17.6 Pathology: Tubulo-interstitial disease Flashcards
(23 cards)
Which are more common, tubulointerstitial or glomerular disease?
Tubulointerstitial diseases
What are 3 causes of tubulointerstitial injury?
Acute tubular necrosis (ischaemia of tubular epithelial cells)
Acute pyelonephritis (tubule/interstitial infection)
Acute/chronic tubulointerstitial nephritis
What is the most common cause of acute renal failure?
Acute tubular necrosis (ischaemia, usually to tubular epithelial cells)
What happens in ATN?
Tubule can’t function, GFR falls, creatinine/urea accumulate
What are the outcomes of ATN?
What is recovery often associated with?
Reversible (dialysis?)
Recovery often associated with diuresis
What do we see on a histological section in ATN?
Massive necrosis, sloughing
What is the difference between hypoperfusion and ischaemic ATN?
Hypoperfusion (pre-renal): GFR falls, perfusion restored? GFR starts again
ATN: Severe/protracted hypoperfusion, necrosis of tubular epithelium
What is toxic ATN?
Similar to ischaemic, seen with:
Heavy metals (esp. mercury)
Some antibiotics
Some cancer chemo drugs
How does Toxic ATN often occur?
Many toxins disturb mitochondria and Ox Phos
In what organs is inflammation mediated by lymphocytes?
Liver, kidney
What is acute interstitial nephritis?
Interstitium/tubules infiltrated by inflammatory cells (incl. eosinophils), fever, maybe a rash
What is acute interstitial nephritis very often due to?
Drug allergy
What is pyelonephritis?
A bacterial infection of the kidney that affects:
Parenchyma
Calyces
Renal pelvis
What kind of infection is pyelonephritis? What might we see?
Acute or chronic
May occur with/without obstruction to urine flow
How does acute pyelonephritis present in adults vs. children?
Adults: acute onset, fever/chills/lumbar tenderness/pain
Children: Abdominal pain, vomiting, fever
What happens to renal function and urine in acute pyelonephritis?
Renal function usually preserved
Urine: contains organisms, WBCs
What commonly causes acute pyelonephritis?
Gram negative bacteria: E. Coli Kelbsiella Proteus Psuedomonas
What may or may not be associated with chronic pyelonephritis?
May be obstructive or non-obstructive
What does chronic pyelonephritis often result in (seen on histological section)?
Interstitial scarring,
tubular atrophy,
‘Saddle scars’
What is reflex nephropathy?
Renal damage due to backflow of urine
What is analgesic nephropathy?
Chronic, associated with ‘compound analgesics’
less common now
What is chronic renal failure defined as?
Insufficient GFR
What are the common causes of chronic renal failure?
Diabetic nephropathy
Glomerulonephritis
Hypertension
