The document discusses Drug Induced Kidney Disease (DIKD), specifically drug induced nephrotoxicity. It notes that DIKD is a common complication of various therapeutic agents that can cause abnormalities in acid-base balance, electrolytes, urine sediment, decline in glomerular filtration rate, and increased creatinine and BUN. It identifies several classes of drugs that commonly cause nephrotoxicity like aminoglycosides, amphotericin B, and cisplatin. It also discusses risk factors, clinical presentation, prevention, and various pathological mechanisms of nephrotoxicity including tubular epithelial cell damage, acute tubular necrosis, osmotic nephrosis, and hemodynamically mediated kidney
In this presentation i have tried to thoroughly discuss about the concept of Drug induced kidney disease or injury, the mechanism behind it, its classification and how to access it.
Definition, Patterns/types and mechanisms of drug induced liver disorders, assessment of drug induced liver disorders and its treatment (pharmacotherapeutics-3)
Drug induced hematological disorders @rxvichu!!!RxVichuZ
This is my 35th powerpoint..published here in Google Slideshare...
And I wish to thank everyone who have supported me in my 2 year long journey......
This ppt is regarding DRUG INDUCED HEMATOLOGICAL DISORDERS, covering the definitions, causative drugs, pathophysiological mechanisms, manifestations,and management of 5 blood disorders.
Do go through this ppt, and send me ur reviews!!
Regards,
Vishnu.R.Nair.
Slides includes the introduction to drug induced renal disease, pathogenic mechanism by which drug acts on kidney, list of drugs and risk factors.
pathogenic mechanism like altered Interglomerular, Rhabdomyolysis, tubular toxicity, etc.
In this presentation i have tried to thoroughly discuss about the concept of Drug induced kidney disease or injury, the mechanism behind it, its classification and how to access it.
Definition, Patterns/types and mechanisms of drug induced liver disorders, assessment of drug induced liver disorders and its treatment (pharmacotherapeutics-3)
Drug induced hematological disorders @rxvichu!!!RxVichuZ
This is my 35th powerpoint..published here in Google Slideshare...
And I wish to thank everyone who have supported me in my 2 year long journey......
This ppt is regarding DRUG INDUCED HEMATOLOGICAL DISORDERS, covering the definitions, causative drugs, pathophysiological mechanisms, manifestations,and management of 5 blood disorders.
Do go through this ppt, and send me ur reviews!!
Regards,
Vishnu.R.Nair.
Slides includes the introduction to drug induced renal disease, pathogenic mechanism by which drug acts on kidney, list of drugs and risk factors.
pathogenic mechanism like altered Interglomerular, Rhabdomyolysis, tubular toxicity, etc.
Rhabdomyolysis is a serious medical condition, encountered in the intensive care unit (ICU). The etiology of rhabdomyolysis is often multifactorial. It leads to complications like acute kidney injury and life-threatening electrolyte abnormalities. A high index of suspicion and early institution of therapy is required to prevent complications and improve patient outcomes.
Brief Information regarding the disorders of the genitourinary system. This presentation involves the disorders of the urinary system including Chronic Kidney Disease, Congenital problems related to the urinary system, and renal cancers.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Drug Induced Kidney
Disease (DIKD)
Clinical Pharmacy
BY: Dr.Muhammad Umair
Pharm.D, M.Phil. Pharmaceutics(Clinical Pharmacy)
Lecturer
Lahore Pharmacy College Of
Lahore Medical & Dental College
(Pakistan)
2. DIKD/DIN
• Drug induced nephrotoxicity (DIN)
• Common complication of several diagnostic and therapeutic agents
• Manifested as
• Acid–base abnormalities, Electrolyte imbalances
• Urine sédiment abnormalities
• Proteinuria, pyuria, and hematuria
• Decline in the glomerular filtration rate (GFR)
• Rise in the serum creatinine (Scr) and blood urea nitrogen (BUN)
3. • Often reversible on discontinuation of the offending agent
• Maylead to acute Renal Failure (ARF) or end-stage renal disease (ESRD)
4.
5.
6. Epidemiology
• 20% of hospital admissions due to AKI are drug related
• Most of them are communityacquired
• AKI: 7% of hospitalized patients, 20-30% of critically illpatients, significant
source of morbidity and mortality
• Up to 25% of ARF cases are attributed by use of certain drugs
8. Risk factors
• Drug-related factors
• Inherent nephrotoxic potential
• Dose
• Duration, frequency and form of administration
• Repeated exposure
• Drug interactions
• Combined or closely associated use of diagnostic or therapeutic agents with added or
synergistic nephrotoxic potential (e.g.Radiocontrast agents, aminoglycosides, NSAIDs,
cisplatin,ACEI)
9. CLINICAL PRESENTATION
• General
• The most common manifestation is a decline in GFR leading to a rise in Scr and BUN.
