Toxic Nephropathies: Core Curriculum 2010

Slides:



Advertisements
Similar presentations
The Rise of Renal Pathology in Nephrology: Structure Illuminates Function Vivette D. D'Agati, MD, Michael Mengel, MD American Journal of Kidney Diseases.
Advertisements

Renal Function Testing
AJKD Atlas of Renal Pathology: Ischemic Acute Tubular Injury
Diagnosis and Treatment of Hyponatremia
Quiz American Journal of Kidney Diseases
Tubulointerstitial Injury Associated With Chemotherapeutic Agents
Peter A. McCullough, MD, MPH, Timothy Larsen, DO, Jeremiah R
Peritoneal dialysis American Journal of Kidney Diseases
Gregory L. Hundemer, MD, MPH, Andrew Z. Fenves, MD, Kristy M
AJKD Atlas of Renal Pathology: Light Chain Proximal Tubulopathy
Tubular Transport: Core Curriculum 2010
Richard J. Glassock, MD  American Journal of Kidney Diseases 
Quiz Page March 2008 American Journal of Kidney Diseases
Quiz Page February 2009 American Journal of Kidney Diseases
Andrew M. Hall, MD, PhD, Bruce M
Renal Manifestations of Plasma Cell Disorders
Biff F. Palmer, Deborah J. Clegg  American Journal of Kidney Diseases 
Jan Havlin, MD, PhD, Karel Matousovic, DSc, Otto Schück, MD, DSc 
Quiz Page July 2009 American Journal of Kidney Diseases
Pathophysiology of Renal Tubular Acidosis: Core Curriculum 2016
Shared Primacy of Sodium and Potassium on Cardiovascular Risk
Evaluation of the Potential Living Kidney Donor
Apical membrane handling of substances, in this example aminoglycosides, by proximal tubular cells. Apical membrane handling of substances, in this example.
Focusing on Health Literacy Might Help Us Cross the Quality Chasm
Kidney specific factors that enhance nephrotoxic risk are noted.
Salt and Hypertension American Journal of Kidney Diseases
Quiz Page July 2007 American Journal of Kidney Diseases
Autosomal dominant distal renal tubular acidosis and the AE1 gene
AJKD Atlas of Renal Pathology: Osmotic Tubular Injury
Dorothea Nitsch, MD, MSc  American Journal of Kidney Diseases 
Iva Gunnarsson, MD, PhD  American Journal of Kidney Diseases 
Hemoglobin Level and Transfusions in Patients on Maintenance Dialysis: Where the Rubber Meets the Road  Eduardo Lacson, MD, MPH, Franklin Maddux, MD 
Biff F. Palmer, MD  American Journal of Kidney Diseases 
Proteinuria and Other Urinary Biomarkers in Kidney Transplantation: Why Are We Still Waiting for Godot?  Bertram L. Kasiske, MD  American Journal of Kidney.
Regulation of renal tubular secretion of organic compounds
IgA Nephropathy: Progress Before and Since Berger
Polyunsaturated Fatty Acids and Kidney Disease
A Decade After the KDOQI CKD Guidelines: A Perspective From Mexico
Transcellular movement of organic cations (OCs) and organic anions (OAs) in kidney proximal tubule epithelial cells. Transcellular movement of organic.
Cellular and molecular aspects of drug transport in the kidney
AJKD Atlas of Renal Pathology: Toxic Acute Tubular Injury
Quiz Page April 2008 American Journal of Kidney Diseases
Study Designs in Patient-Oriented Research
Dennis G. Moledina, MD, Mark A. Perazella, MD 
AJKD Atlas of Renal Pathology: Minimal Change Disease
Gerd A. Kullak-ublick, Bruno Stieger, Peter J. Meier  Gastroenterology 
Volume 80, Issue 4, Pages (August 2011)
Long-term Outcomes of Acute Kidney Injury: The Power and Pitfalls of Observational/Population-Based Studies  Charuhas V. Thakar, MD  American Journal.
Arnold S. Relman, MD, American Journal of Kidney Diseases
Trial Quality in Nephrology: How Are We Measuring Up?
Removal of Dabigatran by Hemodialysis
Advances in the pathogenesis of HIV-associated kidney diseases
Multidrug-Resistant Organisms Within the Dialysis Population: A Potentially Preventable Perfect Storm  David P. Calfee, MD, MS  American Journal of Kidney.
This Month in AJKD American Journal of Kidney Diseases
Quiz Page Answers September 2005
James F. Winchester, MD, Thomas H. Hostetter, MD, Timothy W. Meyer, MD 
Pharmacology American Journal of Kidney Diseases
Soluble CD14 and Endotoxin Levels in Hemodialysis Patients: A Tale of 2 Molecules  Victor F. Seabra, MD, George Thomas, MD, MPH, Bertrand L. Jaber, MD,
This Month in AJKD American Journal of Kidney Diseases
Basolateral transport of drugs.
Dialysis Research and N-of-1 Trials: Made for Each Other?
Quiz Page January 2010 American Journal of Kidney Diseases
Apical transport of drugs in the proximal tubule.
Clinical Practice Recommendations For Peritoneal Dialysis Adequacy
The proximal kidney tubule is the target for tenofovir-associated nephrotoxicities. The proximal kidney tubule is the target for tenofovir-associated nephrotoxicities.
Kidney factors that enhance risk for drug-induced nephrotoxicity.
Cisplatin (Cis) nephrotoxicity is, in part, related to its uptake by proximal tubular cells. Cisplatin (Cis) nephrotoxicity is, in part, related to its.
Clinical Practice Guidelines for Peritoneal Dialysis Adequacy
Quiz page December 2003 American Journal of Kidney Diseases
AJKD Atlas of Renal Pathology: Ischemic Acute Tubular Injury
Presentation transcript:

