Types of renal disorders

2. RENAL
DISORDERS

3. Presented By:
Huma Hameed
M.Phil. (Pharmaceutics)

4. DRUG INDUCED AIN
(Acute interstitial nephritis)
1%-3% of all ARF

5. DEFINITION OF AIN
• It is a form of nephritis affecting the interstitium of the
kidneys surrounding the tubules. This disease can be
either acute, meaning it occurs suddenly, or chronic,
meaning it is ongoing and eventually ends in kidney
failure.
• A kidney disease characterized by acute onset, a
decreased renal function and microscopic changes
mainly located to the renal interstitium (edema and/or
infiltration of white blood cells).

6. MECHANISM
1.Cell mediated immune mechanism(hrs)
2.Humoral immune mechanism (days)

8. 2.Humoral immune mechanism

13. DRUGS
• Penicillins
• Cephalosporins
• Quinolones
• Sulfonamides
• Refampicin
• NSAIDs

14. Clinical case: Penicillin-Induced AIN
J.S. is a 50-year-old woman who developed a cellulitis 3 days after a
car door was closed on her right hand. She was admitted to the
hospital, where blood and wound cultures were found to be positive for
methicillin-sensitive Staphylococcus aureus. She received two full days
of nafcillin 2 g IV Q 4 hr before being discharged to complete a 14-day
course with dicloxacillin 500 mg PO four times daily (QID). Ten days
after discharge, J.S. returned to the emergency department
complaining of malaise, fever, diffuse rash, hematuria, and reduced
urine output. The following laboratory values were significant: BUN, 39
mg/dL (normal, 5–20); SrCr, 2.3 mg/dL (normal, 0.5–1.2); and WBC
count, 18,500 cells/mm3 (normal, 4,000–9,000) with 18% eosinophils.
The urinalysis was positive for elevated specific gravity, WBC, RBC,
eosinophiluria, and a FENa+ of 3%. What objective data suggest drug-
induced AIN?
[SI units: BUN, 13.9 mmol/L (normal, 1.8–7.1); SrCr, 203.3 mol/L
(normal, 44.2–106); WBC count, 18.5 × 106 (normal, 4.0–9.0)]

15. TREATMENT
1. STOP drug therapy immediately
2. SUPPORTIVE MEASURES that
maintain fluid & electrolyte balance
3. CORTICOSTEROIDS (prednisone 1 g/kg
7days
4. DIALYSIS (oliguric patients)

16. POSTRENAL-ARF
(ACUTE RENAL FAILURE)

17. POSTRENAL ARF:
Any condition that result in the obstruction of urine
flow at any level of urinary tract is termed post
renal ARF
Reasons:
• Stone formation
• Malignancies of prostate
• Prostate hypertrophy
• Bilateral ureter strictures

18. SIGNS AND SYMPTOMS
• Dec. force of urine stream
• Dribbling
• Polyuria
• Pain

19. NEPHROLITHIASIS
DEFINITION:
The formation of stone in kidney is termed
as nephrolithiasis
TYPES:
• Calcium stones
• Struvite stones
• Uricacid stones
• Cystine stones

21. Calcium stones
• 70-80% of all kidney stones
• Visible on X-rays examination.
• Calcium oxalate and calcium phosphate
 Lead to dec. urine output
 Hyperoxaluria
 Hypercalciuria
 Hyperuricosuria
 Renal tubular acidosis

22. Struvite stones
• Magnesium ammonium phosphate crystallization termed
as struvite stones.
• 2-20% of all stone’s cases.
• Leads to irreversible kidney damage.
• Mostly filled in renal collecting ducts

23. Existing solutes are colonized with Proteus,
a bacterium that produces urease,
An enzyme that hydrolyzes urea and alkalinizes
the urine.
The alkaline environment promotes the formation
of insoluble crystals of ammonium, calcium, and
phosphate.
Broad-spectrum antibiotics; administration of
acetohydroxamic acid, which inhibits bacterial
urease; or shock-wave lithotripsy are the
treatments

24. Uric acid stones
• Due to alteration in metabolism of uric
acid.
• Pts with gout
• Pts receiving chemotherapy.
• Invisible on x-rays examination.
• CT scan

26. Urinary pH is positively correlated to insulin
sensitivity
Insulin elevate urinary pH by stimulating proximal
renal tubular ammoniagenesis by increasing
catabolism of glutamine into 2 molecules of
ammonia and α-ketoglutarate
As well as the activity of the sodium/hydrogen ion
exchanger 3 (NHE3) increases
that secretes and traps ammonia in the urinary
space as ammonium.

27. Cystine stone
• Cystinuria is rare autosomal recessive
hereditary disorder of amino acid transport in
renal tubules that result in urine excretion of
large amount of cystine.
• Cytine stone is formed when cystine excretion
rate exceeds the urinary solubility limit.

28. Symptoms And Diagnosis
• severe, acute pain on one flank or the lower back.
• Pain may radiate into the scrotum or testicle on the same
side for men,
• and into the groin area of the
same side for women.
• Urinalysis may show microscopic
blood that is not visible to the naked eye.
• X-ray examination
• CT scan

29. Treatment
• Drink plenty of water
• Broad spectrum antibiotics
(struvite stones)
• Acetohydroxamic acid
(- bacterial ureases)
• HCTZ
• Allopurinol
• Surgical interventions
• Shock wave lithotripsy

30. DRUG-INDUCED
NEPHROLITHIASIS
Weak acidic drugs
e.g., methotrexate,
sulfonamides
Weak basic drugs
e.g., indinavir,
ppt at acidic pH of
urine
Ppt at basic urine pH