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Chapter: Medicine Study Notes : Renal and Genitourinary

Specific Nephrotoxins

Rhabdomyolysis (from trauma, status epilepticus, acidosis, etc):

Specific Nephrotoxins

 

·        Aminoglycosides

·        Amphotericin 

·        NSAIDs: ® ¯PGs which vasodilate afferent arteriole ® vasoconstriction. Compounded risk if already dehydrated, elderly, etc 

·        ACE inhibitors. Acute renal failure following introduction of ACE ® ?renal artery stenosis: already reduced renal flow, ACE dilates efferent arteriole ® precipitous fall in GFR. 

·        All radio-contrasts: ¯risk in at risk patients by maintaining hydration with a saline drip

·        Chemotherapy: eg Cisplatin

·        Rhabdomyolysis (from trauma, status epilepticus, acidosis, etc):

o   Injury to membrane of skeletal muscle 

o   ® ­­ Ck 

o   ® Renal failure due to combined effect of nephrotoxic effect of myoglobin, hypovolaemia and aciduria 

o   Urinalysis is +ive for blood but no RBCs on microscopy.  Urine is dark brown

 

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Medicine Study Notes : Renal and Genitourinary : Specific Nephrotoxins |


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