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SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
Peripheral nerve cells, unlike nerve cells of the central nervous system, do regenerate following injury. It is a slow process that occurs at about 1 mm/day and may be followed with nerve conduction studies. Schwann cells are responsible for myelination of nerve fibres which increases the axonal speed of conduction. Following injury (Wallerian degeneration), they are able to regenerate. Mucosal cells are epithelial cells which behave like stem cells and can therefore continuously renew themselves. Liver cells (hepatocytes) under certain circumstances can be stimulated to divide. Renal tubular cells lack the ability to regenerate following injury. This is why renal blood flow is so carefully autoregulated. It is also why acute tubular necrosis is taken so seriously, because damage to renal tubular cells is irreversible and will lead to end-stage renal failure, requiring renal replacement therapy in the form of dialysis or transplantation.
Life Care Planning for Organ Transplantation
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
Following kidney transplant, post-operative care focuses on monitoring urine output, replacing fluids, and maintaining normal electrolyte values. Foley catheters will be maintained for 3 to 5 days post-operatively. Transplanted kidneys may begin to function immediately, producing copious amounts of urine. Acute tubular necrosis may be seen, resulting from ischemia of the kidney tubules. Acute tubular necrosis necessitates an increased length of stay, along with dialysis for resolution and preservation of the patient's health.
Test Paper 1
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
Acute tubular necrosis is common in the early post-operative period and results in reduced function, which gradually recovers over the next few weeks to months. There is no graft tenderness or fever, unlike acute rejection. The scintigraphic findings are abnormal immediately after surgery. The perfusion phase is relatively maintained well; later phases show slow washout and persistent isotope accumulation. In contrast, if the isotope study is normal in the early post-operative phase and becomes abnormal subsequently, acute rejection can be diagnosed confidently.
An update on Alectinib: a first line treatment for ALK-positive advanced lung cancer
Published in Expert Opinion on Pharmacotherapy, 2023
Yourong Zhou, Yiming Yin, Jiangxin Xu, Zhifei Xu, Bo Yang, Qiaojun He, Peihua Luo, Hao Yan, Xiaochun Yang
Ramachandran et al. [72] described a case of acute renal failure requiring emergency dialysis support following the use of alectinib. The patient’s renal failure was secondary to acute tubular necrosis and was completely reversed within 7–10 days after discontinuation of the drug. When he was rechallenged with alectinib, his Cr began to worsen again, confirming the nephrotoxicity of alectinib. Prado-Mel et al. [73] reported a case of alectinib-induced acute interstitial nephritis as a possible diagnosis, with high creatinine levels and metabolic imbalance detected in laboratory tests. Renal biopsy showed a mixed pattern of acute interstitial nephritis and acute tubular necrosis. Cortical therapy was initiated and renal function returned to baseline levels. Nagai et al. [74] described a case of rapid progressive glomerulonephritis induced by alectinib. A 68-year-old female patient with advanced NSCLC developed rapidly progressive glomerulonephritis within 1 year of initiating therapy with alectinib. Kidney biopsy showed light microscopy, interstitial nephritis with tubular vacuolization and several glomerular fibroblast crescent formation. Patients were treated with pulse corticosteroids and corticosteroid tapering.
Safety of current antiviral drugs for chronic hepatitis B
Published in Expert Opinion on Drug Safety, 2022
Chiara Masetti, Nicola Pugliese, Alessio Aghemo, Mauro Viganò
All oral antiviral agents are excreted in active form by the kidney through active uptake by proximal tubular cells and the subsequent elimination in the urinary space. Proximal renal tubule seems most commonly involved in nephrotoxicity induced by oral antiviral agents, as these cells are particularly rich in mitochondria and therefore more susceptible to damage. Renal tubular dysfunction may be difficult to detect, as early indicators, such as fractional excretion of phosphate and retinol-binding protein (RBP), are not commonly used in clinical practice, while commonly used indicators for renal function (glomerular filtration rate, eGFR, and creatinine clearance) may underestimate renal tubular injury [29]. Reductions in renal tubular function may lead to a Fanconi-like syndrome, characterized mainly by metabolic acidosis, hypophosphatemia, hyperphosphaturia, and glycosuria, which can become life-threatening. Conversely, acute tubular necrosis is more frequently observed in patients with preexistent kidney disease [12].
Electron microscopic findings can support multiple etiologies of nephrotoxicity in renal tubules
Published in Ultrastructural Pathology, 2020
Ping L. Zhang, Timothy Pancioli, Wei Li, Hassan D. Kanaan
The light microscopy revealed unremarkable glomeruli. The proximal tubules were slightly dilated with moderate vacuolization changes in the cytoplasm on hematoxylin/eosin stained section and some diminished brush borders on PAS stained section (Figure 2a,b). Proximal tubules stained moderately positive for kidney injury molecule-1 (KIM-1), a specific marker of proximal tubular injury.24,25 The findings are consistent with moderate acute tubular injury (so-called acute tubular necrosis). Vessels were not remarkable and there was no significant interstitial fibrosis and tubular atrophy. Immunofluorescent studies showed negative staining for all panel of antibodies in the glomerular and tubulointerstitial compartments. EM revealed numerous round and dilated lysosomes containing randomly distributed whirling electron dense materials, so-called zebra bodies or myeloid bodies in proximal tubules (Figure 2c). These were found in some distal tubules as well. The myeloid bodies were measured ranging from 500 to 1000 nm in sizes. One year follow-up data indicated that patient’s sCr was returned to a normal level (Table 1).