Rx_2.6 (Renal) Flashcards
1
Q
Oliguria + elevated BUN/Cr following tx for leukemia ==> dx?
A
- acute renal failure due to Tumor Lysis Syndrome
- cytotoxic chemotherapy ==> destruction of neoplastic cells ==> dump cellular contents
- ==> hyperphosphatemia + elevated purines + hypocalcemia
- metabolic acidosis
- purines metabolized to uric acid + other metabolites ==> overwhelm kidney ==> acute renal failure
2
Q
Prevention of Tumor Lysis Syndrome
A
- Allopurinol = xanthine oxidase (final step in synthesis of uric acid from purines) inhibitor
- typically used in tx of gout
3
Q
Presentation of tubulointerstitial nephritis
A
- low-grade fever
- rash
- arthralgias
- sx/signs of acute renail failure
- UA
- sterile pyuria (WBCs w/out bacteria)
- microscopic hematuria
- eosinophiluria
4
Q
Drugs associated w/tubulointerstitial nephritis
A
- most commonly associated with drugs
- sulfonamides
- thiazide diuretics
- loop diuretics
- antibiotics
- methicillin
- ciprofloxacin
- cephalosporins
- rifampin
- allopurinol
- proton pump inhibitors
- cimetidine
- NSAIDs
5
Q
Cyclophosphamide: MOA, SE
A
- MOA: alkylating agent; cross-links DNA and prevents DNA synthesis and cell division
- anti-neoplastic agent
- immunosuppressant
- SE:
- alopecia
- myelosuppression
- N/V
- hemorrhagic cystitis
- renal tubular necrosis
- ==> muddy, brown casts in UA
6
Q
Diphenhydramine: MOA, use, SE
A
- MOA: first-gen H1-antagonist
- Uses
- allergic rxns
- motion sickness
- dystonic rxns
- SE
- sedation
- anticholinergic effects
- anti-alpha-adrenergic effects
7
Q
Isoniazid: MOA, use, SE
A
- MOA: decreased synthesis of mycolic acids
- Use: TB tx
- SE
- neurotoxicity
- hepatotoxicity
- lupus-like syndrome
- hemolysis @ G-6-P deficient patients
8
Q
Lithium: SE
A
- CNS depression
- dizziness
- nephrogenic diabetes insipidus
- acne
- edema
- hyperthyroidism
- associated w/chronic tubulointerstitial nephritis ==> presents years after lithium therapy
9
Q
Tx of post-infectious glomerulonephritis @ children
A
supportive care
10
Q
Presentation and tx of minimal change disease
A
- Presentation
- Recent URI
- periorbital swelling, generalized edema
- malaise
- Tx
- first line = corticosteroid
- second line =
- chlorambucil: interferes w/DNA replication and RNA trxn
- cyclosporine = inhibits IL-2 ==> suppression of T-cell activation
11
Q
Presentation of renal artery stenosis
A
- elevated BP, edema
- renal artery bruits
12
Q
Contraindicated drug in bilateral renal artery stenosis
A
- ACE-inhibitor
- ACE-i prevent the contriction of the efferent arteriole, which is the compensation mechanism of the kidneys to increase GFR
- ACE-i ==> dilation of efferent arteriole ==> decreased GFR ==> increased creatinine
13
Q
Common adverse effects of ACE-i
A
- dry cough
- hyperkalemia
14
Q
Berger’s disease characteristics
A
- “IgA nephropathy”
- IgA deposits @ mesangium ==> nephritic syndrome
- commonly exacerbated after URI
15
Q
p-anca + eosinophilia ==> dx?
A
- Churg-strauss syndrome
- granulomatous small- to medium-sized vessel vasculitis
- sx/signs
- eosinophilia
- necrotizing nephritis (w/out immune complexes or antibody deposition)
- asthma
- elevated P-ANCA
