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Medicine

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Kidney

Question
2 out of 15
 

Causes of Acute Tubular necrosis include: (PGI June 07)



A Radiocontrastagents
B Bence zone protein

C Amphotericin B
D Toxemia of pregnancy

E All of the above

Ans. E All of the above

Classification and Major Causes of Acute Renal Failure (ARF) (Ref. H-18th Edi, P-2300 Table 279-1)

PRERENAL ARF-

I. Hypovolemia, Severe burns

II. Low cardiac output - CHF

III. Altered renal systemic vascular resistance ratio

A. Systemic vasodilatation: sepsis

B. Renal vasoconstriction: hypercalcemia, norepinephrine, epinephrine, cyclosporine, amphotericin B

C. Cirrhosis with ascites (hepatorenal syndrome)

IV. Renal hypoperfusionwith impairment of renal auto regulatory responses NSAID, ACEI

V.Hyperviscosity syndrome (rare) Multiple myeloma, macroglobulinemia, polycythemia

A. INTRISIC RENAL ARF- The urine osmolality is usually isotonic (< 350 mosm/L), the urine sodium concentration is > 40 meq/L, and the FENa+ and renal failure indices are both >1% and frequently > 2 – 3%.The main causes are- Q

I. Renovascular obstruction

II. Disease of glomeruli or renal microvasculature

A. Glomerulonephritis and vasculitis

B. HUS, TTP, DIC, toxemia of pregnancy, accelerated HT, radiation nephritis, SLE, scleroderma

III. Acute tubular necrosis

A. Ischemia: as for prerenal ARF

B. Toxins

1. Exogenous: radiocontrast, cyclosporine, antibiotic (e.g., aminoglycosides Q), chemotherapy (e.g., cisplatin), organic solvents (e.g., ethylene glycol), acetaminophen, illegal abortifacients

2. Endogenous: rhabdomyolysis, hemolysis, uric acid, oxalate, plasma cell dyscrasia (e.g., myeloma)

IV. Interstitial nephritis

V. Intratubular deposition and obstruction

Myeloma proteins, uric acid, oxalate, acyclovir, methotrexate, sulphonamides

VI. Renal allograft rejection

Postrenal ARF (Obstruction)

I. Ureteric II. Bladder neck III. Urethra

Extra Edge: (H-18thPg- 338)

A reduction in urine output (oliguria, defined as <400 mL/24 h) usually denotes more significant AKI

Kidney Flashcard List

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