341.2 🩺 國考版

341.2.1 高頻考點

341.2.1.1 AIN Common Drugs (MEMORIZE)

  • Penicillins (classic with hypersensitivity)
  • PPIs (omeprazole, esomeprazole, pantoprazole)
  • NSAIDs (often without classic hypersensitivity)
  • ICIs (pembrolizumab, nivolumab, ipilimumab)
  • Sulfonamides, rifampin, ciprofloxacin
  • Allopurinol
  • 5-ASA (mesalamine)

341.2.1.2 AIN Diagnosis

  • AKI + sterile pyuria + WBC casts
  • Urine eosinophils (low sensitivity)
  • Variable hypersensitivity features
  • Renal biopsy definitive

341.2.1.3 AIN Treatment

  • Hold offending drug
  • Corticosteroids (prednisone 0.5-1 mg/kg) if severe/persistent
  • Supportive

341.2.1.4 CIN Causes

  • Lithium
  • Analgesics (NSAIDs, phenacetin)
  • Calcineurin inhibitors (chronic)
  • Aristolochic acid (䞭草藥)
  • Reflux nephropathy
  • Cadmium, lead, mercury
  • Hereditary

341.2.1.5 RTA Type 1 (Distal)

  • Hypokalemia + non-AG acidosis
  • Urine pH > 5.5
  • Sjögren most common
  • Treatment: bicarbonate + K

341.2.1.6 RTA Type 2 (Proximal)

  • Hypokalemia + non-AG acidosis
  • Urine pH variable
  • Fanconi syndrome often
  • Causes: MM, tenofovir, acetazolamide, cystinosis
  • Treatment: bicarbonate (high dose) + K

341.2.1.7 RTA Type 4 (Hyperkalemic)

  • Hyperkalemia
  • Mild non-AG acidosis
  • Diabetic nephropathy common
  • Drugs: K-sparing, ACE/ARB, MRA, trimethoprim, calcineurin inh, NSAIDs
  • Treatment: K restriction, fludrocortisone (true hypoaldo), bicarb, K binders

341.2.1.8 Fanconi Syndrome

  • Glucosuria + aminoaciduria + phosphaturia + uricosuria + bicarbonaturia (type 2 RTA)
  • Causes: cystinosis, MM, tenofovir, ifosfamide, heavy metals
  • Treatment: replace losses

341.2.1.9 Nephrogenic DI Causes

  • Lithium (most common acquired)
  • Hypercalcemia
  • Hypokalemia
  • Hereditary (AVPR2, AQP2)

341.2.1.10 Treatment NDI

  • Thiazide (paradoxical reduces UO)
  • Amiloride (esp lithium)
  • Low Na diet
  • Avoid culprit

341.2.1.11 Specific Conditions

Sjögren Renal: - Type 1 distal RTA - Tubulointerstitial nephritis

Sarcoidosis Renal: - Granulomatous interstitial nephritis - Hypercalcemia (1α-hydroxylase) - Steroid-responsive

IgG4-Related: - Multi-organ - Steroid-responsive

ICI Nephritis: - AIN typically - Hold ICI + steroids - Can re-challenge in some

Aristolochic Acid: - Chinese herb nephropathy - Balkan endemic - Progressive CKD + urothelial cancer risk

341.2.1.12 Key Trials

  • TEMPO 3:4: tolvaptan for ADPKD
  • RAVE, MENTOR, AURORA: various

341.2.2 易混淆比范

RTA Type Mechanism K Urine pH Cause
1 (Distal) ↓ H+ secretion Low > 5.5 Sjögren, autoimmune, hereditary, drugs (lithium, amphotericin)
2 (Proximal) ↓ HCO3 reabsorption Low Variable Fanconi, MM, tenofovir, acetazolamide, cystinosis
4 (Hyperkalemic) Hypoaldo High Variable DKD, K-sparing, ACE/ARB, trimethoprim, NSAIDs, calcineurin inh

341.2.3 Special Topics

341.2.3.1 Analgesic Nephropathy

  • Long-term combination analgesics
  • Phenacetin (banned), NSAIDs
  • Papillary necrosis
  • Chronic interstitial nephritis
  • Urothelial cancer risk

341.2.3.2 Tubulointerstitial Nephritis with Uveitis (TINU)

  • Young patients
  • Bilateral anterior uveitis + AIN
  • Often idiopathic
  • Steroid-responsive