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Gen Med (Renal) > Tubulointerstitial Disease > Flashcards

Tubulointerstitial Disease Flashcards

1
Q

Renal tubular acidosis causes what acid-base balance? (be specific)

A

Hyperchloraemic metabolic acidosis

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2
Q

What is the anion gap in the metabolic acidosis of renal tubular acidosis?

A

Normal

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3
Q

What is type 3 renal tubular acidosis?

A

A rare combination of types 1 and 2

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4
Q

What is the commonest cause of type 1 renal tubular acidosis in adults?

A

Autoimmune disease (e.g. SLE, Sjogren’s)

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5
Q

What are some examples of drugs which may cause type 1 renal tubular acidosis?

A

Lithium, amphotericin B

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6
Q

Fanconi syndrome is a cause of which type of renal tubular acidosis?

A

Type 2

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7
Q

What are some examples of drugs which may cause type 2 renal tubular acidosis?

A

Heavy metals, acetazolamide, tetracyclines

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8
Q

Diabetic nephropathy is a recognised cause of which type of renal tubular acidosis?

A

Type 4

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9
Q

What are some examples of drugs which may cause type 4 renal tubular acidosis?

A

Potassium-sparing diuretics, beta blockers, NSAIDs

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10
Q

Addison’s disease is a recognised cause of which type of renal tubular acidosis?

A

Type 4

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11
Q

What are the initial symptoms of renal tubular acidosis?

A

GI symptoms, such as decreased appetite, vomiting and abdominal pain

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12
Q

How may renal tubular acidosis eventually lead to shock?

A

Metabolic acidosis causes vasodilation of the peripheral arterioles

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13
Q

What is the most recognised complication of type 1 renal tubular acidosis?

A

Nephrocalcinosis with calcium phosphate stones

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14
Q

What is the most recognised complication of type 2 renal tubular acidosis?

A

Rickets or osteomalacia

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15
Q

Describe what is meant by type 1 renal tubular acidosis?

A

There is a failure to excrete H+ ions in the distal tubule of the nephron

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16
Q

What happens to the pH of urine in renal tubular acidosis?

A

It is increased (alkaline)

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17
Q

How is type 1 renal tubular acidosis treated?

A

Oral sodium bicarbonate or sodium citrate

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18
Q

Describe what is meant by type 2 renal tubular acidosis?

A

There is a failure to reabsorb bicarbonate in the proximal tubule of the nephron

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19
Q

Which electrolyte abnormality is seen in both type 1 and 2 renal tubular acidosis?

A

Hypokalaemia

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20
Q

How is type 2 renal tubular acidosis treated?

A

High doses of bicarbonate supplementation

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21
Q

Type 4 renal tubular acidosis is due to what?

A

Hypo-aldosteronism, causing hyperkalaemia

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22
Q

How is type 4 renal tubular acidosis treated?

A

Treating the underlying cause and correcting the potassium level

23
Q

Fanconi syndrome is dysfunction of which part of the renal tubule?

A

Proximal tubule

24
Q

Fanconi syndrome leads to the loss of what things in the urine?

A

Amino acids, glucose, phosphate and bicarbonate

25
Q

What is the most common cause of AKI seen in clinical practice?

A

Acute tubular necrosis

26
Q

What are the two main types of acute tubular necrosis?

A

Ischaemic and nephrotoxic

27
Q

How does acute tubular necrosis present?

A

With an AKI

28
Q

Muddy brown casts in the urine are associated with what diagnosis?

A

Acute tubular necrosis

29
Q

How is acute tubular necrosis managed?

A

Treat the underlying cause and manage supportively

30
Q

Interstitial nephritis is inflammation of the renal interstitium. What are the two main causes for this?

A

Direct toxicity or an acute hypersensitivity reaction

31
Q

What are some examples of drugs known for causing interstitial nephritis?

A

Antibiotics, NSAIDs, allopurinol, diuretics

32
Q

Interstitial nephritis usually occurs how long after starting a drug?

A

15 days

33
Q

How does interstitial nephritis present?

A

Mild renal impairment, and systemic features such as a rash, fever and arthralgia

34
Q

What is a common feature on FBC of someone with interstitial nephritis?

A

Eosinophilia

35
Q

What are some features that may be seen on urine microscopy of someone with interstitial nephritis?

A

Sterile pyuria and white cell casts

36
Q

A biopsy of interstitial nephritis shows what in the interstitial space?

A

Oedema and inflammatory cell infiltrate

37
Q

How is interstitial nephritis managed?

A

Treat/stop the underlying cause

38
Q

If there has been no improvement to interstitial nephritis after one week, what medication can be given as a trial for a month?

A

Prednisolone

39
Q

Interstitial nephritis may occur associated with what other condition in young females?

A

Uveitis

40
Q

Chronic interstitial nephritis is most common in individuals with what?

A

Abnormal renal anatomy

41
Q

What is the commonest cause of chronic interstitial nephritis?

A

Analgesic nephropathy

42
Q

What are the 3 main clinical features of renal papillary necrosis?

A

Proteinuria, haematuria and loin pain

43
Q

What are some causes of renal papillary necrosis?

A

Pyelonephritis, diabetic/obstructive/analgesic nephropathy, sickle cell anaemia

44
Q

‘Cup and spill’ appearance on IV urogram is suggestive of what diagnosis?

A

Renal papillary necrosis

45
Q

Acute crystal nephropathy (AKI due to acute uric acid precipitation) is usually due to what?

A

Tumour lysis syndrome

46
Q

How can the risk of acute crystal nephropathy be reduced in individuals undergoing chemotherapy?

A

Give allopurinol before chemotherapy

47
Q

How can the risk of radiocontrast nephropathy be reduced?

A

Stop other nephrotoxic agents and keep patients hydrated with 0.9% IV saline both pre and post procedure

48
Q

When does contrast nephropathy typically occur?

A

2-5 days after administration of contrast dye

49
Q

A massively raised CK is most suggestive of what diagnosis?

A

Rhabdomyolysis

50
Q

What are the two main complications of rhabdomyolysis?

A

AKI and hyperkalaemia

51
Q

Tea/cola coloured urine suggests what?

A

Myoglobinuria

52
Q

What happens to calcium and phosphate levels in individuals with rhabdomyolysis?

A

Phosphate is high, calcium is low

53
Q

What type of acid-base disorder is associated with rhabdomyolysis?

A

Metabolic acidosis

54
Q

How is rhabdomyolysis treated initially?

A

Urgent management of hyperkalaemia and IV fluid therapy

Gen Med (Renal) (18 decks)

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