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From Flashcardlet > SU2M - Tubulointerstitial disease > Flashcards

SU2M - Tubulointerstitial disease Flashcards

0
Q

4 General causes of AIN?

A
  1. Acute allergic rxn to medications –> MOST COMMON CAUSE
    - ex: penicillinc, cephalosporins, sulfa drugs, diuretics (furosemide, thiazide), anticoagulants, phenytoin, rifampin, allopurinol, or PPIs
  2. Infection –> esp in children
    - ex: strep, legionella pneumoniae, etc.
  3. Collagen vascular disease
    - ex: sarcoidosis
  4. Autoimmune dz
    - ex: SLE, Sjogren’s syndrome, etc.
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1
Q

Acute interstitial nephritis: general characteristics?

A
  • inflammation that involves the interestitium
  • interestitium = tissue that surrounds glomeruli and tubules
  • causes 10-15% of the cases of Acute Kidney Injury (AKI)
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2
Q

AIN: ssx (5)?

A
  • Classical findings:
    1. Rash
    2. Fever
    3. Eosinophilia
  • also may be present:
    4. Pyuria
    5. Hematuria
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3
Q

AIN: dx?

A
  1. Renal function tests –> increased BUN & Cr levels
  2. Eosinophilia on urinalysis –> suggests dx given the proper hx and findings!
  3. Mild proteinuria - may be present
  4. Microscopic proteinuria - may be present
    * *impossible to tell the difference btwn ATN and AIN on clinical findings alone! The only definitive test for AIN is renal bx, but not done very often bc its invasive!
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4
Q

AIN: tx?

A
  • remove offending agent –> should reverse sx –> if not add steroids too
  • tx infection if present
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5
Q

Acute v. Chronic interstitial nephritis?

A

Acute:
-interstitial nephritis –> RAPID deterioration in renal fctn
-associated with interstitial eosinophils or lymphocytes
Chronic:
-interstitial nephritis –> more indolent
-associated with tubulointerstitial fibrosis and atrophy

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6
Q

Analgesic nephropathy: what is it?

A

-form of toxic injury to the kidney due to excessive use of over-the-counter analgesics –> containing phenacetin, acetaminophen, NSAIDs, or aspirin

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7
Q

Analgesic neohropathy: 2 ways it can manifest?

A
  1. Interstitial nephritis

2. Renal papillary necrosis

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8
Q

Analgesic nephropathy: what can it lead to?

A

-acute or chronic renal failure

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9
Q

Renal papillary necrosis: what is it most commonly associated with (6)?

A
  1. Analgesic nephropathy
  2. Diabetic nephropathy
  3. Sickle cell dz
  4. Urinary tract obstruction
  5. Chronic alcoholism
  6. Renal transplant rejection
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10
Q

Renal papillary necrosis: dx?

A

-observing changes in the papilla or medulla in an excretory urogram

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11
Q

Renal papillary necrosis: tx?

A

-tx underlying cause and stop offending agent (ex. NSAIDs)

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12
Q

Renal tubular acidosis: what is it? What is it characterized by?

A
  • disorder of renal tubules that leads to a non-anion gap hyperchloremic metabolic acidosis
  • glomerular function is normal
  • decrease in H+ excreted in urine = acidemia + urine alkalosis
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13
Q

Type 1 RTA: what is the defect?

A
  • distal
  • inability to secrete H+ at the distal tubule –> so, new bicarbonate cannot be generated
  • can’t acidify urine –> metabolic acidosis
  • urine pH CANNOT be lowered below 6, regardless of the severity of the acidosis
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14
Q

4 Consequences of distal RTA? Cause?

A
  1. Decrease in ECF
  2. Hypokalemia
  3. Renal stone/nephrocalcinosis –> due to increased Ca and phos excretion into alkaline urine
  4. Ricketts/osteomalacia
    * *cause of all: increased excretion of ions (sodium, Ca, K, sulfate, phos)
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15
Q

What type of acidosis does distal RTA cause?