• Symptoms
• Malaise, anorexia, vomiting, shortness of breath, or edema.
• Signs
• Decreased urine output may be an early sign of toxicity, particularly with radiographic
contrast media, NSAIDs, and ACEIs, with progression to volume overload and
hypertension.
10. • Proximal tubular injury
• Metabolic acidosis with bicarbonaturia
• Glycosuria in the absence of hyperglycaemia
• Reductions in serum phosphate, uric acid, potassium, and magnesium as a result of
increased urinary losses
• Distal tubular injury
• Polyuria from failure to maximally concentrate urine
• Metabolic acidosis from impaired urinary acidification
• Hyperkalaemia from impaired potassium excretion
11. • Laboratory Tests
• Achange in Scr of at least 0.5 mg/dL for subjects with a baseline Scr <2 mg/dL and
• An increase of >30% for those with Scr >2 mg/dL, when correlated temporally with
the initiation of drug therapy is commonly observed
12. Prevention ofDIKD/DIN
• Avoid the use of potentially nephrotoxic agents (patients at increased risk for
toxicity)
• Maintain careful and adequate hydration to establish high renal tubular urine
flow rates
• Drug mechanism specific intervention
13. Injury patterns
• Subtle injury or overt renal failure
• Some drugs perturb renal perfusion and induce loss of filtration capacity
• Others directly injure vascular, tubular, glomerular and interstitial cells
• Specific loss of renal function leads to clinical findings
• Microangiopathy
• Acute tubular necrosis
• Acute interstitial nephritis
• Nephrotic syndrome, obstruction
• Nephrogenic diabetes insipidus
• Electrolyte abnormalities and chronic renal failure
14. • True incidence of DIN is difficult to determine
• Markers of earlyinjury are being investigated
• Detection is often delayed until an overt change in renal functional capacity
is measured as an increase in BUN, Scr
• Subtle renal damages associated with medications are frequently
unrecognized
• Tubulopathy, acid–base abnormalities, electrolyte imbalances and disorders of water
balance and mild urinary sediment abnormalities
16. 1-Tubular epithelial cell damage
• Caused by either direct toxic or ischemic effects of drugs
• Damage is localized in the PCT & DCT epithelia
• Acute tubular necrosis
• Observed as cellular degeneration and sloughing from PCT & DCT basement
membranes
• Osmotic nephrosis
• Swellingand vacuolization of proximal tubular cells
18. Aminoglycoside Nephrotoxicity
• Incidence
• 5% to 15% of patients receiving aminoglycoside therapy
• Clinical Presentation
• Gradual progressive rise in Scr and in CrCl after 6 to 10 days of therapy
• Nonoliguria >500 mL/day
• Magnesium wasting >10 to 30 mg
• Severe kidney injury does not usually develop
19. • Pathogenesis
• Binding, intracellular transport in lysosomes
• Release of lysosomal enzymes
• ROS generation, Altered cell metabolism and membrane fluidity
• Cellular dysfunction and death
• PCT epithelial cell damage leading to obstruction of the tubular lumen
• Back leakage of the glomerular filtrate across the damaged tubular epithelium
• Reduction of GFR
20. • Risk Factors
• Aggressive aminoglycoside dosing
• Combination of nephrotoxic drugtherapy
• Existing predisposing conditions
• Prevention
• Alternative therapy: fluoroquinolones, 3rd or 4th generation cephalosporins
• Limit the total aminoglycoside dose administered
• Avoid concomitant therapy with other nephrotoxic drugs
• High intermittent dosing: Once daily dosing regimen
21.
