WBR0794: Difference between revisions

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(Created page with "{{WBRQuestion |QuestionAuthor={{Rim}} |ExamType=USMLE Step 1 |MainCategory=Pharmacology |SubCategory=Renal |MainCategory=Pharmacology |SubCategory=Renal |MainCategory=Pharmaco...")
 
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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{SSK}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pharmacology
|MainCategory=Pharmacology
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|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Renal
|SubCategory=Renal
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
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|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Renal
|SubCategory=Renal
|Prompt=A 47 year old patient with HIV presents to the emergency department for 3 hours of excruciating left flank pain with minor hematuria. The emergency physician suspects a renal colic and orders a non-contrast abdominopelvic CT scan that comes back negative. Further work-up does not reveal any abnormalities despite the patient being in severe pain and not responding to analgesic therapy. The consulted urologist decides to intervene and prepares the patient for an interventional ureteroscopy. During the procedure, the surgeon recuperates 2 separate stones measuring around 1.5 cm each. If the patient's condition had been caused by a medications, which of the following would be a likely culprit?
|Prompt=A 47-year-old man with HIV presents to the emergency department for 3 hours of excruciating left flank pain and hematuria. The emergency physician suspects a renal colic and orders a non-contrast abdominopelvic CT scan that reveals left ureter dilation and edema without any visible obstruction. Further work-up is unremarkable. Given the patient's worsening status, the urologist decides to prepare the patient for interventional ureteroscopy. During the procedure, the surgeon recuperates 2 separate stones measuring around 1.5 cm each. Assuming the patient's condition had been caused by a medication, which of the following would be a likely culprit?
|Explanation=Indinavir is a protease inhibitor used commonly to treat HIV. A significant portion of patients receiving this drug develop indinavir nephrolithiasis. Usually, indinavir stones cannot be detected on abdominal x-ray nor on abdominopelvic CT especially if the stones are purely composed of indinavir. Some patients can have mixed stones with some calcium content that may be visible. Therapy with indinavir usually needs to be discontinued permanently with a switch to another protease inhibitor warranted. Invasive intervention is sometimes needed in patients with severe pain, sepsis, or prolonged obstruction affecting renal function.
|Explanation=Indinavir is a [[protease inhibitor]] commonly used to treat HIV. A significant portion of patients receiving this drug (4-5%) develop [[indinavir]] nephrolithiasis. Usually, indinavir stones cannot be detected on abdominal x-ray nor on abdominopelvic CT especially if the stones are purely composed of indinavir. Some patients can have mixed stones with some calcium content that may be visible. Therapy with indinavir usually needs to be discontinued permanently with a switch to another protease inhibitor. Invasive intervention is sometimes needed in patients with severe pain, sepsis, or prolonged obstruction affecting renal function.
 
 
Learning objective: Indinavir is a protease inhibitor that can lead to nephrolithiasis with radiolucent stones even on CT scan.
 


References:


Matlaga BR, Shah OD, Assimos DG. Drug-induced urinary calculi. Rev Urol. 2003;5(4):227-31.
|AnswerA=Ibuprofen
|AnswerA=Ibuprofen
|AnswerAExp=Ibuprofen is not associated with kidney stones.
|AnswerAExp=Ibuprofen is not associated with kidney stones.
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|AnswerBExp=Metoprolol is not associated with kidney stones.
|AnswerBExp=Metoprolol is not associated with kidney stones.
|AnswerC=Indinavir
|AnswerC=Indinavir
|AnswerCExp=Indinavir is a protease inhibitor that can cause kidney stones that may not be detected even on CT scan.
|AnswerCExp=Indinavir is a protease inhibitor that can cause radiolucent kidney stones that are difficult to detect even on CT scan.
|AnswerD=Atorvastatin
|AnswerD=Atorvastatin
|AnswerDExp=Atorvastatin is not associated with kidney stones.
|AnswerDExp=Atorvastatin is not associated with kidney stones.
|AnswerE=Augmentin
|AnswerE=Raltegravir
|AnswerEExp=Augmentin is not associated with kidney stones.
|AnswerEExp=Raltegravir is not associated with kidney stones.
|EducationalObjectives=Indinavir is a protease inhibitor that can lead to nephrolithiasis with radiolucent stones that may be hard to visualize on abdominal CT scan.
|References=Matlaga BR, Shah OD, Assimos DG. Drug-induced urinary calculi. Rev Urol. 2003;5(4):227-31.
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=Indinavir, Kidney stones
|WBRKeyword=Indinavir, Kidney stones, Radiolucent, AIDS, Protease inhibitor,
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 01:43, 28 October 2020
Author [[PageAuthor::Serge Korjian M.D. (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Renal
Prompt [[Prompt::A 47-year-old man with HIV presents to the emergency department for 3 hours of excruciating left flank pain and hematuria. The emergency physician suspects a renal colic and orders a non-contrast abdominopelvic CT scan that reveals left ureter dilation and edema without any visible obstruction. Further work-up is unremarkable. Given the patient's worsening status, the urologist decides to prepare the patient for interventional ureteroscopy. During the procedure, the surgeon recuperates 2 separate stones measuring around 1.5 cm each. Assuming the patient's condition had been caused by a medication, which of the following would be a likely culprit?]]
Answer A AnswerA::Ibuprofen
Answer A Explanation AnswerAExp::Ibuprofen is not associated with kidney stones.
Answer B AnswerB::Metoprolol
Answer B Explanation AnswerBExp::Metoprolol is not associated with kidney stones.
Answer C AnswerC::Indinavir
Answer C Explanation AnswerCExp::Indinavir is a protease inhibitor that can cause radiolucent kidney stones that are difficult to detect even on CT scan.
Answer D AnswerD::Atorvastatin
Answer D Explanation AnswerDExp::Atorvastatin is not associated with kidney stones.
Answer E AnswerE::Raltegravir
Answer E Explanation AnswerEExp::Raltegravir is not associated with kidney stones.
Right Answer RightAnswer::C
Explanation [[Explanation::Indinavir is a protease inhibitor commonly used to treat HIV. A significant portion of patients receiving this drug (4-5%) develop indinavir nephrolithiasis. Usually, indinavir stones cannot be detected on abdominal x-ray nor on abdominopelvic CT especially if the stones are purely composed of indinavir. Some patients can have mixed stones with some calcium content that may be visible. Therapy with indinavir usually needs to be discontinued permanently with a switch to another protease inhibitor. Invasive intervention is sometimes needed in patients with severe pain, sepsis, or prolonged obstruction affecting renal function.

Educational Objective: Indinavir is a protease inhibitor that can lead to nephrolithiasis with radiolucent stones that may be hard to visualize on abdominal CT scan.
References: Matlaga BR, Shah OD, Assimos DG. Drug-induced urinary calculi. Rev Urol. 2003;5(4):227-31.]]

Approved Approved::Yes
Keyword WBRKeyword::Indinavir, WBRKeyword::Kidney stones, WBRKeyword::Radiolucent, WBRKeyword::AIDS, WBRKeyword::Protease inhibitor
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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