Toxic Responses of the Respiratory System
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What is the primary function of the nasal passage as the first line of defense against toxic respiratory insults?

  • It produces antibodies to combat toxins.
  • It serves as a reservoir for mucus.
  • It warms and humidifies the air while filtering particles. (correct)
  • It filters particles only through impaction.
  • What leads to the induction of CYP450 2B1 and 4B1 in the nasal mucosa?

  • The presence of dust particles only.
  • Normal physiological state of the respiratory system.
  • High humidity levels in the nasal passage.
  • Exposure to specific airborne toxins. (correct)
  • What are the effects observed in the olfactory region after exposure to 400 ppm methyl methacrylate?

  • Epithelial degeneration and necrosis. (correct)
  • No changes in the tissue structure.
  • Enhanced mucous secretion.
  • Increased cilia production.
  • What is a significant feature of the conducting airways' epithelial structure?

    <p>It contains both ciliated and non-ciliated cells. (B)</p> Signup and view all the answers

    What function does the mucous layer in the conducting airways serve?

    <p>It protects epithelial cells through antioxidant and free radical scavenging functions. (C)</p> Signup and view all the answers

    Which size of silica particles is most likely to trigger inflammation and cancer more effectively?

    <p>Ultrafine particles ~20 nm (D)</p> Signup and view all the answers

    What condition is caused by asbestos exposure and characterized by lung scarring?

    <p>Asbestosis (A)</p> Signup and view all the answers

    Which chemical compound is known to induce extensive lung injury when ingested?

    <p>Paraquat (C)</p> Signup and view all the answers

    What role do polymorphonuclear cells play in the body regarding lung health?

    <p>They are markers for acute inflammatory responses. (C)</p> Signup and view all the answers

    What is a primary toxic effect of cyclophosphamide on lung tissue?

    <p>Targets the pulmonary endothelium with lipid peroxidation. (B)</p> Signup and view all the answers

    What synergistic effects could result from the combination of inorganic particles and a biological compound?

    <p>Greater inflammation and cancer risk. (D)</p> Signup and view all the answers

    Which lung disease is specifically linked to exposure to silica particles?

    <p>Silicosis (B)</p> Signup and view all the answers

    What form of lung injury is caused by monocrotaline over time?

    <p>Pulmonary vasculitis and hypertension (A)</p> Signup and view all the answers

    What is the primary function of Clara cells in the respiratory zone?

    <p>Detoxification through peptide solutions (C)</p> Signup and view all the answers

    Which type of cell serves as a stem cell pool for replacement and repair in the airways?

    <p>Basal cells (B)</p> Signup and view all the answers

    Which particle size is most likely to penetrate epithelial membranes in the lungs?

    <p>Ultrafine particles (below 100 nm) (B)</p> Signup and view all the answers

    What is the key function of pulmonary neuroendocrine cells (PNECs) in the lung?

    <p>Secretion of active peptides as regulators (B)</p> Signup and view all the answers

    What is the first step in the lung's defense mechanism for clearing deposited particles?

    <p>Nasal clearance (A)</p> Signup and view all the answers

    Which determinant of toxic effect correlates with daily mortality rates during smog episodes?

    <p>Concentration of particulate matter (B)</p> Signup and view all the answers

    What mechanism is primarily involved in the clearing of small particles in the lungs?

    <p>Phagocytosis by alveolar macrophages (D)</p> Signup and view all the answers

    In which part of the respiratory system does gas exchange primarily occur?

    <p>Alveolar ducts/sacs (A)</p> Signup and view all the answers

    What is the effect of low dose cyclophosphamide when used for treating paraquat pulmonary toxicity?

    <p>It targets and kills cells in the lungs affected by paraquat. (D)</p> Signup and view all the answers

    Which of the following is NOT a consequence of pulmonary edema?

    <p>Enlargement of the airspaces. (A)</p> Signup and view all the answers

    What leads to fibrosis in lung tissue?

    <p>Inflammatory cascade involving IL-1b and TNF-a. (D)</p> Signup and view all the answers

    Which agent is primarily associated with causing emphysema?

    <p>Cigarette smoke. (D)</p> Signup and view all the answers

    Which factor does NOT influence the hazard associated with airborne particulates?

    <p>Presence of allergens in food. (D)</p> Signup and view all the answers

    What is a significant biochemical consequence of the inhalation of irritant gases?

    <p>Reflex constriction of airways. (A)</p> Signup and view all the answers

    Why are the kidneys particularly vulnerable to toxic substances?

