USMLE Forum Archives - USMLE Step 2 CK - IM- AIDS & Infection
IM- AIDS & Infection
HIV - 01-02-08 13:16
A 35-year-old man with a past medical history of AIDS is admitted for fulminant herpes zoster and is started on intravenous Acyclovir. Two days later, the patient has multiple episodes of hematemesis and is transferred to the intensive care unit, where he is given four units of packed red blood cells. The following day, an upper endoscopy reveals esophagitis. He starts to improve, but two days later he develops jaundice. His labs show a rise in his creatinine from 1.2 to 2.5 mg/dL. His 24-hour urine output drops from 1,200 to 350 mL. Physical examination reveals jaundice. Laboratory studies reveal:
Potbuttium 5.6 mEq/L, bicarbonate 24 mEq/L, BUN 36 mg/dL, creatinine 2.5 mg/dL, hematocrit 32%. The urinalysis is dipstick-positive for blood, and there are pigmented tubular casts with no crystals or bilirubin. No red cells are seen on microscopic examination. The urine sodium is elevated, and the fractional excretion of sodium is >1%.
What is the next best management?
(A) Stop Acyclovir
(B) Repeat ABO testing of the patient's blood
(C) Coombs' test
(D) Hemodialysis
(E) Thiazide diuretic
HIV - 01-02-08 13:16
A 35-year-old man with a past medical history of AIDS is admitted for fulminant herpes zoster and is started on intravenous Acyclovir. Two days later, the patient has multiple episodes of hematemesis and is transferred to the intensive care unit, where he is given four units of packed red blood cells. The following day, an upper endoscopy reveals esophagitis. He starts to improve, but two days later he develops jaundice. His labs show a rise in his creatinine from 1.2 to 2.5 mg/dL. His 24-hour urine output drops from 1,200 to 350 mL. Physical examination reveals jaundice. Laboratory studies reveal:
Potbuttium 5.6 mEq/L, bicarbonate 24 mEq/L, BUN 36 mg/dL, creatinine 2.5 mg/dL, hematocrit 32%. The urinalysis is dipstick-positive for blood, and there are pigmented tubular casts with no crystals or bilirubin. No red cells are seen on microscopic examination. The urine sodium is elevated, and the fractional excretion of sodium is >1%.
What is the next best management?
(A) Stop Acyclovir
(B) Repeat ABO testing of the patient's blood
(C) Coombs' test
(D) Hemodialysis
(E) Thiazide diuretic
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#3
Re: im abdelwhab - 01-04-08 13:29 answer is stop acyclovir
Nephrotoxicity is a well-known side effect of acyclovir therapy. Acyclovir is poorly soluble in urine and easily precipitates in renal tubules causing obstruction and acute renal failure. Crystalluria with renal tubular obstruction usually occurs during administration of large parenteral doses of acyclovir; inadequate hydration is a predisposing factor. The clinical presentation described is typical for acute renal failure: oliguria with elevated creatinine and BUN. Of course, other causes of acute renal failure should be considered
#5
Re: IM- AIDS & Infection 8401glacieres - 01-06-08 12:54 Stop Acyclovir. It's being concentrated in the tubules and manifested by CASTS.
#9
Re: IM- AIDS & Infection Sarahhh - 02-04-08 19:40 stop acyclovir.. toxic to the kidney.. i would go with A
#11
Re: IM- AIDS & Infection vphillips - 02-05-08 22:12 C - Stop Acyclovir is the next best step in management.
#13
Re: IM- AIDS & Infection bingousmle - 06-30-10 12:25 the man has got a acute renal failure... theres evidence for hemolysis and hemoglobinuria ... other likely cause could be nephrotoxicity due to acyclovir... i think its C
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