Tubulointerstitial Diseases - Nichols

Question 1

What are the various forms of tubulointerstitial disease?

Answer 1

acute tubular necrosis
peylonephritis
interstitial nephritis
cystic disease

Question 2

What is the relationship between acute kidney injury and acute tubular necrosis?

Answer 2

ATN is a subset of AKI (the worst kind)

Question 3

What is the relationship between acute tubular necrosis and ischemia?

Answer 3

Ischemic ATN is a subset of ATN (probably around 75% of ATN)

Question 4

What are the gross pathologies of ATN?

Answer 4

enlarged kidneys (up to 30% over normal)
pale cortex (frequently reduced blood flow)
congested medulla, espicially at the cortico-medullary junction

Question 5

Why do you sometimes see bleeding, hemorrhages in ATN?

Answer 5

there can be reperfusion to the area

Question 6

What portion of the renal tubules are most vulnerable to acute ischemic necrosis and why?

Answer 6

the TALH and the proximal straight tubule;
both of these areas are high in active transport but located in the outer medulla. as such, they already receive less blood flow than the parts of the nephron in the cortex. so they are at increased risk of acute ischemic necrosis. this is the area that gets extremely congested in ATN

Question 7

What is the histologic finding of ATN at an early ischemic state?

Answer 7

blebbing of the luminal side cell membranes (looks kinda fuzzy and strands througout the lumen)

diffuse edema of tubular cells (vacuolization of cytoplasm)

Loss of brush borders, flattening of epithelium and necrosis and sloughing

Question 8

What types of casts are typically seen in ATN?

Answer 8

muddy brown casts, that are pigmented, brownish and coarsely granular

Question 9

The apoptotic renal tubular epithelial cells are most likely to have decreased cytoplasmic activity of what?

Answer 9

BCL2

Question 10

What can be seen in ATN from rhabdomyolysis?

Answer 10

condensed, darker cells in the cell, this is myoglobin from rhabdomyolysis

Question 11

What is seen histologically upon ethylene glycol poisoning?

Answer 11

vacuoliztation and calcium oxalate. looks like fragments, like a fan

Question 12

Why is reversible ATN not considered an oxymoron?

Answer 12

at the level of the pt, it’s reversible. just not on the individual cell levels

Question 13

Potassium over what is a medical emergency?

Answer 13

over 7 mmol/L

Question 14

What is the immediate tx for potassium levels of 7 mmol.L

Answer 14

IV CALCIUM GLUCONATE (antagonizes membrane depolarization and protects against cardiac arrhythmiass
IV Insulin + Glucose (drives potassium from bloodstream into cells)

Question 15

Wht is seen on gross pathology in acute pyelonephritis?

Answer 15

dark red congestion and areas of light tan suppurative inflammation, some with necrosis, some coalescing into abscesses

Question 16

Acute pyelonephritis is characteristically abscessing because it produces?

Answer 16

liquefactive necrosis

Question 17

What would microscopy should in renal abscesses?

Answer 17

severe acute inflammation and necrosis, but not liquefaction.

Question 18

What type of debris is found in the breakdown of dead cells that make the stains so blue?

Answer 18

nucleic acids, and breakdown of especially neutrophils

Question 19

When pyelonephritis has exteneded all the way ou tto the capsule, what can be seen?

Answer 19

scarrinb visible on the cortical surface ie blunted calyx

Question 20

What are the two ways the pyelonephritis can occur?

Answer 20

infection ascending from the bladder or infection arriving via the bloodstream

Question 21

What is the most common hematogenous infection in pyelonephritis?

Answer 21

staph

Question 22

what is the most common acscneding infection in pyelonephritis?

Answer 22

e coli

Question 23

What is the relationshpi between Acute Interstitial nephritis and drug reactions?

Answer 23

ain due to drug rxns are a subset of AIN. over 75% of ain cases. but most drug reactions do not cause interstitial nephritis

Question 24

What is seen on histology in interstitial nephritis?

Answer 24

edema, lymphocytes, macrophages, neutrophils and eosinophils

Question 25

who is at risk for analgesic nephropathy?

Answer 25

elderly fmelaes, due to long term combination analgesic use

Question 26

What mutations can lead to autosomal dominant polycystic kidney disease?

Answer 26

polycystin-1 or 2

Question 27

what is the pathology of autosomal dominant polycytisc kidney disease?

Answer 27

slowly expanding cysts compress normal tissue, causing ischemic atrophy. leading to ciliopathy, defective mechanosensing of urine flow, dysregulatino of cell adhesion

Question 28

In childhood what is the common cystic kidney diseaes type?

Answer 28

autosomal recessive, with numerous small cysts replacing normal tissue during fetal life, due to mutation sin fibrocystin.

Question 29

why does autosomal recessive polycystic kidey disease lead to immediate untreatable respiratory failure at birth?

Answer 29

you have pulmonary hypolasia because “breathing” amniotic fluid goes through kidneys. so lungs don’t develop

Question 30

What is the most common genetic cause of esrd in children?

Answer 30

nephronophthisis - medullary cystic disease complex. small kidneys with numerou ssmall cysts at the corticomedullary junction and chronic tubulo-interstitial nephritis and fibrosis