MTB 1 Flashcards
Ethylene Glycol Toxicity effect on kidney
Acute kidney injury
Oxalic acid and oxalate precipitate in tubule to cause ATN
Envelope shaped crystals
LOW Calcium (calcium oxalate)
NSAIDs and Ibuprofen cause what kidney damage
Acute interstitial nephritis
Papillary necrosis
Presentation of Papillary necrosis
Sudden flank pain
Fever
Opiates ass’d with what kidney damage
Focal Segmental Glomerulonephritis
What electrolyte disturbance increases risk of aminoglycoside or cisplatin toxicity
Low Magnesium
Bence Jones protein effect on kidney
Directly toxic to renal tubules
Death by RF and Infxn in Myeloma
What kind of crystals do we see in Crohn’s?
Why?
Oxalate
Fat malabsorption - fat stays in gut, binds to calcium, so oxalate can’t bind to calcium and we get oxalate crystals
Best initial test for rhabdomyolysis
UA
Positive on dipstick for large amts of blood, but no cells seen on microscope
Causes of rhabdomyolysis
Crush Injury Immobilization Snake bite Trauma SEizures
Labs in rhabdomyolysis
Markedly elevated CPK
Hyperkalemia
Hyperuricemia
Hypocalcemia
Most specific test for rhabdomyolysis
Urine test for myoglobin
TX for rhabdomyolysis
Saline hydration
Mannitol
Bicarbonate = drives K+ back into cells
Wrong answers for TX for ATN
Low dose dopamine
Diuretics
Mannitol
Steroids
Dialysis is answer when
Fluid Overload Encephalopathy Pericarditis Metabolic Acidosis Hyperkalemia
TX for hypocalcemia
Vitamin D + Calcium
Drugs that cause ototoxicity
Pathophys of ototoxicity
Furesomide, Gentamicin
Damages hair cells of cochlea - sensorineural hearing loss, burns inner ear
Aminoglycosides decrease trough for free period to prevent damage
Signs of hepatorenal syndrome
Cirrhosis New onset renal failure w no explanation Very LOW Urine Sodium < 10-15 FeNa < 1% Elevated BUN/Cr > 20:1
TX for hepatorenal syndrome
Albumin
Midodrine - increase mean arterial pressure
Octreotide
What is Midodrine
MOA
Use
Pressor/Inotrope
Stimulates alpha 1 receptors
Constricts arterioles and veins = Increases peripheral resistance
Significant improvement of Supine BP
Atheroemboli - Cholesterol emboli in kidney presentation
Blue/purplish skin lesions in fingers and toes
Livedo reticularis
Ocular lesions
What is Livedo reticularis
Venule swelling caused by capillary obstruction by thrombi
“Blue fish net stocking”
What are peripheral pulses in Atheroemboli
Normal
Too small to occlude vessels
Labs in Atheroemboli
Eosinophilia
Low complement
Eosinophiluria
High ESR
Most accurate diagnostic test for atheroemboli
BX of purplish skin lesions
Acute/Allergic Interstitial Nephritis Definition
ARF damaging tubules
Abs and eosinophils attack cells lining tubules as rxn to drugs, infxn, AI dz
Drugs that cause AIN
PCNs Cephalosporins Sulfas Phenytoin Rifampin Quinolones Allopurinol PPIs
Presentation of AIN
Fever
Rash
Arthralgias
Eosinophilia + Eosinophiluria
Most accurate test for AIN
Hansel or Wright stain - detects eosinophils
TX for AIN
Resolves spontaneously - treat underlying cause
If Creatinine keeps rising after, admin glucocorticoids
Best initial test for AIN
UA for eosinophils
Pathophys of analgesic nephropathy
PG Inhibition (constriction at afferent arteriole) causes vascular insufficiency = decreased renal perfusion
ATN - directly toxic to tubules
Papillary necrosis
Papillary Necrosis seen in
Underlying renal disease + NSAIDs
- Sickle Cell
- Diabetes
- Urinary obstruction
- Chronic Pyelonephritis
Papillary Necrosis Presentation
Sudden onset flank pain
Fever
Hematuria
Best diagnostic test for Papillary Necrosis
UA shows red and white cells
Most accurate test for Papillary Necrosis
CT scan shows abnormal internal structures
Chronic Pyelonephritis on IVP
Blunting of calices
Calyceal clubbing focal, parenchymal scarring
CT scan of Papillary Necrosis
Bumpy contour (lost papillae)
TX for Pyelonephritis
Abx
- Amp/Gent
- FQ’s
Tests for Glomerular DZ
UA w hematuria UNa and FeNa= Low Red cell casts Proteinuria Dysmorphic red cells
Goodpasture Dz Presentation
Lungs and kidney
No = URT, skin, joint, GI, eye, or neuro
Anemia often present
Goodpasture v Wegener
Goodpasture = No Upper respiratory tract involvement
Wegener =URT involvement
Best initial test for Goodpasture
Antiglomerular BM Abs
Most accurate test for Goodpasture
Lung or Kidney BX
- Kidney Bx = linear deposits
TX for Goodpasture
Plasmapheresis + Steroids
IgA Nephropathy
Aka?
Presentation?
Complement levels
Berger Dz Young, adult men Asians Recurrent gross hematuria 1-2 days post URI Normal Complement levels
MCC of acute glomerulonephritis
IgA Nephropathy
Post URI glomerulonephritis
- IgA Nephropathy = 1-2 days
2. Poststrep GN = post pharyngitis by 1-2 weeks
Post strep GN Presentation
Test results
Labs
MC in children
High ASO +/-DNAase Abs for GAS
Subepithelial humps of C3
Low complement C3 levels
Most accurate test for IgA Nephropathy
Kidney BX
IgA only elevated in 50%
TX for IgA Nephropathy
No Tx to reverse
Severe proteinuria w ACE-I + Steroids
Postinfectious GN Presentation
Dark urine (cola-colored)
Edema = periorbital
HTN
Oliguria
Management of Postinfectious GN
Supportive
- Abx
- Diuretics
Pathophys of Hepatorenal syndrome
Arterial Vasodilation of splanchnic circulation
Results in under filling of arterial circulation
Pathophys of Atheroemboli
Cholesterol plaques near aorta/coronary arteries broken off during manipulation of vessels with catheterization
Lodge in kidney
Cause AKI
Infxn that cause AIN
Leptospira Legionella CMV Rickettsia Streptococcus Hantavirus