    <p>They serve as a site for xenobiotic metabolism. (C)</p> Signup and view all the answers

    Which response describes a significant consequence of lung cancer?

    <p>Obstructed gas exchange in lung function. (A)</p> Signup and view all the answers

    What is the most common site of toxicant-induced renal injury?

    <p>Proximal tubule (A)</p> Signup and view all the answers

    Which of the following is an example of a mycotoxin?

    <p>Aflatoxin (A)</p> Signup and view all the answers

    What class of nephrotoxins does mercury belong to?

    <p>Heavy metals (D)</p> Signup and view all the answers

    Which nephrotoxin is known for impairing glomerular ultrafiltration?

    <p>Cisplatin (D)</p> Signup and view all the answers

    What is a potential consequence of cadmium exposure in the kidneys?

    <p>Disruption of cadherin dependent cell-cell junctions (C)</p> Signup and view all the answers

    Which agents are considered therapeutic nephrotoxins?

    <p>Amphotericin B and cyclosporin (B)</p> Signup and view all the answers

    Which nephrotoxin is associated with altered hemodynamics due to indirect effects?

    <p>Chloroform (B)</p> Signup and view all the answers

    What is a characteristic of distal tubule injury in nephrotoxicity?

    <p>Impairment of acidification and concentrating ability (C)</p> Signup and view all the answers

    What role do cell-cell junctions play in the nephron's architecture?

    <p>They maintain structural and functional integrity. (D)</p> Signup and view all the answers

    What is a consequence of cadmium exposure in kidney cells?

    <p>Apoptosis and necrosis. (B)</p> Signup and view all the answers

    What is the primary mechanism by which NSAIDs can lead to acute renal failure?

    <p>Inhibition of prostaglandin synthesis. (C)</p> Signup and view all the answers

    Which type of nephropathy is characterized by oxidative stress and chronic damage?

    <p>Analgesic nephropathy. (B)</p> Signup and view all the answers

    What leads to crystal nephropathy?

    <p>Insulation of crystals in urine. (B)</p> Signup and view all the answers

    What common effect does nephrotoxicity have on kidney function?

    <p>Loss of cell polarity. (A)</p> Signup and view all the answers

    Which situation best illustrates a direct chemical insult to the kidneys?

    <p>The presence of nephrotoxic drugs in the bloodstream. (D)</p> Signup and view all the answers

    What structural component of the kidney is primarily affected by nephrotoxic agents?

    <p>Nephron structures. (A)</p> Signup and view all the answers

    Flashcards

    Nasal passage's role in respiratory defense

    The nasal passage acts as the initial filter of inhaled particles, warming and humidifying the air entering the respiratory system.

    Nasal mucosa enzyme function

    The nasal lining (mucosa) contains enzymes (CYP450s) that help break down harmful substances, and can be affected by air quality.

    Conducting airway structure

    Conducting airways (tubes) are lined with cells (e.g., ciliated cells), which help move mucus and trapped particles

    Mucus function in the airways

    Mucus in the airways plays a protective role, acting as an antioxidant, neutralizing acids, and combating free radicals.

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    Toxic effect on olfactory region

    Exposure to toxins can cause damage and deterioration of the olfactory (smell) part of the nasal passage.

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    What is the effect of smaller silica particles?

    Smaller silica particles, like ultrafine ones, penetrate deeper into the lungs, causing more inflammation and cancer. They are harder to remove by the body's defenses.

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    What happens to DNA in silica exposure?

    Silica exposure can lead to inflammation and DNA damage, creating an environment that can promote cancer development.

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    What is silicosis?

    Silicosis is a lung disease caused by inhaling silica dust. It can be acute or chronic and leads to inflammation and scarring.

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    What is asbestosis?

    Asbestosis is a lung disease caused by asbestos fibers. It leads to scarring and breathing problems.

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    What causes pulmonary vasculitis?

    Monocrotaline, a naturally occurring plant toxin, can damage blood vessels in the lungs, causing inflammation and high blood pressure.

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    What is the mechanism of paraquat toxicity?

    Paraquat, a pesticide, is taken up by lung cells and disrupts electron transport, leading to the creation of harmful reactive oxygen species.

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    What is the role of polymorphonuclear cells?

    Polymorphonuclear cells (PMNs) are immune cells that engulf and destroy foreign substances, like bacteria. They are markers of an acute inflammatory response.

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    What is the target of cyclophosphamide?

    Cyclophosphamide, a cancer drug, specifically targets the blood vessel lining in the lungs, creating inflammation and scarring.

