present with hematuria, proteinuria, oliguria,
and red cell casts, frequently along with fever, malaise,
myalgias, and arthralgia

25
Q

Treatment of Renal Vasculitis

A

: D/C the offending drug, administer

corticosteroids or other immunosuppressive therapy

26
Q

Outpatient setting, nephrotoxicity is recognized by

A

the symptoms of
malaise, anorexia, vomiting, volume overload (shortness of breath
or edema), and hypertension

26
Q

Outpatient setting, nephrotoxicity is recognized by

A

the symptoms of
malaise, anorexia, vomiting, volume overload (shortness of breath
or edema), and hypertension

27
Q

Nephrotoxicity may also be evidenced by

A

y primary alterations in

renal tubular function: proteinuria, biomarkers

28
Q

Many toxic substances including drugs are filtered through kidney

A

High concentration in the kidney, i.e., aminoglycosides, cisplatin

29
Q

Directly affect on glomerular membranes

A

Immunologic reaction, gold, penicillamine

30
Q

increase uric acid

increase chance to

A

crystal formation

31
Q

The primary agents associated with this type of injury are↓↓1-Tubular Epithelial Cell Damage

A
A.Aminoglycosides
B. radiocontrast media
C. cisplatin,
D. amphotericin B
E. foscarnet
F. osmotically active agents such as immunoglobulins, dextrans, and
mannitol
32
Q

Typically seen within 5 to 10 days of therapy

A

A.Aminoglycoside

33
Q

Presentation:↓↓ of aminoglycosiodes

A

• Nonoliguria, microscopic hematuria and proteinuria

sometimes

34
Q

pathogenesis of aminoglycosides

A

Accumulation of high drug conc within proximal tubular cells, and
generation of reactive oxygen species that produce mitochondrial injury,
which leads to cellular apoptosis and necrosis.
 The number of cationic groups appears to correlate with the
nephrotoxicity: neomycin > gentamicin > tobramycin > amikacin
 aminoglycosides cause renal vasoconstriction and mesangial contraction

35
Q

Prevention of aminoglycosides

A

Follow up the patient and switch to another antibiotic as
fluoroquinolones (e.g., ciprofloxacin or levofloxacin) and
third-or fourth-generation cephalosporins (e.g., ceftazidime
or cefepime).
– Avoid volume depletion and other nephrotoxic drugs.
– Aminoglycoside dose adjustment
– concurrent use of antioxidant compounds such as alpha- lipoic acid, vitamin E and N-acetylcysteine

36
Q

management of amionoglycosides

A
D/C aminoglycoside or the dosage regimen revised if AKI is evident.
Usually reversible after drug D/C
 D/C other nephrotoxic agents
 Hydration
 Short-term RRT may be necessary
37
Q

• Third leading cause of hospital-acquired AKI, accounting

for 10-13% of case

A

Contrast media-induced nephrotoxicity

38
Q
  • Increased risk in patients with CKD or DM

* 5x increased risk of death

A

Contrast media-induced nephrotoxicity

39
Q

Presentation Contrast media-induced nephrotoxicity

A

s nonoliguria with kidney injury apparent within 24
to 48 hrs of administration
– Scr peaks between 3 and 4 days and recovers after 7-10 days
– Urine: Casts with low Na

40
Q

(rise in
SCr of at least 0.5 mg/dL (44 μmol/L) or a 25% increase in Scr within 48
hours of contrast administration.

A

Contrast media-induced nephrotoxicity