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

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Flashcards in 05.19 - Tubulointerstitial 1 (Wall) - PP, No reading Deck (80):
1

Granular casts mean that there is what in sediment

Renal tubular cells

1

Acute Interstitial Nephritis is a ___ reaction

immune-mediate hypersensitivity

1

Primary lesions in Arist Acid nephropathy are likely centered in

vessel walls --> Ischemia and interstitial fibrosis

2

PT dysfunction is manifested by

Decr reabsorption of Glucose, AA's, etc

3

Urine Sediment in Pre-Renal AKI vs ATN

Hyaline casts vs Muddy Brown Coarse Granular Casts

4

Signs of tubular function abnormality w/ interstitial disease

GFR, Anemia, Dehydration, HyperK, RTA

4

Aminoglycosides injure what part of nephrone

PT

4

Earliest functional defect in Hypercalcemic Nephropathy is

Inability to concentrate the urine

5

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

CD --> Nephrogenic DI

6

Mechanism of Arist Acid Nephropathy

DNA adducts

7

Goal of interstitial disease treatment is to

not let interstitial fibrosis occur

8

Type of immunity that plays predominant role in Acute IN

Cell-mediated --> Sometimes form granulomas

9

Proteinuria and Pyuria in Interstitial Disease

Minimal proteinuria, Sterile pyuria

9

Type of immunity that plays role in Methicillin-induced AIN

Ab-mediated plays role in addition to Cell-mediated

10

Most frequent cause of Interstitial Nephritis

NSAID-associated

10

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

Cortex

11

Prolonged, severe Hypercalcemia leads to

Nephrogenic DI - Can't concentrate urine

11

All the heavy metals have been associated with __ injury

tubular

11

Most common genetic kidney disease

PCKD

13

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

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

14

2 methods of injury by contrast

Vasoconstriction, Direct nephrotoxicity

14

__ gets lower with larger volume in PCKD

GFR

15

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

15 days

16

Urinalysis of Contrast-induced Nephropathy

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

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