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ABIM NEP Drugs & AIN

ABIM NEP Drugs, AIN & CIN

QuestionAnswer
Explain DRESS Syndrome Life threatening drug reaction with fever, rash, eosinophilia, LAD, atypical lymphocytes, and and organ damage (granulomatous AIN, hepatitis, pneumonitis). Fever develops 1st then rash.
Explain Aristolochic acid nephropathy. aka Chinese herb slimming regimen associated with GU malignancy. Tends to progress rapidly, assoc w/ fanconi syn, enzymuria, LMW proteinuria, small kidneys with extensive fibrosis and tubular atrophy. Rx-stop drug, steroids may slow progression
Cause of Balkan nephropathy? Aristolochic acid! Seeds of Aristolochia clematitis co-mingled with wheat grain during annual harvest.
What is main concern long term for pts w Aristolochic acid nephropathy lifelong risk of transitional cell carcinoma esp after transplantation, where it may occur in >30% of patients
Gold causes ___________. Nephrotic syndrome from membranous disease and not minimal change lesions
Platinum compounds cause ___________. acute tubular necrosis (ATN) through both apoptosis and necrosis, especially of the proximal tubule
Noni juice can cause ______ hyperK
Ephedra (Ma Huang) can cause ______ HTN and stones
Star fruit (carambola) can cause ______ oxalate nephropathy & neurotoxin accumulates in renal disease
Glycerrhizic acid (used as a sweetener) can cause_______. - “apparent” mineralocorticoid excess (AME)
Cadmium exposure can cause? HTN +CKD from chronic tubulointerstitial nephritis w non-nephritic proteinuria and a bland urine sediment, but not associated with gout. Associations inc working in battery plant, bone disease and stones.
Cadmium affects the_____? proximal tubule
Chronic lead toxicity can cause? triad of gout, HTN, and CKD. Lead is similar to cadmium in causing a chronic tubulointerstitial nephritis with non-nephritic proteinuria and a bland urine sediment
Which cancer drugs cause AIN/CIN? ifosfamide, TKI (tyrosine kinase inh), platins, ipilimumab
What AIN associated with urothelial cancers? Aristolochic acid nephropathy
Ascorbic acid (vit C) can cause what type of kidney disease? oxalate nephropathy
Three main causes of AIN? antibiotics, NSAIDs, PPIs (can develop after yrs)
T/F urine eosinophils are specific for AIN. FALSE. 1/3 of AKI cases have + eos. very nonspecific. Also + eos with UTI, pyelo, etc.
T/F WBC casts are common with AIN. FALSE. 50% of pos have no WBC or RBC casts. many pos have casts, but seldom WBC casts. Can see RBC casts. Think pyelonephritis if see WBC casts.
Gallium scan usefulness in AKI? (based on binding of lactoferrin on WBCs). Gallium scan measures uptake 48-72 hrs after injection. + in normal kidneys, ATN, cancer, pyelo, CIN, atheroembolic dz, GNs, IgAN, MCD, and AIN!!! Not very sensitive or specific.
Diagnosis of AIN made using ________. kidney biopsy.
Drug induced AIN associated with what microscopy findings? >10 eos/20x field + granulomas
T/F steroid therapy within a week of AIN diagnosis is associated with improved kidney function. TRUE. Stop offending agent + SM 1gram pulse + pred 1 mg/kg for ?time.
Most common renal manifestation of sarcoidosis? hypercalciuria 50%. Hypercalcemia seen in 10%. Glomeruli normal. T-cell interstitial infiltrate, sometimes with granulomas or giant cells
Renal manifestations of Sjogren Syndrome? AIN, CIN. Assoc w/ + serologies, bland sediment, ,1 g proteinuria, AKI with tubulopathies (Fanconi, dRTA, NDI, fibrosis).
Explain renal manifestations of TINU. uveitis, AIN, sterile pyuria, tubulopathies (Fanconi, dRTA, NDI, fibrosis). +/- granulomas.
What is IgG4 disease? lymphoplasmacytic (T&B). infiltrate with reactive changes, plasma + for IgG4.. Rx- steroids. 60% have high IgG4 levels. + nodular masses on imaging suspicious for malignancy.
“Whorled” or storiform pattern of interstitial fibrosis is seen with ________. IgG4 disease. Immunoperoxidase stain + IgG4 in plasma cells.
Microcystic dilatation of tubules is seen in _____. lithium induced CIN. Rx CKD care, amiloride, adequate hydration if have NDI.
Lead nephropathy findings? AKI, Fanconi's syndrome, CKD (CIN), HTN
Sickle cell nephropathy? hematuria, AKI, CKD (CIN), FSGS, papillary necrosis.
Presentation of papillary necrosis? asymptomatic hematuria, , Gross hematuria, Pain, UTI. + renal tissue and sediment, imaging shows partial or complete necrosis of papilla (“claw”)
Medullary sponge kidney is caused by _____. Ectasia collecting ducts. Urine stasis, lo citrate, dRTA—> ca containing stones. Asymptomatic hematuria and flank pain. Dx made on CT urogram. Rx citrate.
Name immune mediated causes of CIN. Sjogrens, sarcoidosis, IgG4 disase.
Xanthogranulomatous CIN distinguished by _______. lipid laden macrophages. Usually infected with gram negative bacteria. Form staghorn calculi.