22. • Management
• Measure Scr every 2 to 4 days
• Maintain adequate hydration (Avoid volume depletion)
• Discontinue or revised regimen ifScr increase of 0.5 mg/dL ormore
• Short-term dialysis
23. Amphotericin-B Nephrotoxicity
• Incidence
• Toxicityrelates to cumulative dosage, starts from 300-400mg, 4g (at higher doses 80%
incidence)
• Clinical Presentation
• Renal tubular potassium, sodium, and magnesium wasting
• Impaired urine concentrating ability
• Distal renal tubular acidosis
• Decrease in renal blood flow and GFR
• Rise in Scr and BUN
24. • Pathogenesis
• Increases tubular permeability
• Consequent increase in energy and oxygen requirements
of epithelial cells
• Reduced cellular oxygen delivery due to renal
vasoconstriction
• Renal medullary tubular epithelial cell necrosis and kidney
injury
• Risk Factors
• CKD
• Higher average daily
doses
• Volume depletion
• Concomitant
administration of
diuretics
• Rapid infusion rate
25. • Prevention
• Liposomal amphotericin Bformulations (Targeted drug delivery)
• IV infusion of NS daily during the course of therapy reduces toxicity
• Management
• Discontinuation and substitution of therapy
• Daily monitoring of Renal function indices i.e. Scr and BUN
• Daily monitoring of serum magnesium, potassium, and calcium concentrations
26. Cisplatin and Carboplatin Nephrotoxicity
• Incidence
• Previously incidence was 50-100%, now it has reduced to 6-13%
• 20% to 40% decline in GFR is frequently observed
• Pathogenesis
• Binding to PCT cell proteins and sulfhydryl groups
• Disruption of cell enzyme activity, uncoupling of oxidativephosphorylation
• Initially PCT is damaged which progresses to DCT and glomerular necrosis
27. • Clinical Presentation
• Scr reaches at peak after 10-12 days of therapy which recovers in 21 days
• Dose related toxicity, cumulative response on subsequent cycles
• Hypocalcaemia and hypokalaemia
• Hypomagnesemia is associated with seizures, neuromuscular irritability, or personality
changes, and persist long after chemotherapy
• Risk Factors
• Age, dehydration, renal irradiation, concurrent use of aminoglycoside antibiotics, and
alcohol abuse
28. • Prevention
• Dose reduction and decrease frequency of administration
• Combination with other safer chemotherapeutic agents
• Vigorous hydration (maintain 100 ml/h of urineoutput)
• Start 24 hrs prior therapy: 250 ml/h 1 to 4 Lof NS
• 4-8 hrs after dose: 150 to 250 ml/h
• Amifostine: organic thiophosphate
• Chelates cisplatin in normal cell,reduces nephrotoxicity, neurotoxicity, ototoxicity and
myelosuppression
29. • Management
• Cisplatin induced AKI is partially reversible
• Daily monitoring of Renal function indices i.e. Scr and BUN
• Daily monitoring of serum magnesium, potassium, and calcium concentrations
• Electrolyte correction as per need
• Supportive care
• Dialysis
31. • Refers to structural changes that occur at the cellular levelin nephrons
• Morphological pattern with vacuolization, swelling and ultimately, necrosis
of the renal proximal tubular cells
• Several drug are associated
• Mannitol, LMWdextran, radiographic contrast media
• Drug vehicles, such as sucrose and propylene glycol
• IV immunoglobulin solutions
• Plasma volume expanders: Hydroxyethyl starch
35. Pathogenesis
• Within each nephron, blood flow and pressure are regulated by glomerular afferent
and efferent arterioles to maintain intraglomerular capillary hydrostatic pressure,
glomerular filtration, and urine output
• Afferent and efferent arteriolar vasoconstriction are primarily mediated by
angiotensin II
• Afferent vasodilation is primarily mediated by prostaglandins
• Arachidonic acid metabolites, natriuretic factors, nitric oxide, the sympathetic
nervous system, the renin–angiotensin system, and the macula densa response to
distal tubular solute delivery
36. Normal glomerular autoregulation serves to maintain intraglomerular capillary
hydrostatic pressure, glomerular filtration rate (GFR), and, ultimately, urine
output
40. Clinical Presentation
• Kidney injury can occur within days of initiating therapy
• NSAIDs
• Diminished urine output, weight gain, and/or oedema
• Urine volume and sodium concentration are usually low,and BUN, Scr, and potassium
are typically elevated
• Cyclosporine, Tacrolimus
• Scrrises
• Crcl decreases
• Hypertension, hyperkalaemia, sodium retention, and hypomagnesemia may occur
41. • ACEIs and ARBs
• Acutely reduce GFR (Dose-related)
• Normally, moderate rise of 0.1-0.3mg/dl