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    Nephrotoxicity

    Damage to the kidneys caused by toxins or harmful substances. It can affect various parts of the kidney, leading to impaired function.

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    Heavy Metals as Nephrotoxins

    Certain heavy metals like mercury and cadmium can directly damage kidney cells, leading to nephrotoxicity.

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    Halogenated Hydrocarbons and Nephrotoxicity

    These compounds can cause kidney damage indirectly by disrupting blood flow and pressure, impairing kidney function.

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    Glomerular Injury

    Damage to the glomerulus, the filtering unit of the kidney, can lead to leakage of proteins and reduced filtration.

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    Proximal Tubule Injury

    The proximal tubule, responsible for reabsorption, is the most common site of kidney damage. Toxins can accumulate here and cause dysfunction.

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    Distal Tubule Injury

    Rare damage to the distal tubule, affecting concentration and acidification processes, can lead to kidney issues.

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    Cadmium and Nephrotoxicity

    Cadmium disrupts cell junctions in the kidneys by interfering with calcium binding, affecting kidney's filtering and reabsorption abilities.

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    Specific Toxic Profiles

    Different regions of the kidney have varying blood flow and susceptibility to toxins, leading to region-specific damage.

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    Paraquat Pulmonary Toxicity

    Paraquat, a herbicide, can cause severe lung damage. It targets and kills lung cells, leading to inflammation and potentially fatal complications.

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    Airway Reactivity

    The narrowing of airways in response to irritants, such as smoke or gases. This reflex constriction helps protect the lungs but can be problematic in conditions like asthma.

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    Pulmonary Edema

    Fluid buildup in the lungs due to increased permeability of the alveolar capillary barrier. It can be caused by inflammation, injury, or allergic reactions, hindering gas exchange.

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    Fibrosis in the Lungs

    Scarring of the lung tissue, caused by chronic inflammation and deposition of collagen. It makes the lungs stiff and less efficient.

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    Emphysema

    Abnormal enlargement of air sacs in the lungs, often caused by smoking. It leads to difficulty breathing and the lungs don't exchange oxygen effectively.

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    Asthma

    A chronic condition characterized by narrowing of the airways due to inflammation and bronchospasm. This is triggered by allergens or other irritants.

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    Lung Cancer

    Uncontrolled growth of abnormal cells in the lungs, often caused by smoking. It obstructs lung function and can be fatal.

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    Airborne Particulate Hazards

    The risk of exposure to small particles in the air depends on their type, concentration, size, and duration of exposure. Smaller particles are generally more hazardous.

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    Cadmium nephrotoxicity

    Cadmium (Cd) causes damage to the kidneys (nephrotoxicity), leading to cell death and impaired kidney function.

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    Cell-cell junctions

    These are connections between cells that hold them together in tissues, like the lining of the nephron in the kidneys.

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    How does Cd disrupt kidney function?

    Cadmium disrupts the tight junctions between kidney cells, making them leak and lose their protective barrier. This leads to cell death and impaired kidney function.

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    What are the signs of Cd nephrotoxicity?

    Cadmium nephrotoxicity can cause cell death (apoptosis and necrosis), sloughing of cells, cast formation, and tubular obstruction in the kidneys.

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    What is the key mechanism involved in NSAID-induced nephrotoxicity?

    Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen inhibit the production of prostaglandins, which are crucial for vasodilation (widening of blood vessels). This can lead to reduced blood flow to the kidneys and damage.

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    How do crystals lead to kidney damage?

    Crystals from certain medications can form in the urine, blocking the filters in the kidneys (glomeruli) and hindering blood filtration, leading to kidney damage.

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    What are common mechanisms of nephrotoxicity?

    Common mechanisms of kidney damage include direct chemical insult (from toxins), disruption of blood flow, and the formation of crystals that block kidney structures.

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    Why is the kidney vulnerable to toxicity?

    The kidneys are sensitive to damage because of their vital role in filtering blood and exposing them to many potentially harmful substances.

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    Clara cells

    Cells found in the respiratory tract that secrete a protective solution to detoxify the airways and contain enzymes to break down harmful substances.

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    Terminal bronchioles

    The smallest branches of the bronchi, where Clara cells are highly concentrated, and they are important for gas exchange in the lungs.

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    Pulmonary neuroendocrine cells (PNEC)

    Specialized cells in the airways that secrete active peptides that act as paracrine regulators, monitor oxygen levels, and control growth and repair.

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    Tracheobronchial clearance

    The process of removing particles from the trachea and bronchi through the movement of mucus.

