±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¤»óȵǸé 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