• Detrimental cases >0.5mg/dl in 1-2 weeks
• Hyperkalaemia
42. Management
• Discontinue therapy
• Management of severe hyperkalaemia
• Caution: combined NSAID or COX-2 inhibitor and ACEI or ARB therapy is
contraindicated
44. • Obstructive nephropathy is the result of mechanical obstruction to urine
flow following glomerular filtration
• Most commonly caused by
• Intratubular obstruction or post renal obstruction
• Secondary to nephrolithiasis or prostatic hypertrophy
45. INTRATUBULAR OBSTRUCTION
• Intratubular precipitation
• Acute oliguric or anuric kidney injury
• Nephropathy, dysuria, urinary frequency, back and flank pain
• Clinical manifestations
• Tumor lysis syndrome
• Chemotherapeutics
• Urine uric acid/creatinine > 1
• Rhabdomyolysis
• Intratubular precipitation of myoglobin
• β-hydroxy-β-methylglutaryl-coenzyme A reductase inhibitors
46. • Intratubular precipitation of drugs
• Acyclovir (oliguric patients)
• Sulfadiazine, Ascorbic acid (high doses)
• Methotrexate (in acidic urine)
• Low-molecular-weight dextran therapy
• Triamterene, Foscarnet (calcium-foscarnet salt crystals), Indinavir
• Management
• Administering the drug after vigorously prehydrating the patient,
• Maintaining a high urine volume,
• Urinary alkalinisation
47. NEPHROLITHIASIS
• Formation of renal calculi or kidney stones
• Occurs as the result of abnormal crystal precipitation in the renal collecting
system
• Intratubular precipitation of crystallinematerial
• Prevalence of drug induced nephrolithiasis is 1%
• Signs and Symptoms
• Pain, haematuria, infection, or, occasionally, urinary tract obstruction with kidney injury
48. • Drugs
• Triamterene, Sulfadiazine (acetylsulfadiazine crystalluria), Indinavir,
• Antiviral drugs nelfinavir and foscarnet
• Antibacterial agents: ciprofloxacin, amoxicillin and nitrofurantoin
• Products containing ephedrine, norephedrine, and pseudoephedrine
• Management
• Stop using causative agent
• A high urine volume and urinary alkalinisation to pH >7.15 may be protective
49. Glomerular disease
• Hallmark of glomerular injury:Proteinuria
• Patches of glomerular sclerosis, interstitial inflammation and fibrosis
• Clinical manifestation
• Focal segmental glomerulosclerosis
• Membranous nephropathy
• Direct toxicity
• Immune complex formation
52. NEPHROCALCINOSIS
• Characterized by
• Extensive tubulointerstitial precipitation and deposition of calcium phosphate
• Marked tubular calcification
• Risk factors
• Hypercalcemia, hyperparathyroidism, increased bone turnover, hypercalcemia of
malignancy, and increased intake of calcium or vitamin D
• Prolonged intestinal transit
• Oral sodium phosphate solution (OSPS) along with concomitant volume depletion
53. • Clinical manifestation
• Low-grade proteinuria (<1.0 g/day), and a bland urinary sediment are usually observed
• Causative agents
• Diuretic
• NSAID
• ACEi
• ARBs
54. PAPILLARY NECROSIS
• Chronic tubulointerstitial nephritis
• Necrosis of the renal papillae (region where collecting ducts enter the renal
pelvis)
• Risk Factors
• Cumulative consumption of combination analgesics, phenacetin, or acetaminophen and
aspirin
• Caffeine in combination analgesics
• Causative agents
• Analgesic
55. • Chronic excessive consumption of combination analgesics (especially containing
phenacetin) evolves insidiously over years
• Difficult to recognize, misunderstood as a cause of ESRD
• Diagnostic criteria
• History of chronic daily habitual analgesic ingestion
• Intravenous pyelography, renal ultrasound, or renal computed tomography imaging papillary
calcifications
• Clinical Manifestation
• Pyuria, microscopic hematuria, and low levels of proteinuria
• Hypertension and atherosclerotic cardiovascular disease
56. • Prevention
• Limiting the total dose, avoiding combined use of two or more analgesics, and
maintaining good hydration or NSAIDs
• Management
• Cessation of analgesicconsumption
• Monitoring of Renal function indices
57. CHRONIC INTERSTITIAL NEPHRITIS
• A progressive and irreversible lesion
• Causative agents
• Lithium
• Cyclosporine
• Aristolochic Acid (Chinese Herb Nephropathy)
58. Lithium toxicity
• Long-term lithium therapy is associated with nephrotoxicity
• Impaired ability to concentrate urine (nephrogenic diabetes insipidus)
• Distal renal tubular acidosis
• Clinical Presentation
• Polydipsia (excessive thirst) and polyuria (excessive urination)
• Acute tubular necrosis (acute lithium toxicity)
• Proteinuria, a few red and white blood cells, and granular casts.
