Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nephrology > Tubulointerstitial nephropathy and nephrotoxins > Flashcards

Tubulointerstitial nephropathy and nephrotoxins Flashcards

Acute tubulointerstitial nephritis (ATN) Chronic tubulointerstitial nephritis (CTN) Analgesic nephropathy Aminoglycosides Rhabdomyolysis

1
Q

How does ATN present? When should you consider it as a diagnosis?

A

AKI

Consider ATN when there are no obvious pre or post renal causes of AKI

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

What is seen on biopsy of ATN?

A

inflammatory cell infiltrate in interstitium +/- tubule

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

What are the causes of ATN?

A
  1. Drugs - abx, NSAIDs, PPIs, diuretics, ranitidine, anticonvulsants, warfarin
  2. Infection - strep, pneumonia, staph, campylobacter, e.coli, mycoplasma, CMV, EBV, HSV, hep A+C
  3. Autoimmune: SLE, sarcoid, Sjogrens, ANCA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the treatment of ATN?

A

Stop causative agent or rx underlying cause

Steroids?

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

What is CTN?

A

Insidious onset of interstitial nephritis w slowly progressive renal impairment

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

What is seen on biopsy in CTN?

A

interstitial fibrosis and tubular atrophy

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

What are the causes of CTN?

A
  1. drugs - NSAIDS, lithium, calcineurin inhibitors, aminosalicylates (sulfasalazine), chemo e.g. cisplatin
  2. Infection: TB, pyelonephritis, leptospirosis, HIV
  3. Immune: sarcoid, sjogrens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the treatment of CTN?

A

Stop causative agent
Rx underlying cause
CKD Rx: ACEi/ARB, glucose, lipids

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

what drugs cause analgesic nephropathy?

A

NSAIDs
Aspirin
Paracetamol

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

How does analgesic nephropathy present?

A

Hx of chronic pain

Silent until CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What tests would you do to help diagnose analgesic nephropathy

A
  1. Urinalysis - sterile pyuria? proteinuria
  2. USS - small irregular kidneys
  3. IVU - cup and spill appearance - clubbed calyces
  4. Non-contrast CT - reduced renal mass, papillary calcification
  5. Biopsy - CTN secondary to papillary necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is analgesic nephropathy treated?

A

discontinue analgesia
manage CKD
Exclude obstruction from sloughed papilla

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

What are examples of aminoglycosides?

A

Gentamycin

Streptomycin

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

What are RFs for ahminoglycosides causing nephropathy?

A

high dose
prolonged use
CKD
volume depletion

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

What is rhabdomyolysis?

A

Skeletal muscle breakdown leading to release of intracellular contents (K+, myoglobin) into extracellular space
Increased cytokines and lowered nitric oxide leads to renal vasoconstriction
myoglobin is filtered by the kidney and leads to obstruction and inflammation

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

Explain how rhabdomyolysis leads to kidney damage

A
  1. Myoglobin usually binds to haptoglobin but increased amount leads to M exceeding binding capacity, XS M interacts w Tamm-Horsfall proteins and forms casts causing obstruction
  2. Low BP due to renal vasoconstriction caused by increased cytokines and lowered nitric acid so lack of blood flow to kidney
  3. Increased uric acid can cause crystals leading to obstruction
17
Q

How does rhabdomyolysis present?

A

Hx of trauma, surgery, immobility, hyperthermia, seizures,
Muscle pain, swelling, tenderness, AKI
Red brown urine

18
Q

How is rhabdomyolysis diagnosed?

A

Myoglobinuria (false +ve on dipstick but no rbcs on microscopy) raised K+ and PO4, low calcium, increase in plasma creatinine kinase

19
Q

What is the treatment of rhabdomyolysis

A

Supportive
Urgent treatment for hyperkalaemia
IV fluid rehydration
Maybe RRT?

20
Q

Give examples of antimicrobials that are nephrotoxic

A 
aminoglycosides (gentamycin)
co-trimoxazole 
Penicillins
Rifampicin
Aciclovir 
Amphotericin
21
Q

Give examples of anticonvulsants that are nephrotoxic

A

lamotrigine
valproate
phenytoin

22
Q

Give examples of anaesthetics that are nephrotoxic

A

methoxyflurane

enflurane

23
Q

Give examples of crystals that are nephrotoxic

A

urate

24
Q

Give examples of parasites that are nephrotoxic

A

toxoplasmosis

leishmania

25
Q

Give examples of other drugs that are nephrotoxic

A 
PPIs
furosemide
thiazides
ACEi/ARBs
lithium 
iron
calcineurin inhibitors
cisplatin
26
Q

Give examples of bacteria that are nephrotoxic

A 
Strep
legionella
TV
chlamydia 
mycoplasma
salmonella
syphilis
campylobacter
27
Q

Give examples of viruses that are nephrotoxic

A 
EBV
CMV
HIV
measles
adenoviruses
28
Q

Give examples of proteins that are nephrotoxic

A

Igs in myeloma
Light chain disease
Hb in haemolysis
Myoglobin in rhabdo

Nephrology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions