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Renal > 05.19 - Tubulointerstitial 1 (Wall) - PP, No reading > Flashcards

05.19 - Tubulointerstitial 1 (Wall) - PP, No reading Flashcards

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1
Q

Granular casts mean that there is what in sediment

A

Renal tubular cells

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1
Q

Acute Interstitial Nephritis is a ___ reaction

A

immune-mediate hypersensitivity

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1
Q

Primary lesions in Arist Acid nephropathy are likely centered in

A

vessel walls –> Ischemia and interstitial fibrosis

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2
Q

PT dysfunction is manifested by

A

Decr reabsorption of Glucose, AA’s, etc

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3
Q

Urine Sediment in Pre-Renal AKI vs ATN

A

Hyaline casts vs Muddy Brown Coarse Granular Casts

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4
Q

Signs of tubular function abnormality w/ interstitial disease

A

GFR, Anemia, Dehydration, HyperK, RTA

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4
Q

Aminoglycosides injure what part of nephrone

A

PT

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4
Q

Earliest functional defect in Hypercalcemic Nephropathy is

A

Inability to concentrate the urine

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5
Q

Lithium typically injures what part of nephron and thus leads to what

A

CD –> Nephrogenic DI

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6
Q

Mechanism of Arist Acid Nephropathy

A

DNA adducts

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7
Q

Goal of interstitial disease treatment is to

A

not let interstitial fibrosis occur

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8
Q

Type of immunity that plays predominant role in Acute IN

A

Cell-mediated –> Sometimes form granulomas

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9
Q

Proteinuria and Pyuria in Interstitial Disease

A

Minimal proteinuria, Sterile pyuria

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9
Q

Type of immunity that plays role in Methicillin-induced AIN

A

Ab-mediated plays role in addition to Cell-mediated

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10
Q

Most frequent cause of Interstitial Nephritis

A

NSAID-associated

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10
Q

As opposed to Analgesic Abuse Nephropathy, Aristolochich Acid Nephropathy is localized to

A

Cortex

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11
Q

Prolonged, severe Hypercalcemia leads to

A

Nephrogenic DI - Can’t concentrate urine

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11
Q

All the heavy metals have been associated with __ injury

A

tubular

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11
Q

Most common genetic kidney disease

A

PCKD

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13
Q

AKI is a rise in serum creatinine of at least __ over a __ period and/or a rise of ___times baseline within previous ___ days

A

0.3 mg/dL over 48 hour period; >1.5 times baseline within previous 7 days

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14
Q

2 methods of injury by contrast

A

Vasoconstriction, Direct nephrotoxicity

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14
Q

__ gets lower with larger volume in PCKD

A

GFR

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15
Q

Time frame of Acute Drug-Induced IN after use of drug

A

15 days

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16
Q

Urinalysis of Contrast-induced Nephropathy

A

Renal Tubular Epithelial Cells and Coarse Granular Casts; No pyuria because non-inflammatory process (nephropathy)

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17
Most common process behind AIN after NSAIDs
Viral infections
18
4 Causes of Papillary Necrosis
DM, Analgesic Nephropathy, Sickle-Cell, Obstruction
19
Origin of uric acid
Breakdown of DNA
20
Urinalysis in PCKD
Bland b/c no glomerular disease
21
Histology of NSAID-assoicated IN
Minimal Change Disease
21
Analgesic Abuse Nephropathy initially was reported with use of
Phenacetin
22
DT dysfunction is manfiest by
Decr reabsorption of Na, K, H
23
Waxy casts in interstitial disease tell you what
Chronic
24
At what age are cysts visible in PCKD
20-30 years
25
Description of Arist Acid Nephropathy
Chornic, irreversible, scarring, non-inflammatory
26
Clinical presentation of AIN
Sudden renal insufficiency, fever, rash, flank pain
27
What cells get damaged in kidney in Hypercalcemia Nephropathy
Tubular epithelial cells
29
Prognosis of NSAID-associated IN
Usually improves with discontinuation
30
Elevated CPK, myoglobin in urine
Rhabdomyolysis (statins, trauma)
31
PCKD can be thought of as a
Ciliopathy (genes mutated encode proteins within primary cilia of renal tubular cells)
32
Is Arist Acid Nephropathy acute or chronic
Chronic, irreversible, scarring, non-inflammatory
34
Urine Osmolarity in Pre-Renal AKI vs ATN
\>500 vs 300
35
What does urine specific gravity of 1.010 mean
Can't concentrate or dilute --\> urine osmolarity is same as plasma
36
What cytokine plays a critical role in Acute IN
TGF-beta
37
Setting in which Acute Phosphate Nephropathy usually occures
High doses of oral phosphate for colonoscopy
38
Cause of Balkan Nephropathy
Aristolochic Acid Nephropathy
40
What indicates chronic interstitial disease? What indicates allergic?
Waxy casts if chronic. Eo's if allergic.
41
Most sensitive indication of PT dysfunction
Glucose in urine with normal blood sugar
42
Histology of Uric Acid Nephropathy
Uric Acid crystals in tubules
44
Anemia in Glomerular disease vs Tubular
Worse in tubular because tubule produce the EPO
45
Timeline of clinical presentation after starting drug that causes AIN
within 3 weeks
45
Unusual finding/symptom of NSAID-associated IN
Nephrotic Range proteinuria
45
Triad of Acute Drug-Induced Interstitial Nephritis
Fever, Eosinophilia, Rash
46
Inflammatory infiltrate in Arist Acid Nephropathy
Minimal, more direct injury
47
Urine Na concentration in Pre-renal AKI vs ATN
\< 20 vs \>40
49
Causes of Hyperkalemia and RTA in Interstitial Diseas
Impaired K secretion in cortical CD, Impaired H+ secretion
51
In Analgesic Abuse Nephropathy, drug accumulates in \_\_\_
Renal Medullary Interstitium
52
Medullary dysfunction is manifested by
Impaired urine concentrating ability
53
\_\_ stones are not visible w/ plain radiographs
Uric Acid Stones
54
Clinical manifestation of Aminoglycoside Nephrotoxicity
Progressive incr serum creatinine, Renal K and Mg wasting, Renal Glucosuria
56
Papillary dysfunctin is manifested by
Impaired urine concentrating ability
58
Hallmark in urinalysis of Interstitial Disease
Concentrating defect --\> Sp Gravity of 1.010 (urine osmolarity of 300 mOsm/kg)
59
Time course of papillary necrosis from DM
10 years
60
Plasma BUN/Creatinine Ratio in Pre-Renal AKI vs ATN
\>20 vs
62
Exposure to Arist Acid
Soil
63
Analgesic Abuse Nephropathy may progress to
Papillary Necrosis
64
Urine Specific Gravity in Pre-Renal AKI vs ATN
\> 1.018 (high) vs 1.010 (low)
65
Chinese Herb Nephropathy is due to
Rapid IN from Aristolochic Acid
66
Heavy metals typically injure what part of nephron
Proximal Tubule
67
What types of patients are likely to get contrast nephropathy
Preexisting renal insuff; DM; Volume depleted
68
2 causes of free iron in urine that damages tubules
Rhabdomyolysis, Intravascular Hemolysis
69
2 conditions with high frequency of uro-epithelial cancer
Analgesic Abuse Nephropathy, Aristocholic Acid Nephropathy
71
Papillary necrosis is mostly associated with
infection
73
Eosinophils in pyuria indicated what
Allergic reaction
74
Study of choice for kidney stone evaluation
CT w/out contrast
75
Acute Phosphate Nephropathy presents with
Renal insufficiency several weeks after exposure
76
Tx of Contrast-Induced Nephropathy
Usually reversible and can be managed with supportive care, not dialysis
77
2 most common causes of Papillary Necrosis
DM w/ infection, Obstruction w/ infection
78
3 Tubular Dysfunction from Analgesic Abuse Nephropathy is characterized by
Hyperkalemic, Hyperchloremic RTA (Medulla and CD injury); Nephrogenic DI (Medulla injury)
79
PCKD is associated with what CNS finding
Intra-cranial Aneurysms
80
Acute Uric Acid Nephropathy is due to
AKI caused by patients with cancer

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