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    Alveolar macrophages

    Immune cells that engulf and digest particles in the alveoli, the tiny air sacs in the lungs.

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    Particle size

    The size of inhaled particles influences how deeply they penetrate the lungs and how easily they are removed.

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    Correlation between particle concentration and mortality

    Studies have shown a link between high levels of airborne particles and increased death rates, highlighting the dangers of air pollution.

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    Ultrafine particles

    Extremely small particles, less than 100 nanometers in diameter, that can reach deep into the lungs and cause inflammation and damage.

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    Study Notes

    Toxic Responses of the Respiratory System

    • The respiratory system's first line of defense against toxic insults is the nasal passage.
    • Particles are filtered by diffusion or impaction onto nasal mucosa.
    • Nasal mucosa possesses CYP450 enzymes for metabolism, allowing it to match the challenges posed by low air quality.
    • This makes the mucosa a target for metabolically induced lesions.
    • The conducting airways consist of pseudostratified epithelium containing ciliated and non-ciliated cells, which become simple cuboidal as the tract descends.
    • Mucous (goblet) cells produce glandular tract mucus.
    • Mucous layers provide antioxidant, acid-neutralizing, and free radical-scavenging functions to protect epithelial cells.
    • Conducting airways progressively divide into narrower, shorter, and more numerous tubes.
    • Epithelial cells are increasingly interspersed with Clara cells, which secrete protective and regulatory peptides to detoxify distal airways.
    • Clara cells also contain xenobiotic enzymes.
    • The gas-exchange region branches into bronchioles and alveolar ducts/sacs, facilitating gas exchange.
    • Clara cells are highly concentrated in terminal bronchioles.
    • Cellular composition varies along the airways, with ciliated cells, Clara cells, pulmonary neuroendocrine cells (PNECs), basal cells, and goblet cells.
    • PNECs secrete active peptides, playing regulatory and growth/repair roles.
    • Basal cells are stem cells responsible for replacement and repair.
    • Nasal clearance removes particles rapidly, depending on size.
    • Tracheobronchial clearance involves mucous, but cellular injury can impair it.
    • Pulmonary clearance includes trapping in a fluid layer, phagocytosis by macrophages in mucous and alveolar macrophages, and removal via lymphatic drainage.
    • Small particles penetrate epithelial membranes, dissolve, and are removed in the bloodstream.
    • Distinct mechanisms are matched to specific challenges; toxic consequences increase with airway penetration and removal difficulty.

    Types of Toxic Particles

    • Combustion processes, such as diesel engines, create primary and aggregate elemental carbon, ultrafine particles, and metals.
    • Secondary atmospheric chemistry produces particles like sulfates, nitrates, and chlorides.
    • Fossil fuel combustion leads to fly ash, metals, and materials like mullite and glass.
    • Natural minerals, soil, and wind-blown materials contribute to air pollution.
    • Biological sources include bacteria, spores, organic carbon debris, and products like 2° cigarette smoke (with components such as PAH, acrolein, and nitroso compounds).

    Determinants of Toxic Effect: Exposure Quantity

    • A correlation exists between daily mortality rates and particle concentrations during London Smog episodes (1958-1972).
    • Exposure length significantly impacts toxic effects.

    Determinants of Toxic Effect: Particle Size

    • Ultrafine particles (50nm) and fine colloidal particles (480nm) have differing effects. Fine particles are more difficult to remove by the body's defenses compared to smaller particles.

    Size Makes a BIG Difference!

    • Smaller particles penetrate deeper into the lungs, triggering inflammation and cancer more effectively, and are more difficult to remove.
    • Larger particles tend to remain more superficial in the airways.

    Combined Insults Can Be Synergistic

    • Combining inorganic particles with biological components like endotoxin can have synergistic effects, increasing the immune response and toxicity compared to either insult alone.
    • Polymorphonuclear cells (PMNs) with phagocytic activity are relevant markers for acute inflammatory responses.

    Specific Toxicants: Airborne Agents

    • Asbestos causes asbestosis, lung cancer, and malignant mesothelioma depending on fibre length, diameter, and iron content (different fibres have different impacts).
    • Silica causes silicosis (acute or chronic).
    • Naphthalene causes necrosis in tissues.

    Specific Toxicants: Blood Borne Agents

    • Paraquat (pesticide) induces extensive lung injury (fibrosis) by targeting type I and II alveolar cells and interfering with electron transfer and reactive oxygen species.
    • Monocrotaline, a naturally occurring plant product, damages specific endothelial cells lining pulmonary vasculature.
    • Low dose cyclophosphamide treats paraquat pulmonary toxicity by targeting and killing paraquat-affected cells in the lungs to clear the area.

