Renal Toxicology

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Last updated 11:57 PM on 10/14/26
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1
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Why are kidneys vulnerable to toxins?

Receive 20–25% of cardiac output, high metabolic activity, concentrate xenobiotics, susceptible to immune‑mediated injury

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<p>Receive 20–25% of cardiac output, high metabolic activity, concentrate xenobiotics, susceptible to immune‑mediated injury</p><img src="https://assets.knowt.com/user-attachments/b7feb635-859e-4556-8152-58ab8c377db5.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Functional toxic disorders?

Renal tubular acidosis, nephrogenic diabetes insipidus, SIADH

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<p>Renal tubular acidosis, nephrogenic diabetes insipidus, SIADH</p><img src="https://assets.knowt.com/user-attachments/98c163f1-ee92-4993-8c55-a18796365f3a.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Toluene toxicity hallmark?

Type I (distal) RTA with urine pH >5.5 + severe hypokalemia

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<p>Type I (distal) RTA with urine pH &gt;5.5 + severe hypokalemia</p><img src="https://assets.knowt.com/user-attachments/32d92c86-a672-489d-b905-98b6b6503bfc.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><img src="https://assets.knowt.com/user-attachments/428f1b17-fe9f-4548-a573-cd399d43f859.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Toluene source?

Paints, glues, lacquer thinners

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<p>Paints, glues, lacquer thinners</p><img src="https://assets.knowt.com/user-attachments/7cf5f8d8-2889-426b-9854-c723bba39ac8.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Mechanism of toluene RTA?

α‑intercalated cell failure → cannot secrete H⁺ → no new HCO₃⁻ generation

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<p>α‑intercalated cell failure → cannot secrete H⁺ → no new HCO₃⁻ generation</p><img src="https://assets.knowt.com/user-attachments/bf1473e3-30ae-4f12-8dea-e8b2ceda64da.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Ethylene glycol source?

Antifreeze ingestion

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<p>Antifreeze ingestion</p><img src="https://assets.knowt.com/user-attachments/b04e4677-676d-4b09-80e7-46a584c8603d.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Ethylene glycol acid‑base pattern?

High anion gap metabolic acidosis

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<p>High anion gap metabolic acidosis</p><img src="https://assets.knowt.com/user-attachments/34a925e4-0604-485d-9fbb-64b2770f3d85.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Ethylene glycol toxic metabolites?

Glycolic acid, glyoxylic acid, oxalic acid

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<p>Glycolic acid, glyoxylic acid, oxalic acid</p><img src="https://assets.knowt.com/user-attachments/d98e026d-7d17-4a44-8b4e-615aabff2b9a.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Ethylene glycol renal injury mechanism?

Oxalic acid binds Ca → calcium oxalate crystals → ATN + AKI

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<p>Oxalic acid binds Ca → calcium oxalate crystals → ATN + AKI</p><img src="https://assets.knowt.com/user-attachments/83106bae-09fc-47f3-a79f-334908c8eacd.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Ethylene glycol urine crystals?

Calcium oxalate

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<p>Calcium oxalate </p><img src="https://assets.knowt.com/user-attachments/1e31c03d-b174-46f1-a802-a2ae73f9093a.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><img src="https://assets.knowt.com/user-attachments/4baabdfb-d1e8-4b02-adf6-8766fb2ec046.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Ethylene glycol treatment?

Fomepizole, dialysis, thiamine + pyridoxine adjuncts

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<p><u>Fomepizole</u>, dialysis, thiamine + pyridoxine adjuncts</p><img src="https://assets.knowt.com/user-attachments/972e1be4-5a94-4f0d-a213-dedf7585901a.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Methanol vs ethylene glycol key difference?

Methanol → formic acid (ocular toxicity)

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<p>Methanol → formic acid (ocular toxicity)</p><img src="https://assets.knowt.com/user-attachments/3ab8e606-4964-4dfd-8d84-c69a0da45599.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Mechanism of salicylate respiratory alkalosis?

Direct stimulation of respiratory center → hyperventilation

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<p>Direct stimulation of respiratory center → hyperventilation</p><img src="https://assets.knowt.com/user-attachments/ec448f14-6cb4-4e86-be20-27de417bf095.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><img src="https://assets.knowt.com/user-attachments/565c51bb-177d-46f7-8195-0a47528db928.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Mechanism of salicylate metabolic acidosis?

Uncouples oxidative phosphorylation → lactic acidosis + ketoacids

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<p>Uncouples oxidative phosphorylation → lactic acidosis + ketoacids</p><img src="https://assets.knowt.com/user-attachments/218f8766-9b3b-46de-814d-9bd7c016a278.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Salicylate toxicity symptoms?

Tinnitus, tachypnea, agitation, confusion, nausea/vomiting

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<p>Tinnitus, tachypnea, agitation, confusion, nausea/vomiting</p><img src="https://assets.knowt.com/user-attachments/65a91838-d022-4a53-8ccd-a9c0b453eec2.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Salicylate treatment?

