L2: Tubulointerstitial Diseases Flashcards
(90 cards)
1
Q
Def of Acute Tubulointerstitial Nephritis
A
- Acute inflammation of the renal interstitium and tubules that causes a decline in renal function over a period of days to weeks.
2
Q
Etiology of Acute Tubulointerstitial Nephritis
A
- Drugs
- Systemic Disease
- Infections
- Idiopathic
3
Q
Etiology of Acute Tubulointerstitial Nephritis
- Drugs
A
4
Q
Etiology of Acute Tubulointerstitial Nephritis
- Most Common Causes
- Most Common Specific Cause
A
DRUGS (MOST COMMON)
- Antibiotics (most important) e.g., β-lactams (methicillin) - Sulfonamides
5
Q
Etiology of Acute Tubulointerstitial Nephritis
- is it dose-dependent?
A
Development of drug-induced AIN is not dose-dependent.
6
Q
Etiology of Acute Tubulointerstitial Nephritis
- causes pf recurrence
A
Recurrence or exacerbation of AIN can occur with a second exposure to the same or a related drug.
7
Q
Etiology of Acute Tubulointerstitial Nephritis
- Systemic Diseases
A
① Sarcoidosis.
② Sjögren’s disease.
③ Systemic lupus erythematosus (SLE).
8
Q
Etiology of Acute Tubulointerstitial Nephritis
- Infectious
A
9
Q
Etiology of Acute Tubulointerstitial Nephritis
- Idiopathic
A
10
Q
Pathophysiogy of Acute Tubulointerstitial Nephritis
A
11
Q
Pathophysiogy of Acute Tubulointerstitial Nephritis
- Principal mechanism
A
12
Q
CP of Acute Tubulointerstitial Nephritis
A
13
Q
CP of Acute Tubulointerstitial Nephritis
- Asymptomatic
A
…
14
Q
CP of Acute Tubulointerstitial Nephritis
- Symptomatic
A
15
Q
CP of Acute Tubulointerstitial Nephritis
- Onset
A
within days of exposure to the offending drug in most instances.
16
Q
CP of Acute Tubulointerstitial Nephritis
- Symptoms
A
17
Q
Dx of Acute Tubulointerstitial Nephritis
A
- Hx
- Labs
- Bx
18
Q
Dx of Acute Tubulointerstitial Nephritis
- Hx
A
HISTORY OF :
▪ Drug intake
▪ Exposure to toxic substance
▪ Infection.
19
Q
Dx of Acute Tubulointerstitial Nephritis
- Labs
A
20
Q
Dx of Acute Tubulointerstitial Nephritis
- KFTs
A
Increased plasma creatinine.
21
Q
Dx of Acute Tubulointerstitial Nephritis
- CBC
A
Eosinophilia
22
Q
xDx of Acute Tubulointerstitial Nephritis
- urinalysis
A
23
Q
Dx of Acute Tubulointerstitial Nephritis
- FENA
A
High fractional sodium excretion (FENa) may be >2 %
24
Q
Dx of Acute Tubulointerstitial Nephritis
- Signs of Tubulointerstitial Diseases
A
Such as Fanconi syndrome and renal tubular acidosis.
25
Dx of **Acute Tubulointerstitial Nephritis**
- What to make of absence of eosinophilia and eosinophiluria?
Absence of eosinophilia and eosinophiluria doesn’t exclude the disease.
26
Dx of **Acute Tubulointerstitial Nephritis**
- Bx
27
Bx in Dx of **Acute Tubulointerstitial Nephritis**
- Value
Definitive diagnosis of AIN is made by kidney biopsy.
28
Dx of **Acute Tubulointerstitial Nephritis**
- Findings of Bx
29
managment of **Acute Tubulointerstitial Nephritis**
30
Management of **Acute Tubulointerstitial Nephritis**
- Algorithm
31
Def of **Chronic Interstitial nephritis**
- Chronic inflammation of the renal tubules and interstitium that can progress to end-stage renal disease (ESRD) after months or years.
32
Pathophysiology of **Chronic Interstitial nephritis**
① Chronic inflammation of the renal tubules and interstitium ⇨ Interstitial scarring, fibrosis, and tubule atrophy ⇨ Progressive chronic kidney insufficiency
33
Etiology of **Chronic Interstitial nephritis**
34
Etiology of **Chronic Interstitial nephritis**
- Meds
① Analgesic nephropathy.
② Calcineurin inhibitors (e.g., Cyclosporine - Tacrolimus).
③ Chemotherapeutic agents (e.g., Cisplatin).
④ Nucleoside inhibitors (e.g., Cidofovir).
⑤ Others: Mesalamine - Lithium.
35
Etiology of **Chronic Interstitial nephritis**
- Toxins
① Lead (i.e., chronic lead nephropathy).
② Cadmium.
36
Etiology of **Chronic Interstitial nephritis**
- infections
① Chronic pyelonephritis.
② Tuberculosis.
37
Etiology of **Chronic Interstitial nephritis**
- Systemic diseases
① Multiple myeloma - Lymphoma.
② SLE - Sjogren syndrome - Sarcoidosis.
③ Sickle cell disease - Vasculitis.
④ IgG4-related systemic disease.
⑤ Tubulointerstitial nephritis with uveitis
38
Etiology of **Chronic Interstitial nephritis**
- Metabolic Diseases
① Hyperuricemia.
② Hypercalcemia.
39
Etiology of **Chronic Interstitial nephritis**
- Miscellaneous
① Radiation nephritis.