• Nephrotoxicity may develop insidiously and only be recognized by rising BUN or
creatinine concentrations or the onset of hypertension.
59. • Pathogenesis
• Decrease in collecting duct response to antidiuretic hormone
• Management
• Discontinuation of lithiumtherapy
• Amiloride 10-20 mg daily during continued lithium therapy
• Adequate hydration, and avoidance of other nephrotoxic agents
60. Cyclosporine
• Delayed chronic interstitial nephritis has been reported after 6 to 12 months
of therapy
• Clinical manifestations
• Biopsy findings include arteriolar hyalinosis, glomerular sclerosis, and a striped pattern
of tubulointerstitial fibrosis
• Sustained renal arteriolar endothelial cell injury
• Increased ET-1, decreased nitric acid, increased TGF- β
61. Aristolochic Acid (Chinese Herb
Nephropathy)
• Certain weight-loss treatments containing Chinese herbs
• Aristolochia fangchi (Guang fang ji), known to contain an alkaloid Aristolochic
acid
• Majority of cases are women
• Develops within 6 to 24 months of exposure
• Clinical Presentation
• Mild to moderate hypertension
• Mild proteinuria, glucosuria
• Anaemia and shrunken kidneys are also common on initial presentation
62. • Pathogenesis
• Aristolochic acid are metabolized to mutagenic compounds called aristolactam I and
aristolactam II
• Form DNA adducts
• Direct DNA damage
• Interstitial fibrosis with atrophy and destruction of tubules throughout the renal cortex
• Prevention
• Ban the use of Chinese herbs
63. ACUTE ALLERGIC INTERSTITIAL
NEPHRITIS
• An allergic hypersensitivity response
• Characterized as an interstitial infiltrate of lymphocytes, plasma cells, eosinophils,
and occasional polymorphonuclear neutrophils
• Pathogenesis
• Cell-mediated immune mechanism
• Predominantly T-lymphocyte infiltrate
• Humoral antibody-mediated mechanism
• Presence of circulating antibody to a drug–tubular basement membrane complex
• Low serum complement levels
• Deposition of IgG and complement in tubular basement membrane
64. • Clinical manifestation
• Rare extrarenal symptoms (fever, rash, and eosinophilia)
• Proteinuria >3.5 g/day
• Management
• Discontinue causative drug
• Prednisone therapy
• Initial dose of 1 mg/kg/day for a week, which is then tapered over 3 weeks to
discontinuation
67. Vasculitis
• Inflammation of blood vessels
• Immunological reaction
• Clinical manifestation
• Cutaneous, renal, and pulmonary vasculitis (Propylthiouracil, Hydralazine)
• Cutaneous, renal, and hepatic vasculitis (Allopurinol)
• Cutaneous, renal, pulmonary, and gastrointestinal vasculitis (Isotretinoin)
• Systemic polyarteritis nodosa (Minocycline)
• Antineutrophil cytoplasmic antibody-positive vasculitis
• Hydralazine, propylthiouracil, allopurinol, and penicillamine
• High titre of antimyeloperoxidase antibodies
68. • Signs and Symptoms
• Haematuria, proteinuria, reduced renal function, and hypertension
• Withdrawing the offending drug
• Tapering course of prednisone
69. Thrombosis
• Formation or presence of a thrombus (clot of coagulated blood attached) in a
blood vessel
• Thrombotic Microangiopathy
• Endothelial proliferation and thrombus formation in the renal and CNS vasculature
• Clinical manifestation
• Haemolytic uremic syndrome
• Thrombotic thrombocytopenic purpura
• Drugs
• Mitomycin C, oral contraceptives, cyclosporine, tacrolimus, muromonab-CD3, antineoplastic
agents, interferon, ticlopidine, clopidogrel, gemcitabine and quinine
70. • Mitomycin C
• At doses <30 mg/m2
• Pathogenesis
• Direct, dose related toxic effect
• Clinical manifestation
• Nephrotoxicity along with thrombotic microangiopathy
• Systemic endothelial damage with multisystem organ failure
• Interaction
• 5-fluorouracil, cisplatin, bleomycin and tamoxifen
72. Cholesterol Emboli
• Abnormal particle (air bubble, clot) circulating in the blood
• Drugs
• Anticoagulants and thrombolytics e.g. warfarin
• Pathogenesis
• Aortic atherosclerotic plaques > embolized cholesterol particles
• Small arteries and arterioles
• Inflammatory obliterative vascular response
• Renal ischemia
• Signs and symptoms
• Purple discoloration of the toes and mottled skin over the legs