A

-hypokalemic, hyperchloremic, non-anion gap acidosis

16
Q

Distal RTA: sx?

A

-secondary to nephrolithiasis

17
Q

Causes of Distal RTA

A
  1. Congenital* –> kids
  2. Multiple myleoma*
  3. Nephrocalcinosis
  4. Nephrotoxicity (ex. Amphotericin B toxicity*)
  5. Autoimmune dz (ex. Lupus, Sjogren’s*)
  6. Medullary sponge kidney
  7. Analgesic nephropathy w
18
Q

Distal RTA: tx?

A
  1. Correct acidosis with sodium bicarb –> helps prevent kidney stones (major goal of tx!)
  2. Administer phosphate salts –> promotes excretion of titratable acid
19
Q

Type 2 RTA: defect?

A
  • proximal
  • defect: inability to rabsorb HCO3 at the proximal tubule –> causes increased excretion of bicarb in the urine –> metabolic acidosis
  • pt also loses K & Na in urine
20
Q

Type of metabolic acidosis caused by type 2 RTA?

A

-hypokalemic, hyperchloremic non-anion gap acidosis (same as w/ type 1)

21
Q

Causes of type 2 RTA in adults and children?

A 
Children:
1. Fanconi's syndrome*
Adults:
1. Cystinosis*
2. Wilson's dz
3. Lead toxicity 
4. Multiple myeloma* --> make sure to rule this out in any pt with proximal RTA, bc the excretion of monoclonal light chains can be a common feature!! 
5. Nephrotic syndrome
6. Amyloidosis
22
Q

Neohrolithiasis and nephrocalcinosis in type 1 v type 2 RTA?

A

-both occur ONLY in type 1!

23
Q

Type 2 RTA: tx?

A
  1. Tx underlying cause
  2. DONT give bicarb to correct acidosis, bc they will just urinate it out!
  3. Sodium restriction –> will increase sodium reabsorption = also increases bicarb reabsorption in PT!
24
Q

Type 4 RTA: what can it be the result of? Who is it commonly seen in? What is happening with Na, H, and K?

A
  • can result from any condition where there is hypoaldo or increased renal resistance to aldo
  • common in pts with interstitial renal dz and diabetic nephropathy
  • characteristics:
    1. Decreased Na absorption
    2. Decreased H+ secretion –> in DT
    3. Decreased K+ secretion –> in DT
25
Q

What type of acidosis does type 4 RTA cause?

A
  • non-anion gap metabolic acidosis
  • acidic urine
  • HYPERkalemia
26
Q

Hartnup syndrome: what is it?

A
  • autosomal recessive inheritance of defective amino acid transporter
  • causes: Decreased interstitial and renal reabsorption of neutral AAs, such as tryptophan –> causes nicotinamide deficiency
27
Q

Hartnup syndrome: clinical features?

A
  • similar to pellegra:
    1. Dermatitis
    2. Diarrhea
    3. Ataxia
    4. Psychiatric disturbances
28
Q

Fancomi’s syndrome: what is it?

A
  • hereditary or acquired proximal tubule dysfunction
  • defective transport of any if these:
    1. Glucose
    2. AAs
    3. Sodium
    4. Potassium
    5. Phosphate
    6. Uric acid
    7. Bicarb
29
Q

What can Fanconi’s syndrome be associated with?

A
  1. Glucosuria
  2. Phosphaturia –> leads to skeletal problems: rickets/impaired growth in kids, osteomalacia, osteoporosis, pathologic fractures in adults
  3. Proteinuria
  4. Polyuria
  5. Dehydration
  6. Type 2 RTA
  7. Hypercalciuria
  8. Hypokalemia
30
Q

Fanconi’s syndrome: tx?

A

Supplement:

  1. phosphate
  2. Potassium
  3. Alkali
  4. Salt
  5. Hydration!

From Flashcardlet (79 decks)

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