Endogenous Toxins Flashcards
Endogenous compounds that could cause AKI:
MHUM
Myoglobin, hemoglobin, uric acid, and myeloma light chains
Endogenous nephrotoxin released by injured muscle
cells
Myoglobin
Endogenous nephrotoxin released during hemolysis
Hemoglobin
Rhabdomyolysis, a known cause of myoglobin-induced AKI, may result from:
TSC/I- SEH- IM
- traumatic crush injuries,
- muscle ischemia during vascular or orthopedic surgery,
- compression during coma or immobilization,
- prolonged seizure activity,
- excessive exercise,
- heat stroke or malignant hyperthermia,
- infections,
- metabolic disorders (e.g., hypophosphatemia, severe hypothyroidism), and
- myopathies (drug-induced, metabolic, or inflammatory)
Pathogenic factors for AKI due to endogenous
toxins include:
VTO
-intrarenal vasoconstriction,
-direct proximal tubular toxicity, and
-mechanical obstruction of the distal nephron lumen when
myoglobin or hemoglobin precipitates with Tamm-Horsfall protein
(UROMODULIN, the most common protein in urine and produced in the thick ascending limb of the loop of Henle), a process favored by ACIDIC URINE.
Condition that may follow after initiation of cytotoxic therapy
in patients with high-grade lymphomas and acute lymphoblastic leukemia
Tumor lysis syndrome
MASSIVE release of URIC ACID is defined as
serum levels often exceeding
15 mg/dL
mechanism of uric acid for AKI
precipitation in the renal tubules
Mechanism of myeloma light chains for AKI
by direct tubular toxicity and by binding to Tamm-Horsfall protein to form obstructing intratubular casts.
Conditions that could precipitate endogenous- toxin induced AKI
Rhabdomyolysis
-release of myoglobin
Tumor lysis syndrome
-massive release of uric acid
Hemolysis
- release of hemoglobin
Hypercalcemia (can be seen in multiple myeloma)
- intense renal vasoconstriction and volume depletion
What do you call the AKI that results from massive release of myoglobin and/or hemoglobin?
pigment nephropathy
