Internal Nephrology

Question 1

Drug induced AKI:
7

Answer 1

1. Amphotericin B
2. Methotrexate
3. High dose oral phosphatase
4. Phenytoin
5. Cisplatin
6. Clopidogrel
7. Norepinephrine

Question 2

Allergic interstitial nephritis (AIN):

Answer 2

• clinical picture fever, rash, peripheral eosinophilia and Liguria renal failure that occurs usually 7-10 days after treatment with:
  1. Beta lactation antibiotics/methicillin
  2. NSAIDs, diuretics, anticonvulsants, PPIs
• diagnostic findings: high Cr, peripheral eosinophilia, pyuria, hematuria and WBC casts
• treatment stop the causative agent, seriodscan help accelerate Neal recovery in severe renal failure

Question 3

Side effect of keyexelate?

Answer 3

Constipation

Question 4

Causes of hypokalemia:
(K 3.5 - 5.2)

Answer 4

1. Low intake: cancer, bulimia, anorexia
2. Increased loss: diarrhea, vomiting, diuretics, laxatives
   3 shifting: asthma Agilent’s on medication
3. Drugs: PPIs, aminoglycoside, amphotericin, chemotx.-playin (also decrease magnesium)

Question 5

ECG changes in hypokalemia:

Answer 5

1. Flat T waves
2. U waves (extra small waves after the T wave)

Question 6

Treatment of hypokalemia:

Answer 6

1. Mild (3.2-3.3) —> K pills
2. Symptomatic/ECG changes: IV K —> femoral line

N.B.: if the hypokalemia does not resolve by giving potassium, check for hypomagnesemia

Question 7

Tip about lithium:

Answer 7

Causes nephrogenic diabetes insipidus
Low Na, very high urine output
Very low urine osmolarity

Question 8

Re-feeding syndrome:

Answer 8

Fasting/malnuritied/ people
Neglected elderly
Low magnesium, phosphate and glucose

Question 9

The effect of vomitting on electrolyte balance:

Answer 9

1. Vomiting leads to loss of H from the GI tract and the retention of bicarbonate—> (M. Alkalosis)
2. During vomiting bicarbonate filtration capacity exceeds its absorption —> loss of bicarbonate in the urine which leads to an alkaline urine with high potassium (hypokalemia)
3. The continuation of the hypokalemia status leads to loss of chloride —> (hypochloremia)

Hypokalemia, hypochloremic metabolic alkalosis

Question 10

Diarrhea/laxatives effect on electrolytes balance:

Answer 10

1. Metabolic acidosis
2. Hypokalemia
3. Urinary anion gap negative

Question 11

SIADH:

Answer 11

1. Serum osmolarity <280
2. Urine osmolarity >400
3. UNA >20-30