Michaels Guttman bodies seen in _______. renal malacoplakia.
Nl physiologic fcns of prostaglandins? maintain renal blood flow& GFR: inc Na reabsorption, inc aldo secretion (results in inc K secretion), lowers water reabsorption, causes vasodilation
List NSAID induced renal problems/diseases. edema, exa HTN, CHF, hyperK, RTA IV, hypoNa, pre renal AKI, ischemic ATN, AIN, NS (MCD, membranous), analgesic nephropathy, papillary necrosis, renal cancer.
Describe drug induced small vessel vasculitis classic leukocytoclastic skin lesion & necrotizing and prolif GN with 2+ IgG stain in mesangium . Often Low complements +MPO & PR3 & human neutrophil elastase. Assoc w levamisole used to cut cocaine (potentiates euphoria)
Gemcytabine causes ____. AKI from TMA. low plt, low haptoglobin, , hi LDH,
Drugs reported to cause TMA bevacizumab, CNI, gemcitobine, mitomycinC, clopidrogel, ticlopidine, opana (oxy morphone), quinine
Drugs reported to cause vasculitis cocaine, PTU, infliximab
Interferon reported to cause? NS from min change dz MCD
Anabolic steroids reported to cause? FSGS
Zolendronate reported to cause? ATN
Tenofivir reported to cause? AKI/ATI/ATN, CKD, fanconi like tubulopathy (RTAII) , rarely NDI (mitochondrial toxin)
Aminoglycosides reported to cause? tubular injury starts 3+days, AKI seen after 7-10 days, usually recovers. EM—> abnl mitochondria, myelin bodies d/t liposomal injury. Causes Bartter like (Na, K, Mg, Ca wasting +, met alk), fanconi syn
Polymyxin B or E reported to cause? ATI/ATN, most common w high dose and long duration of rx + other nephrotoxin
Vancomycin reported to cause? ATI/ATN. AIN. NOT metabolized & excreted by kidney. Dose related. Suspected mech: mitochondrial inj, complement activation & inflammation, oxidative stress.
Amphotericin B reported to cause? ATI/ATN, dRTAI, NDI, hypoK, hypoMg. Constricts off arteriole, creates pores—> permeability cause K & Mg leak out of cells and H+ to leak back in (hypoMg, hypoK, RTAI distal)
Hydroxymethyl starch (Hextend) reported to cause? osmotic nephropathy
Atazanavir reported to cause? crystal nephropathy (rod like crystals) w granulomas + (radioopaque) stones
Indinavir reported to cause? crystal nephropathy (rod like crystals) + (radioopaque) stones
Quinolones reported to cause? AIN (+/-granulomatous), necrotizing vasculitis, ATN, crystal nephropathy (rod like crystals). AIN is most commonly seen on biopsy. No stones.
Methotrexate reported to cause? crystalline nephropathy, most common ppt in acid urine pH <7. Avoid with IVF + alkalinization.
Rx methotrexate nephrotoxicity? leucovorin, hi flux dialysis but see rebound, glucarbidase (cleaves MTX to nontoxic metabolite)
Acyclovir reported to cause? crystalline nephropathy, no stones. Note usu IV high dose, not oral.
Sulfadiazine reported to cause? crystalline nephropathy, +/- (radioluscent) stones. Rx alkalinize urine.
Ascorbic acid reported to cause? crystalline nephropathy
Orlistat reported to cause? crystalline (oxalate) nephropathy
Topiramate reported to cause? (weak CA inh) met acidosis + CaPhos stones, RTAIII
Lithium reported to cause? NDI (hyperNa w dilute urine), ATI/ATN, CIN, renal cysts, FSGS
ARBs and ACEIs reported to cause? hemodynamic AKI, ATI/ATN, hyperK, NAGMA (hi renin, low aldo)
Alendronate reported to cause? no renal effects
Pamidronate reported to cause? NS, AKI from collapsing FSGS or MCD
Zolendronic acid reported to cause? AKI from toxic ATI/ATN
PPIs to cause? AIN, rarely hypoNa, hypoMg or CKD
reported to cause?
Medication causes of crystal nephropathy atazanavir/indinavir, quinolones, acyclovir, sulfonamides, MTX, ascorbic acid, orlistat, triamterene,
Medication causes of nephrolithiasis atazanavir/indinavir (radioopaque), topiramate, carbonic anhydrase inh, sulfadiazine, triamterene,ephedrine
Explain osmotic nephropathy & list causes. Cause AKI/ATI. IVIG/sucrose, hydroxyethyl starch, dextran, mannitol, radiocontrast. drug taken into cell by pinocytosis and cannot be metabolized—> swell
Tyrosine kinase inhibitors (sunitinib and sorafenib) reported to cause? TMA & preeclampsia-like state. Also, acute & chronic interstitial nephritis, CKD, hypophosphatemia. Have anti-VGEF effect
Anti-VEGF agents like bevacizumab reported to cause? preeclampsia-like state w/ HTN and proteinuria. Dose dependent denovo HTN or worsened preexisting HTN..
SGLT2 inhibitors (canagliflozin) renal effects? cause the kidneys to remove sugar from the body through the urine—>UTIs + euglycemic diabetic ketoacidosis
Created by: ka1usg