¼±Åà - È­»ìǥŰ/¿£ÅÍŰ ´Ý±â - ESC

 

±âŸ ´ëÀå°æ Á¤¸®

<Tubulointerstitial disease>

1. eosinophiluria¸¦ ÈçÈ÷ º¸ÀÌ´Â ½ÅÁúȯ

i) allergic interstitial nephritis

ii) atheroembolic ARF

iii) contrast-induced ARF

2. cisplatin¿¡ ÀÇÇÑ ARF´Â ½ÅºÎÀüÀÌ »ó´çÈ÷ ÁøÇàÇÏÁö ¾Ê´ÂÇÑ ÇÌ´¢°¡ »ý±âÁö ¾Ê´Â °ÍÀÌ

º¸ÅëÀÌ´Ù.

3. chronic interstitial nephritis¿¡¼­´Â eosinophilia°¡ ¾ø´Ù.

4. ACE inhibitor»ç¿ë½Ã ¹ß»ýÇÒ¼ö ÀÖ´Â ½ÅÀåÇÕº´Áõ

ATN, interstitial nephritis, hemodynamic deterioration, membranous nephropathy

5. chronic tubulointerstitial disease¿¡¼­ º¼¼ö ÀÖ´Â ³»ºÐºñ Àå¾Ö

i) erythropoietin»ý¼º Àå¾Ö·Î ÀÎÇÑ ºóÇ÷

ii) vit D3 deficiency·Î ÀÎÇÑ renal osteodystrophy

iii) hyporeninemic hypoaldosteronismÀ¸·Î ÀÎÇÑ hyperkalemic metabolic acidosis

(type IV RTA)

6. ½Å¼¼´¢°ü°ú °£ÁúÀÌ µ¶¼º¹°Áú¿¡ ¾àÇÑ ÀÌÀ¯

i) blood flow°¡ ¸¹¾Æ toxin exposure°¡ ¸¹´Ù.

ii) pH°¡ ³·¾Æ µ¶¼º¹°ÁúÀÌ ionization ÀߵȴÙ.

iii) transport process¿¡ ÀÇÇØ accumulationÀߵȴÙ.

iv) ³óÃà±âÀü¿¡ ÀÛ¿ëÇÏ´Â medulla, papilla°¡ ÁַΠħ¹üµÈ´Ù.

7. lead nephropathyÄ¡·á

i) ³ëÃâÁßÁö

ii) chelating agent: calcium disodium edetate

8. contrast-induced ATN¿¡¼­ FENa < 1%

<Vascular injury to the kidney>

9. Á¤»ó ÀӽŽà GFRÀÌ 30-50%Á¤µµ Áõ°¡Çϱ⠶§¹®¿¡ ÀÓ½ÅÁß BUNÀÌ 13mg/dL, CrÀÌ 0.8

mg/dLÀÌ»óÀÌ¸é ½ÅÀå±â´É¿¡ ÀÌ»óÀÌ ÀÖÀ» °ÍÀÌ´Ù.

10. ÀνŽà ¹ß»ýÇÏ´Â acute cortical necrosisÀÇ ¿øÀÎ

septic aborption, abruptio placentae, severe preeclampsia,

amniotic fluid embolism, retained fetus

11. renovascular hypertensionÀ» ÀǽÉÇÒ¼ö ÀÖ´Â ¼Ò°ß

i) USG»ó kidney size discrepancy

ii) abdominal bruit

iii) ACE inhibitorÁß´ÜÈÄ azotemiaÀÇ È£Àü

12. renovascular hypertension¿¡¼­ angioplastyÈÄ¿¡µµ °íÇ÷¾ÐÀÌ Áö¼ÓµÉ ¶§ °í·ÁÇÒ »çÇ×

i) incomplete angioplasty

ii) underlying essential hypertension

iii) ÀÌ¹Ì renal parenchymal hypertensionÀ¸·Î ÁøÇà

13. captopril PRA test Àüóġ

- diuretics, ACE inhibitor´Â 2ÁÖÀü¿¡ Áß´ÜÇØ¾ß ÇÑ´Ù.

