05.19 - Tubulointerstitial Disease 2 (Nichols) - PP + Handout, no reading Flashcards Preview

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Flashcards in 05.19 - Tubulointerstitial Disease 2 (Nichols) - PP + Handout, no reading Deck (97):
1

Most common nephrotoxic cause of ATN

Radiologic contrast dye

1

Tx of ATN

Dialysis, but after tx of shock and organ failure

2

Two options for quick tx of Hyperkalemia

IV Calcium Gluconate, IV Insulin + Glucose

2

ATN with Vacuolization and Calcium Oxalate

Ethylene Glycol

3

Common source of hematogenous infection leading to pyelonephritis

Central Venous Catheter - Staph Aureus

4

Male-Female preponderance of Pyelonephritis

Males under one, females b/t 1 and 50

4

Presence of a few renal cortical cysts is clinically significant

No, common finding in older adults with no clinical signficance

5

Mutations in AD (Adult) PCKD

Polycystin-1 or -2

6

Region of kidney most susceptible to ischemia

Outer medulla

6

Kidney injury caused by Rhabdomyolysis

Myoglobin precipitates in renal tubules causing ATN

6

New-onset azotemia w/ oliguria, fever, skin rash, and especially eosinophilia suggests

Drug-induced acute interstitial nephritis

6

Prognosis for AR PCKD

Immediate untreatable respiratory failure at birth

7

Potassium over __ is a medical emergency

7 mMol/L

8

T/F: Biopsy is often needed to dx etiology of AKI

False, unlike Nephrotic and Nephritic syndromes

9

As injury crosses line of irreversibility in ANT, the cells

undero coagulative necrosis and slough into the lumen (contributing to casts)

9

Symptoms of ATN

Anorexia progressing thru nausea to vomitting, along with pruritis and confusion

10

Ascending pyelonephritis in patients >1 is associated with

Vesicoureteral Reflux

10

When do patients with AD PCKD start getting symptoms? Is the progression of this disease rapid?

30s, no gradual

11

Mutation in Fibrocystin

AR (Childhood) PCKD

12

autosomal recessive diseases of cilia components leading to end-stage renal disease in children

Nephronopthisis-Medullary Cystic Disease Complex

12

Analgesic Nephropathy causes

Chronic Interstitial Nephritis and Papillary Necrosis

14

Which is reversible: ATN or Glomerular Necrosis

ATN

15

4 gross complications of Acute Pyelonephritis

Pyenephrosis, Perinephric Abcess, Acute Papillary Necrosis, Scars

17

Most common genetic cause of end stage renal disease in children

Nephronopthisis-Medullary Cystic Disease Complex

19

Gross changes in ATN

Kidneys enlarged up to 30%, with pale cortex and congested medulla

20

most common histopathologic counterpart to moderate-severe acute kidney injury

ATN

21

Acute Pyelonephritis produces what type of necrosis

Liquefactive --> Abcessing

22

Symptoms of ATN are the sames as symptoms of

AKI

22

Primary leukocyte in Acute Pyelonephritis

Neutrophils

23

Patients with Acute Pyelonephritis may have flank pain, with corresponding physical sign of

Costovertebral Angle Tenderness

24

Perinephric Abcess

Necrotizing pyelonephritis infection spreads thru renal capsule into surrounding fat

25

One of the earliers LM findings of ATN

Loss of brush border and bleb formation

27

Most common cause of ischemia leading to ATN

Shock, especially septic

28

Most common cause of ATN

Ischemia (75%)

28

Prognosis for AD PCKD

Avg patient needs dialysis or transplant at 50

29

Why are GI hemorrhage and epistaxis common in ATN

Platelets not functioning properly

29

Common symptoms of AD PCKD

Flank pain or dragging sensation in the abdomen

30

What causes Myoglobin casts

Necrosis of skeletal muscle (Rhabdomyolysis)

30

Abrupt impairment in renal fxn manifested by increased creatinine, BUN, and Oliguria

AKI

31

Histology of ATN

Blebbing, Vacuolization, Loss of BB, Flattening, Necrosis and Sloughing

32

Why is the percent of AKI represented by ATN not known

Rarely biopsied

33

More diffuse gross pyelonephritis rather than foci indicates what route of infection

Vesicoureteral Reflux

34

Depressed cortical scars indicates what about Pyelonephritis

Hematogenously spread chronic

35

Why does AR (childhood) PCKD lead to immediate untreatable respiratory failure at birth

Pulmonary Hypoplasia

36

Diffuse vacuolated tubular cells with no glomeruli or tubules in field

Renal Cell Carcinoma

37

Most common cause of acute kidney injury

Ischemia --> ATN

37

Muddy Brown Granular Casts or Tubular Epithelial Casts are a diagnostic feature of ___ in up to ___ percent of cases