② Kidney graft rejection.
③ Hypertension.
④ Ischemia.
40
CP of **Chronic Interstitial nephritis**
41
TTT of **Chronic Interstitial nephritis**
42
Compare between **Pyelonephritis & Pyelitis** in terms of
- Infection Site
- Constitutional Symptoms
43
etiology of **Acute Pyelonephritis**
44
etiology of **Acute Pyelonephritis**
- Organisms
45
etiology of **Acute Pyelonephritis**
- Most Common Organism
46
etiology of **Acute Pyelonephritis**
- Routes of Infection
47
etiology of **Acute Pyelonephritis**
- Risk factors
48
Risk Factors for **Acute Pyelonephritis**
- Impaired Urine Flow
▪ Anatomical abnormalities (as vesico-ureteric reflux - ureteric stricture).
▪ Renal stones.
▪ Senile prostatic enlargement and bladder neck obstruction.
▪ Neurogenic bladder (leads to residual urine in the bladder and stasis).
49
Risk Factors for **Acute Pyelonephritis**
- Instruments
(as cystoscopy):
▪ May introduce organisms into the urinary tract.
50
Risk Factors for **Acute Pyelonephritis**
- Female
due to:
▪ Short urethra allows easy passage of bacteria from perineal area to bladder.
▪ Trauma such as honeymoon cystitis (cystitis occurring in early marriage).
▪ Stasis with pregnancy (due to hormones secreted during pregnancy causing relaxation of ureteric muscles and ureteric dilatation).
51
Risk Factors for **Acute Pyelonephritis**
- Impaired Immunity
▪ Diabetes mellitus.
▪ HIV.
▪ Renal disease (e.g. nephrotic syndrome - analgesic nephropathy).
52
CP of **Acute Pyelonephritis**
53
CP of **Acute Pyelonephritis**
- Classical Presentation
54
CP of **Acute Pyelonephritis**
- Cystitis
55
CP of **Acute Pyelonephritis**
- Gross Hematuria
Hemorrhagic Cystitis
56
CP of **Acute Pyelonephritis**
- Elderly Patients
57
Complications of **Acute Pyelonephritis**
58
INVx for **Acute Pyelonephritis**
- urinalysis
- Urine culture / susceptibilities
- Blood Culture
- KFTs
- Imaging
59
INVx for **Acute Pyelonephritis**
- Urinalysis
60
INVx for **Acute Pyelonephritis**
- Urine Culture
61
Causes of sterile pyuria (pus cells with negative repeated cultures)
62
INVx for **Acute Pyelonephritis**
- Blood Culture
...
63
INVx for **Acute Pyelonephritis**
- KFTs
Renal dysfunction could be a preceding event or a complication of pyelonephritis.
64
INVx for **Acute Pyelonephritis**
- Imaging
65
INVx for **Acute Pyelonephritis**
- Value of Imaging
- Identify predisposing factors (e.g. obstruction).
- Identify complications (e.g. abscess emphysematous pyelonephritis).
66
INVx for **Acute Pyelonephritis**
- CT
67
INVx for **Acute Pyelonephritis**
- Others
- Renal US
- IVP
68
Management of **Acute Pyelonephritis**
69
Management of **Acute Pyelonephritis**
- Supportive
70
Management of **Acute Pyelonephritis**
- Antibiotics
71
Management of **Acute Pyelonephritis**
- managment of Complications
perinephric abscess
72
Management of **Acute Pyelonephritis**
- Correct Predisposing Factors
stone
73
Def of **Chronic Pyelonephritis**
Inflammation and scarring induced by recurrent or persistent kidney infection.
74
Predispoing Factors for **Chronic Pyelonephritis**
① Vesicoureteric reflux.
② Urinary tract obstruction (e.g., nephrolithiasis, neurogenic bladder).
75
Pathology in **Chronic Pyelonephritis**
76
CP of **Chronic Pyelonephritis**
77
CP of **Chronic Pyelonephritis**
- Symptoms
78
CP of **Chronic Pyelonephritis**
- Examination
79
INVx for **Chronic Pyelonephritis**
80
INVx for **Chronic Pyelonephritis**
- urinalyisis
▪ Pyuria.
▪ Proteinuria may be present (negative prognostic factor).
81
INVx for **Chronic Pyelonephritis**
- urine Culture
Negative urine culture does not exclude chronic pyelonephritis.
82
INVx for **Chronic Pyelonephritis**
- Renal Function tests
- Serum creatinine & blood urea nitrogen (BUN) levels are elevated (azotemia) in late cases.
83
INVx for **Chronic Pyelonephritis**
- Imaging
84
INVx for **Chronic Pyelonephritis**
- Gold Standard Imaging
85
TTT of **Chronic Pyelonephritis**
86
Incidence of **Xanthogranulomatous pyelonephritis**
- Unusual variant of chronic pyelonephritis mostly occurs in the setting of obstruction due to infected kidney stones.
87
Pathology of Xanthogranulomatous pyelonephritis
- Affected patients usually have massive destruction of the kidney due to granulomatous tissue containing lipid-laden macrophages.
88
Presentation in **Xanthogranulomatous pyelonephritis**
**Symptoms:**
- flank pain, fever, malaise, anorexia and weight loss.
**Physical examination:**
- A unilateral kidney mass can usually be palpated.
89
Dx of Xanthogranulomatous pyelonephritis
CT Scan
90
TTT of **Xanthogranulomatous pyelonephritis**
- Surgical removal of affected part (after an initial course of antimicrobials to control the local infection).
