Renal pre-exam 3

jdlevenson's version from 2015-05-07 15:31

Lectures 29-30

Question Answer
Fire victim receives02, D50 and Vitamin b12 from high CO.
AsyphixiantsCO, CN, Hydrogen Sulfide
Irritatnt GasesSulfar dioxide, NO, Ozone, phosgene -> pulmonary edema, rhinorrhea; stay in same place; less water soluble; stay in lung
Irritants with high water solubilityHCl and Ammonia vs. Phosgene which has low water solubility
Diethylene glycolantifreeze
Heavy metalsPb, Fe, Cu, Hg, As, Cd
CCl4 ->Hepatic dysfunction, cancer
DioxinsDermatitis, Chloracne, NHL
BenzeneBone marrow suppression
TolueneRTA, hypokalemia
TOCP/OPPeripheral neuropathy
Activating charcoalto get something out of your stomach
London fogSulfur dioxide.
Activated charcoal ratio to toxin 10-1.
Activated charcoal should beGiven within 1 hour of ingestion.
Toxins that do not bind to charcoalCHILE. Caustics, Hydrocarbons, Iron, Lithium, Ethanol.
STEP 1 Stop absorption. Step 2 toxidromes? Physical exam
Question Answer
Recall, a lot of antihistamines, antipsychotics and antidepressantscan cause anticholinergic excess.
Beyond alcohol, sedative hypnotics and opioids alsoCause withdrawal.
TCAs causetachycardia and hypotension.
TCA overdose treatmentBenzodiazepines, Barb.
Mercury OverdoseLungs
Radioopaque substancesChloral hydrate, Heavy Metals, Iron/ Iodine, Phenothiazines, Enteric coated ASA, Solvents/ halogenated
Methanol -> ? -> blindnessFORMIC ACID. Via optic disc hyperemia and edema.
Ethylene Glycol -> ? -> fluorescent uirineOxalic Acid.
AntifreezeEthylene Glycol.
MethanolWindshield wiper fluid, gas line antifreeze.
Dialyzable ToxinsEthylene Glycol, Isopropanol, Lithium, Methanol, Salicylates, Theophyilline, Carbamazepine. A. E. I. O. U.
TCAs are () vs Salicylates are ()TCAs are BASIC so acidify urine whereas Salicylates are ACIDIC so alkalinize urine.
Sodium Nitrite -> MetHb + Toxin ->Sodium Thiosulfate. OR HydroxyB12.
To enhance eliminationPEG-ES.
Deferoxamine A/EHypotension.
Deferoxamine mechanismAffinitty for Fe3+; used in iron toxicity.
LeadButonian line in gums and or lines in metaphysis growth plate. Lead should be less than 10 mcg/ dl. Basophilic stippling too.
Leads hematologic toxicityACQUIREd Prophyria. Deplets ferrocheltase, ALA dehydratase, pyrimidine 5 nucleotidase.
Lead neuroEncephalpathy, seizures, palsy- - arm or leg drop.
Arsenic clinicalMee’s lines/ nails. Hyperkeratosis.
Aresenic antidoteBAL which is DiMErca/ DMSA.
Edta used inPb encephalopathy. Can cause hypocalcemia.
Hg2+ is more toxicthan Hg+. Can lead to ATN, gastroenteritis, CNS.

Lecture 21

Question Answer
TTPDefects in ADAMTS-13; failure to break down multimers of vWF -> uncontrolled platelet aggregation and inappropriate thrombi
TTP pentadThrombocytopenia with purpura**, neurololgical changes, fever, AKI (not so major though), microanagiopathic hemolytic anemia (decreased Hb, HCT, Hapto, increased LDH, bilirubin)
HUS triadThrombocytopenia with purpura, Microangiopathic hemolytic anemia, Renal dysfunction**. And N/V. Only for typical/ secondary.
HUS mechanismMore complement than necessary. Endothelial injury, thrombosis, hemolysis.
TTP occurs withCalineurin inhibitors; Pregnancy.
Secondary HUSShiga toxin, E. Coli.
HUS prodromeAbdominal pain, N/V, diarrhea.
TTP/ HUS on light microscopy and EMfragmented RBCs in glomerulus, fibrin thrombi, pale material in SUBENDOTHELIAL. Fibrinogen deposition on IF.
TTP treatmentPlasma exchange.
Eculizumab? Use?Monoclonal AB to C5. Blocking terminal complement cascade. For primary/ atypical HUS.
Secondary HUS treatmentRest and maybe plasmapheresis.
HSPImmune mediated vasculitis associated with deposition of IgA.
HSP clinicalPalpable purpura on legs and buttocks. Nephropathy. Acute onset arthritis, abdominal pain, N/V. OCCURS AFTER URI OR STREP PHARYNGITIS. 90% of cases are children.
Knee ankle arthritisHSP/ IgA vasculitis.
Iga NephropathyMesangial matrix proliferation and increased cellularity.
HSP Iga Nephropathy prognosisVariable.
HSP treatmentSupportive. Sympomatic relief.
CryoglobulinImmunoglobulins and complements which precipitate at cooler temperature.
Cryoglobulin a/wHep C. Chronic stimulation of immune system -> production of cyoglobulins in higher concentration. Immune complexes form.
Cryoglobulin6th decade!! And then similar to HSP – palpable pupura (with macules*** and purpursa) from cutaneous vasculitis, weakness or sensory changes from peripheral neuropathy, arthralgias, fatigue, malaise.
MPGN IFGranular deposits of complement.
MPGN EMThickened membrane. TRAM TRACKS. And FINGER PRINT like STRUCTURES are CRYOGLoBULIN. Immune complexes of cryo and antigens in target organs. Decreased or defective clearance of immune complexes.
Small papules on tattoo?Sarcoidosis.
Sarcoidosis leads to what renal findingAIN.
Nephrogenic Sclerosing Fibrosisextensive skin thickening and plaques; brawny hyperpigmentation, papules and nodules. Seen in CKD.