Sodium bicarbonate alkalinization of serum and urine to eliminate salicylate

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<p>Sodium bicarbonate alkalinization of serum and urine to eliminate salicylate</p><img src="https://assets.knowt.com/user-attachments/9a11ddaf-71fd-48d4-9ba6-a2483a1bd457.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Why bicarbonate helps in salicylate toxicity?

Alkalinizes urine → traps salicylate → increases renal excretion

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<p>Alkalinizes urine → traps salicylate → increases renal excretion</p><img src="https://assets.knowt.com/user-attachments/fe095ed7-fa29-4a8e-93fc-705a02813ccc.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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MDMA renal effect?

SIADH causing profound dilutional hyponatremia

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<p>SIADH causing profound dilutional hyponatremia</p><img src="https://assets.knowt.com/user-attachments/58e67120-e5ba-44c2-b379-76245e5ce942.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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MDMA hyponatremia presentation?

Confusion, seizures, coma

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<p>Confusion, seizures, coma</p><img src="https://assets.knowt.com/user-attachments/6f272ca2-d0ae-47c7-ad7b-811eee05d132.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Lithium renal effect?

Nephrogenic diabetes insipidus

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<p>Nephrogenic diabetes insipidus</p><img src="https://assets.knowt.com/user-attachments/33a6a866-58e6-4da6-a6a0-9df8a367ef1d.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Mechanism of lithium NDI?

Lithium enters principal cells via ENaC → downregulates aquaporin‑2 → inability to concentrate urine

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<p>Lithium enters principal cells via ENaC → downregulates aquaporin‑2 → inability to concentrate urine</p><img src="https://assets.knowt.com/user-attachments/4a1c76a1-dd53-4a57-898f-37908ffdc5d8.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Lithium toxicity symptoms?

Tremor, hyperreflexia, clonus, ataxia, GI upset

LITHIUMS: Leukocytosis Increased thirst/weight Tremors/thin hair Hypothryoidism Impaired memory Upset stomach Medication Skin issues

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Lithium handling in kidney?

Reabsorbed like sodium

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<p>Reabsorbed like sodium</p><img src="https://assets.knowt.com/user-attachments/4f2fd365-d96c-4c78-88be-d85719eefdbe.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Winters formula?

Predicted PCO₂ = 1.5 × HCO₃⁻ + 8 ± 2

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Ethylene glycol vs methanol treatment?

Both use fomepizole

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<p>Both use fomepizole</p><img src="https://assets.knowt.com/user-attachments/2ab6cb16-2bd8-4250-804b-7d98cb863d65.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><img src="https://assets.knowt.com/user-attachments/20d6b33c-a4e7-4b8d-9c9f-3072fe1120de.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Causes of Respiratory Alkalosis

Anxiety/Panic attack, Hypoxemia, Salicylates(early), Tumor, PE, Pregnancy

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High Anion Gap Metabolic Acidosis mneumonic (not GOLDMARK)

CAT MUDPILES: Cyanide/CarbonMonoxide, Acetaminophen/Aspirin/AlcoholicKetoacidosis, Toulene(glue/paint huffing), Methanol/Metformin/Massive overdoses, Uremia, Diabetic Ketoacidosis, Paraldehyde/Propylene glycol, Iron/Isoniazide/Ibuprofen, Lactic acidosis, Ethylene glycol, Salicylates

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<p>CAT MUDPILES: <strong>C</strong>yanide/CarbonMonoxide, <strong>A</strong>cetaminophen/Aspirin/AlcoholicKetoacidosis, <strong>T</strong>oulene(glue/paint huffing), <strong>M</strong>ethanol/Metformin/Massive overdoses, <strong>U</strong>remia, <strong>D</strong>iabetic Ketoacidosis,<strong> P</strong>araldehyde/Propylene glycol, <strong>I</strong>ron/Isoniazide/Ibuprofen, <strong>L</strong>actic acidosis, <strong>E</strong>thylene glycol, <strong>S</strong>alicylates</p><img src="https://assets.knowt.com/user-attachments/866641c7-1710-4ace-87f5-525a120a8c26.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>
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Causes of Metabolic Alkalosis

Hyperaldosteronism, Bartter syndrome, Gitelman syndrome, Loop/thiazide diuretics, vomiting, antacids

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<p>Hyperaldosteronism, Bartter syndrome, Gitelman syndrome, Loop/thiazide diuretics, vomiting, antacids</p><img src="https://assets.knowt.com/user-attachments/79b0ba5e-7eb7-47d4-97f0-ccb18a160f36.png" data-width="50%" data-align="center" alt="knowt flashcard image" style="display: block; width: 50%; margin-left: auto; margin-right: auto;"><p></p>