Toxic Nephropathies: Core Curriculum 2010 Mark A. Perazella, MD  American Journal of Kidney Diseases  Volume 55, Issue 2, Pages 399-409 (February 2010) DOI: 10.1053/j.ajkd.2009.10.046 Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Aminoglycoside (AG) antibiotics are filtered freely at the glomerulus. Because of their cationic charge, they are attracted to the proximal tubular apical membrane brush border, which is rich in anionic phospholipids. At this site, they bind the cationic drug receptor megalin (M; encoded by the LRP2 gene) located deep at the base of the brush border villi. The receptor-AG complex is internalized by pinocytosis and taken up by lysosomes (denoted with dotted lines). The adenosine triphosphatase sodium-potassium pump (Na+-K+-ATPase) is shown at the basolateral surface. American Journal of Kidney Diseases 2010 55, 399-409DOI: (10.1053/j.ajkd.2009.10.046) Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 Hydroxyethyl starch (HES) uptake by the apical membrane of proximal tubular cells occurs by pinocytosis. When these pinocytotic vesicles are internalized within the cell, the vesicles fuse with each other and lysosomes. The cytoplasm becomes packed with the lysosomal vacuoles (denoted with HES-containing lysosomes), causing cell swelling and dysfunction. The adenosine triphosphatase sodium-potassium pump (Na+-K+-ATPase) is shown at the basolateral surface. American Journal of Kidney Diseases 2010 55, 399-409DOI: (10.1053/j.ajkd.2009.10.046) Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 Organic anion drugs, such as tenofovir (TDF), are delivered to the basolateral membrane of proximal tubular cells. At this site, they are transported from the blood into the cell by the human organic anion transporter (OAT; encoded by the SLC22A6 gene). When within the cell, they are transported through carrier proteins. Eventually, the organic anion drugs are secreted into the urinary space by apical efflux transporters. In the case of drugs such as tenofovir, multidrug resistance–associated protein (MRP) family members MRP2 and MRP4 (encoded by the ABCC2 and ABCC4 genes, respectively) are the major transporters. Abbreviations: OCT, organic cation transporter; NaDC, sodium dicarboxylate symporter; Pgp, P-glycoprotein. American Journal of Kidney Diseases 2010 55, 399-409DOI: (10.1053/j.ajkd.2009.10.046) Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions