Clinical Differentiation Of Tubulointerstitial Disease

Front 1

What causes Acute Interstitial Nephritis (AIN)?

Back 1

Immune mediated injury

Front 2

What causes Acute Tubular Necrosis (ATN)?

Back 2

Ischemia (hypoperfusion) or Toxic Agents

Front 3

What disease is associated with renal failure following use of NSAIDs?

Back 3

AIN

Front 4

What disease is associated with renal failure following IV contrast?

Back 4

ATN

Front 5

What characteristic do all of the drugs associated with ATN have in common?

Back 5

They are all known to be toxic/ have toxic effects in other parts of the body:

Aminoglycosides (mitochondrial damage hearing loss)

Amphotericin B (amphoterrible)

Cisplatin (chemotherapy agent)

Front 6

What medications are associated with ATN?

Back 6

Aminoglycosides

Amphotericin B

Cisplatin

Front 7

What disease is associated with renal failure after taking allopurinol?

Back 7

AIN

Front 8

What characteristic is shared by all of the antibiotics associated with AIN?

Back 8

Severe allergic reaction is associated with all of them

Front 9

Which antibiotics are associated with AIN?

Back 9

Penicillins

Sulfonamides

Cephalosporins

Front 10

Does AIN produce symptoms?

Back 10

It can be asymptomatic or symptomatic

Front 11

What symptoms are associated with AIN?

Back 11

Fever, rash, eosinophilia

Front 12

What cause of renal failure is associated with a Fractional Excretion of Sodium > 1%?

Back 12

AIN

Front 13

Which cause of renal failure is associated with a Fractional Excretion of Sodium < 1%?

Back 13

ATN

Front 14

What is the timeline for a patient who develops renal failure due to aminoglycoside therapy?

What is the diagnosis for this patient?

Back 14

Onset of renal failure 7-10 days after initiating aminoglycoside therapy

ATN

Front 15

What is the timeline for a patient who develops renal failure due to IV contrast?

What is the diagnosis for this patient

Back 15

Onset of renal failure 1-2 days post administration of IV contrast

ATN

Front 16

What agents are associated with developing CIN (chronic interstial disease)?

Back 16

Long Term Analgesic Use + codeine/ caffeine

Front 17

In what population is CIN (chronic interstitial disease) most prevalent?

Back 17

Females

Front 18

What is the most common cause of AIN?

Back 18

Antibiotics

Front 19

What is the most likely diagnosis in acute renal failure if urinalysis shows granular and tubular epithelial casts?

Back 19

ATN

Front 20

What is the most likely diagnosis in an acute renal failure if urinalysis shows eosinophils?

Back 20

AIN

Front 21

At what point does renal failure occur in patients where the inciting event was radiation (timeline)?

What is the diagnosis?

Back 21

6-12 months post-radiation

AIN

Front 22

In a crush injury causing Acute Kidney Injury, what is the most likely cause for the injury?

What would you likely see on urinalysis and sedimentation?

Back 22

Rhabdomyolysis

Urinalysis will come back positive for blood (since it only detects the presence of globin chains)

Sedimentation will show granular casts but no RBCs

Front 23

If a patient is known to have hematuria, what would point to it being glomerular hematuria rather than extraglomerular?

Back 23

Presence of dysmorphic RBCs

proteinuria > 500 mg/ day may be present

Front 24

If a patient is known to have hematuria, what would point to it being extraglomerular hematuria rather than glomerular?

Back 24

Lack of dysmorphic RBCs

proteinuria < 500 mg / day