=> Ç×°íÇ÷¾ÐÁ¦´Â CCB and/or labetalol·Î switch

- dietary saltÀÇ Á¦ÇÑÀº ÇÊ¿ä¾ø´Ù.

14. renovascular hypertensionÀÇ screening test: captopril PRA test

15. renovascular hypertensionÀ» ±â´ÉÀûÀ¸·Î ¹Ý¿µÇÒ °Ë»ç? captopril scan

16. ADPKD with hypertension¿¡¼­ 1Â÷ÀûÀ¸·Î ¼±ÅÃÇÒ Ç×°íÇ÷¾ÐÁ¦? ACE inhibitor

<Hereditary tubular disorders>

17. ADPKD

- AD trait, 16p(90%), 4p(10%)ÀÌ»ó°ú °ü·Ã

- 20¼¼ ÀÌÈÄ¿¡ 80-90%, 30¼¼ ÀÌÈÄ¿¡´Â °ÅÀÇ 100%¿¡¼­ renal cyst°¡ ¹ß°ßµÈ´Ù.

- calcium oxalate, uric acid stone(15-20%) µ¿¹Ý

- ½ÅÀåÀÇ Å©±â°¡ Ŭ¼ö·Ï, °íÇ÷¾ÐÀ» µ¿¹ÝÇÒ¼ö·Ï ¸¸¼º½ÅºÎÀüÀÌ Àß »ý±ä´Ù.

- 60´ë±îÁö 50%¿¡¼­ ¸»±â½ÅºÎÀüÀ¸·Î ÁøÇàÇÑ´Ù.

18. ADPKD´Â urinary salt wasting°æÇâÀÌ ÀÖÀ¸¹Ç·Î Àû±ØÀûÀÎ salt restrictionÀº ÇÊ¿ä¾ø´Ù.

19. ADPKDÀÇ extrarenal manifestation

hepatic cyst(50-70%), intracranial aneurysm(5-10%), colonic diverticular disease

MVP(25%), spleen, pancreas, ovary cysts

cf. ADPKDÀÇ mc extrarenal abnormality? colonic diverticular disease

20. ADPKD¿¡ infectionÀÌ »ý°åÀ» ¶§ »ç¿ë°¡´ÉÇÑ Ç×»ýÁ¦?

* cyst³»·Î penetration°¡´ÉÇÑ Ç×»ýÁ¦¸¦ »ç¿ëÇØ¾ß ÇÑ´Ù.

: Bactrim, chloramphenicol, ciprofloxacin

21. ADPKD¿¡¼­ aneurysm study°¡ ÇÊ¿äÇÑ °æ¿ì?

i) family Hx(+)

ii) new onset headache, intracranial disease sign(+)

iii) LOCÀ§ÇèÀÌ Å« Á÷¾÷

iv) severe hypertensionÀÌ ¿¹»óµÇ´Â elective surgery

v) º»ÀÎÀÌ ¿øÇÒ ¶§

22. ADPKD¿¡¼­ Á¶±â½ÅºÎÀüÀÌ ¹ß»ýÇÒ °¡´É¼ºÀÌ ³ôÀº °æ¿ì

early age of onset, male, hypertension, recurrent infection, proteinuria, gross hematuria,

PKD1 genotype

<Acquired cystic kidney disease>

23. ESRD duration°ú °ü°èÀÖ´Ù.

3cm ÀÌÇÏ´Â 1³â¿¡ Çѹø¾¿ CT F/UÇϵµ·Ï ÇÑ´Ù(¡ñRCC detectÇϱâ À§ÇØ)

<Urinary tract stones, obstruction, tumors>

24. ¼Òº¯³» °á¼®¿øÀι°ÁúÀÌ supersaturationµÇ´Âµ¥ °¡Àå ÈçÇÑ ¿øÀÎÀº? low urine volume

cf. supersaturation À¯¹ßÀÎÀÚ: dehydration, overexcretion, low urine pH

25. crystal growth and aggregation inhibitors

inorganic pyrophosphate, glycoprotein, citrate

26. staghorn calculi¸¦ Çü¼ºÇÏ´Â °á¼®: struvite stone, uric acid stone, cystine stone

27. idiopathic hypercalciuriaÀÇ ±âÀü 3°¡Áö

1) absorptive hypercalciuria: Àå¿¡¼­ CaÈí¼ö°¡ Áõ°¡ÇÏ¿© PTH´Â ¾ïÁ¦µÇ°í, urine CaÀº Áõ°¡

2) renal hypercalciuria: ½ÅÀå¿¡¼­ Ca excretionÀÌ Áõ°¡ÇÏ¿© serum CaÀº °¨¼ÒÇϰí

±× °á°ú PTH´Â Áõ°¡ÇÑ´Ù.