    Responses to Lung Injury

    • Airway reactivity includes reflex constriction, stimulated decrease in airway diameter due to irritant gases or cigarette smoke.
    • Pulmonary edema arises from thickened alveolar capillary barriers due to inflammation and tissue proliferation. This reduced exchange and compromised function.
    • Inflammation from allergic reactions or chemicals like NO2 and phosgene, or mechanical factors, can injure the lungs.
    • Fibrosis involves collagen deposition, causing the lung to shrink and stiffen.
    • Emphysema is characterized by abnormal enlargement of airspaces, macrophage accumulation, and destruction of alveolar walls.
    • Hyper-inflated lungs can't effectively exchange oxygen and carbon dioxide.
    • Asthma involves narrowed airways due to provoking agents like dust and pollen.
    • Lung cancer involves malignant tissue growth, obstructing lung function (common causes include cigarette smoking and asbestos fibres/metallic dusts).

    Summary of Respiratory System Toxicity

    • Four main factors determine the degree of harm from airborne particles: type, concentration, particle size (small is usually bad), and duration of exposure.
    • Biological effects include systemic toxicity, allergies, and hypersensitivity, as well as carcinogenesis, and irritation of mucous membranes.
    • The respiratory system is highly repairable and can handle many toxic environmental insults.

    Toxic Responses of the Renal System

    • The kidney's high blood flow (25% cardiac output; GFR 120 mL per minute) and concentrated urine production make it a target for toxicants.
    • The kidney is also a site for xenobiotic metabolism; the proximal tubule is particularly vulnerable due to leaking (e.g., from antibiotics, halogenated hydrocarbons, mycotoxins, heavy metals).

    Nephrotoxicity

    • Nephrotoxins have various causes including direct chemical toxicity, altered haemodynamics, and pH-dependent crystallization.
    • Heavy metals, halogenated hydrocarbons, therapeutic agents (e.g., aminoglycosides, cisplatin, amphotericin B, cyclosporin, NSAIDs), mycotoxins (e.g., aflatoxin), and their impacts on kidney function are relevant here.

    Specific Sites of Nephrotoxicity

    • Glomerular injury can alter glomerular permeability to proteins (e.g. doxorubicin), and impair glomerular ultrafiltration (e.g. amphotericin B and cyclosporin).
    • Proximal tubule injury is a common site for toxicant-induced renal injury, influenced by transport and accumulation of toxicants (e.g., aminoglycosides, Beta-lactam antibiotics, cisplatin, and metals). There are segmental differences in transport within the proximal tubule as well as in the activation of CYP450s and 𝛽-lyase activity.
    • Distal tubule injury is less common and affects concentrating ability and acidification (e.g. amphotericin B).

    Nephrotoxicity Examples (Specific Mechanisms)

    • Direct chemical toxicity Cadmium interacts with the extracellular Ca2+ binding domains/E-Cadherin, impacting their adhesive properties and disrupting cadherin-dependent cell-cell junctions. This disrupts the integrity of cell-cell junctions, which are critical to the structure and function of the nephron.
    • Haemodynamic failure (e.g., NSAIDs) impacting the kidney by reducing renal blood flow. It can cause acute renal failure (reversible with large doses), and chronic cases lead to Analgesic nephropathy (oxidative stress and necrosis), and Interstitial nephritis (rare) inflammation and oedema in the kidney.
    • Crystal nephropathy occurs due to compound insolubility in urine, reducing intravascular volume, impacting GFR, and altering urine pH. This forms crystals which obstruct kidney function (e.g., antivirals, antibacterial and anti-cancer agents).

    Summary of Renal Toxicity

    • The kidney is vulnerable to toxic insults due to its function, high blood flow, and exposure/accumulation.
    • Sites and mechanisms of damage are important, specifically those linked to glomerulus, proximal tubule and distal tubule.
    • Common mechanisms involve direct chemical insult, haemodynamic disruption, and crystallization.
    • The complex structure and function contribute to the kidney as a common target for toxicity.

    Reading List

    • Casarett & Doull's Toxicology: Chapter 14 (Kidney) and Chapter 15 (Respiratory system).

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    Description

    This quiz explores the defenses of the respiratory system against toxic insults, focusing on the roles of nasal mucosa and conducting airways. It covers how different epithelial cells, including goblet and Clara cells, contribute to respiratory health by detoxifying and protecting airway tissues. Test your understanding of respiratory anatomy and functions!

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