Examkin

Soru

Zorluk: OrtaNephrology

Match each clinical presentation of acute renal impairment to the pharmacological agent most likely responsible for its underlying pathogenesis.

  • Acute kidney injury with muddy brown granular casts on urinalysis after treatment for severe Gram-negative pneumoniaGentamicin
  • Acute kidney injury with white blood cell casts, urinary eosinophils, and a maculopapular rashOmeprazole
  • Acute asymptomatic 30% rise in serum creatinine shortly after initiating therapy for heart failureLisinopril
  • Acute oliguric kidney injury occurring 24-48 hours after administration of intravenous antiviral therapy for encephalitisIntravenous acyclovir
  • Polyuria, polydipsia, and hypernatremia with persistently dilute urine in a patient with bipolar disorderLithium

Cevap

Gentamicin matches with muddy brown casts (ATN); Omeprazole matches with WBC casts and eosinophils (AIN); Lisinopril matches with asymptomatic 30% creatinine rise (hemodynamic); Intravenous acyclovir matches with rapid oliguric AKI (crystal nephropathy); Lithium matches with polyuria and hypernatremia (nephrogenic DI).
Each medication listed operates via a distinct mechanism of toxicity affecting different compartments of the kidney: aminoglycosides (tubular toxicity), PPIs (allergic interstitium inflammation), ACE inhibitors (glomerular hemodynamics), IV acyclovir (tubular obstruction via crystallization), and lithium (collecting duct ADH resistance).

Adım Adım Çözüm

1
Analyze the urinalysis, clinical symptoms, and timeline for each patient presentation.
Identified specific patterns: ATN, AIN, hemodynamic alteration, crystal-induced tubular obstruction, and nephrogenic DI.
These patterns point toward distinct mechanisms of drug-induced renal injury.
2
Match the identified pathogenesis to the pharmacological agent known to cause that specific adverse effect.
Assigned each drug to its classic toxicological profile.
Recognizing classic drug-induced nephrotoxicity patterns is essential for appropriate diagnosis and discontinuation of the offending agent.

Anahtar Kavram

Drug-induced nephrotoxicity patterns
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Konular

Nephrology

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