3) resorptive hypercalciuria: PTH°¡ Áõ°¡ÇÏ¿© bone resorptionÀÌ Áõ°¡, serum & urine Ca¡è

28. hyperuricosuria

³²ÀÚ > 800 mg/24hr, ¿©ÀÚ > 750 mg/24hr

* uric acid stone¿¡¼­ °¡Àå Áß¿äÇÑ º´ÀÎÀº uric acid ³óµµº¸´Ù urine pH°¡ ´õ Áß¿äÇÏ´Ù.

29. uric acid stoneÀÇ Ä¡·á

low purine diet < 1g/day, allopurinol

urine alkalinization(urine pH 6-6.5) with potassium citrate(sodium citrate or sodium

bicarbonate¾Æ´Ô)

30. calcium stoneÀ» À¯¹ßÇÏ´Â ¿øÀÎÁúȯ mc: idiopathic hypercalciuria

±× ¿Ü> hyperuricosuria, hyperoxaluria

31. ½Å°á¼® ¹ß»ýºóµµ¼ø

calcium stone > struvite stone > uric acid stone > cystine stone

32. idiopathic hypercalciuria¿Í ¹Ýº¹Àû ½Å°á¼® ȯÀÚ¿¡¼­ °¡Àå À¯¿ëÇÑ °Í? thiazide

thiazide -> ½ÅÀå¿¡¼­ Ca reabsorptionÀ» Áõ°¡½Ã۰í, Àå¿¡¼­ CaÈí¼ö ¾ïÁ¦

33. struvite stoneÀÌ Àß »ý±â´Â °æ¿ì

¿©ÀÚ, bladder catheterization, urease-producing bacteria¿¡ ÀÇÇÑ UTI

cf. ¿øÀαÕ: Proteus, Pseudomonas, enterococci, morganella, providencia

34. Áö¹æ Èí¼öÀå¾Ö¿Í °ü·ÃÇÏ¿© Àß »ý±â´Â ´¢¼®: calcium oxalate stone

35. cystine stoneÀÇ Ä¡·á: penicillamine

36. postobstructive diuresisÀÇ ±âÀü

i) osmotic diuresis: retained urea°¡ poorly absorbable solute·Î ÀÛ¿ëÇϰí

salt & water ÀçÈí¼ö¸¦ ¾ïÁ¦ÇÑ´Ù.

ii) intratubular pressure¡è: net NaCl reabsorption Àå¾Ö¸¦ ÃÊ·¡ÇÑ´Ù. ƯÈ÷ terminal nephron

¿¡¼­

iii) natriuretic factor(ureaÀÌ¿Ü)

37. urinary tract obstructionÀÌ ÀÖÀ¸³ª ureterial dilatationÀº ¾ø´Â °Í?

volume contraction, staghorn calculi, retroperitoneal fibrosis

38. postobstructive diuresis¿¡¼­ replacement´Â half salineÀ¸·Î 2/3fmf ³ÑÁö¾Ê´Â ¹üÀ§¿¡¼­

º¸ÃæÇÑ´Ù.

ECF volumeÀÌ Á¤»óÈ­µÇ¸é ÀÌ´¢°¡ °¨¼ÒÇÑ´Ù.

39. RCCÀÇ paraneoplastic syndromes

erythrocytosis, hypercalcemia, nonmetastatic hepatic dysfunction(Stauffers'

syndrome),

acquired dysfibrinogenemia

40. sterile pyuria¸¦ °¨º°ÇØ¾ß ÇÒ Áúȯ

Tb, fungi, atypical mycobacteria, H. influenza, anaerobes

urinary tract calculi, papillary necrosis

renal infiltration by lymphoma or myeloma cells