ATN, 80%

39

Renal ischemia usually spares the

Glomeruli

40

Acute Pyelonephritis characteristically produces

Intense neutrophilic infiltration w/ liquefactive necrosis leading to abcess formation

40

Thyroidization

Chronic Pyelonephritis

41

Cysts in medulla, which generally do not impair renal fxn or effect prognosis of patient as whole

Medullary Sponge Kidney is characterized by

42

Mutation in AR PCKD

Fibrocystin

42

Genes mutated in Nephronopthisis-Medullary Cystic Disease Complex are __ components

Ciliary

43

Enlarged kidney, Pale cortex, Congested Medulla

ATN

43

Most specific cell type for Interstitial Nephritis

Eosinophils

45

Interstitial nephritis is either rich in ___ or ___

Eosinophils and Neutrophils (Type 1), or Macrophages with Giant Cells and Granulomas (Type 4)

46

Foci of pyelonephritis grossly means what route of infection

Hematogenous

47

Pyelonephritis essentially means

bacterial infection of kidney

48

Most common histopathologic counterpart of AKI

Acute Tubular Necrosis

50

Ascending Pyelonephritis in babies is associated with

Congenital malformation of valves b/t ureters and bladder

51

Most common cause of Intersitial Nephritis

Immune-mediated reaction to medication

52

Cortical hemorrhages

ATN

53

Necrosis --> Liquefaction --> Abcesses

Acute Pyelonephritis

54

Mutations in Polycystin-1 or -2

AD (Adult) PCKD

56

Second most common cause of ATN after ischemia

Nephrotoxins

57

Small kidneys w/ numerous small cysts at corticomedullary junction and chronic tubulointerstitial nephritis and fibrosis

NMCDC

59

Most common cause of Acute Pyelonephritis

E Coli

61

What presentation suggests drug-induced acute interstitial nephritis

New-onset azotemia w/ oliguria, fever, skin rash, and especially eosinophilia

64

BP in ATN

Usually low, because usually caused by septic shock

64

Key determinant of which ATN patients need dialysis

Potassium (hyperkalemia)

65

Baseline normal renal tubule histology

Cuboidal cells with granular eosinophilic cytoplasm

66

Pyenephrosis

Infected pus fills and distends the renal calyces, pelvis, and ureter

67

Presence of Small-moderate numbers of globally sclerotic glomeruli is clinicaly significant?

No, common finding in older adults with no clinical signficance

68

What causes Thyroidization? What condition has this?

Fibrosis and tubules distended with inspissated urine, making them look like thyroid follicles; Chronic Pyelonephritis

69

What percent of AIN is due to drug reactions

75%

71

Hematogenous pyelonephritis is most commonly due to

Staph Aureus

72

Prognosis for Acute Pyelonephritis

Good

72

Two regions of renal tubule most vulnerable to acute ischemic necrosis

PST, Ascending Thick Limb

73

Timeline of Intersitial Nephritis after expsoure to offending drug

15 days

74

Good evidence that you're in recovery phase after AKI

Mitotic figures

75

Urinalysis feature of ATN

Muddy Brown Casts

77

With chronic pyelonephritis, there is usually ___, primarily with __ and ___, primarily involving ___

Usually inflammation, primarily involving lymphocytes and plasma cells, primarily involving the interstitium

79

Recurring or chronic Pyelonephritis is associated with

Scarring

81

Gross pathology of Acute Pyelonephritis

Dark red congestion; Areas of tan suppurative inflammation (some with necrosis, some becoming abcesses)

82

What type of necrosis is seen in ATN

Coagulative

83

Area of dark blue in microscopic path of Renal Abcesses

Nuclear debris from breakdown of dead cells (especially neutrophils)

85

Electrolytes and Acid Base in ATN

Hyperkalemia and Metabolic Acidosis; Sometimes Hyponatremia

86

Is ATN reversible?

Yes, because tubules can regenerate their epithelial cells

88

Medullary Sponge Kidney is characterized by

Cysts in medulla, which generally do not impair renal fxn or effect prognosis of patient as whole

89

T/F: Most drug reactions cause interstitial nephritis

False, but most intersitial nephritis is caused by drug reactions

90

Myoglobin Casts indicate

Rhabdomyolysis cause ATN - myoglobin precipitated in renal tubules

91

Classic triad of Intersitial Nephritis

Fever, rash, eosinophilia

93

___ is a disease of chronic intersitial nephritis and papillary necrosis

Analgesic Nephropathy

94

Ethylene Glycol poisoing causes ATN with what 2 features

Prominent cytoplasmic vacuolization and oxalate crystals

95

Why does ATN cause cortical hemorrhages? Why are they triangular?

Disease of intrarenal arteries that causes ischemia and then allows reperfusion

96

Infiltrating cells in Acute vs Chronic Pyelonephritis

Neutrophils vs Lymphocytes and Plasma Cells

97

Fibrosis + Distended tubules w/ inspissated urine, making them look like thyroid follices

Chronic Pyelonephritis