Quiz 2

(Ref: Harrison 20th edition, page 2108; Harrison 19th edition/1808, 1810)
 Acute kidney injury will cause inability to excrete H+ and K+ both leading to hyperkalemic acidosis.
 The acidosis seen in high anion gap metabolic acidosis.

(Ref: Harrison 19th page 289)
 S. Creatinine concentration usually begins to increase within 24 hours after contrast agent administration, peaks between days 3 and 5, and returns to baseline in 7-10 days. Serum cystatin C is also increased in patients with contrast induced nephropathy
 Nonspecific formed elements can appear in the urine, including renal tubular epithelial cells, pigmented granular casts, urate crystals, and debris. However, these urine findings do not correlate with severity
 Urine osmolality tends to be less than 350 mOsm/kg. The fractional excretion of sodium (FENa) may vary widely. In the minority of patients with oliguric CIN, the FENa is low in the early stages, despite no clinical evidence of volume depletion.

(Ref: Harrison 20th edition, p 2111-2119; Harrison 19th p 1030)
 HUS is a cause of development of acute kidney injury.
 The toxins in CRF cause myopathy and neuropathy while the hyperphosphatemia explains the ectopic calcification of tubules.

(Ref: Nelson Textbook, 18th edition ch. 527, Harrison 19th p 252)
 Steroid-dependent patients, frequent relapsers, and steroid-resistant patients may be candidates for alternative agents, particularly if the child suffers severe corticosteroid toxicity (cushingoid appearance, hypertension, cataracts, and/or growth failure).
 Cyclophosphamide prolongs the duration of remission and reduces the number of relapses in children with frequently relapsing and steroid-dependent nephrotic syndrome.
 The potential side effects of the drug (neutropenia, disseminated varicella, hemorrhagic cystitis, alopecia, sterility, increased risk of future malignancy) should be carefully reviewed with the family before initiating treatment. The dose of cyclophosphamide is 2-3 mg/kg/24 hr given as a single oral dose, for a total duration of 8-12 wk. Alternate-day prednisone therapy is often continued during the course of cyclophosphamide administration. During cyclophosphamide therapy, the white blood cell count must be monitored weekly and the drug should be withheld if the count falls below 5,000/mm3.

(Ref: Harrison 20th edition, p 2130-2131; Harrison 19th p 1190)
 CMV is a common and dangerous DNA virus in transplant recipients. It does not generally apprear until the end of the first post – transplant month.
 Tissue invasion of CMV is common in the gastrointestinal tract and lungs. CMV retinopathy occurs late in the course, if untreated.
 Valganciclovir is drug of choice that has been proved effective in both prohylaxis and treatment of CMV disease
 Treatment of active CMV disease with valganciclovir is always indicated. In many patients immune to CMV, viral activation can occur with major immunosuppressive regiments.
List of Organsims causing infection > 1 Month after kindey transplant
 Pneumocystis carinii
 Cytomegalovirus
 Legionella
 Hepatitis B
 Hepatitis C