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Flashcards in Renal Path II Deck (21):
1

What is the presentation of acute pyelonephritis?

fever, flank pain, costovertebral angle tenderness
neutrophils
WBCs in urine, WBC casts
**often ascending UTI like E coli

2

What does a CT show w/ acute pyelonephritis?

striated parenchymal enhancement

3

What are risk factors for acute pyelonephritis?

indwelling urinary catheter
obstruction
vesicoureteral reflux
diabetes
pregnancy

4

When do you see thyroidization of the kidney?

Chronic pyelonephritis
get eosinophilic casts

5

What is drug-induced interstitial nephritis?

give drugs that act as haptens and induce hypersensitivity 1-2 weeks later
get pyuria and azotemia

6

What are the presenting symptoms of drug-induced interstitial nephritis? Treatment?

fever
rash
eosinophilia
azotemia

Treat w/ 1-2 weeks corticosteroids

7

Which drugs cause drug-induced interstitial nephritis?

NSAIDs
Diuretics
Penicillin Derivatives
PPI
sulfonamides
rifampin
allopurinol
indinavir
mesalamine

8

What is diffuse cortical necrosis?

cortical infarction of both kidneys via combo of vasospasm and DIC
seen in patients who experience obstetric catastrophes or septic shock or ARDs.

9

What are the 2 mechanisms of injury in acute tubular necrosis? Key finding?

ischemic and nephrotoxic
see granular muddy brown casts

10

What are the 3 phases of acute tubular necrosis?

1. inciting event
2. maintenance phase---oliguric, 1-3 weeks, risk of hyperkalemia, metabolic acidosis, uremia
3. recovery phase-polyuric, BUN and serum creatinine fall, risk of hypokalemia

11

How does ischemia cause acute tubular necrosis? Which parts of the kidney are most susceptible to injury?

renal tubular cells slough into lumen
PCT and thick ascending limb are super suspectible

12

What are some toxic substances that could cause nephrotoxic acute tubular necrosis?

aminoglycosides
radiocontrast dye
lead
cisplatin
crush injury (myoglobinuria)

13

What do you see in renal papillary necrosis?

sloughing off of necrotic renal papillae
gross hematuria and proteinuria
**triggered by recent infection or immune stimulus

14

Which conditions is renal papillary necrosis associated with?

SAAD papa
Sickle Cell
Acute pyelonephritis
analgesics (NSAIDs)
Diabetes

15

What defines acute renal failure?

decline in renal fcn w/ increase in creatinine and BUN

16

Describe prerenal azotemia.

BUN/CR>20 (BUN reabsorbed relatively more)
decreased renal blood flow
decreased FENa 500

17

Describe intrinsic renal failure.

BUN/Creatinine ratio 2%
Urine osmolality

18

Describe postrenal azotemia.

caused by outflow obstruction like BPH or kidney stone
only get this w/ bilateral obstruction
FENa

19

What are the consequences of renal failure?

MAD HUNGER
Metabolic Acidosis
Dyslipidemia
Hyperkalemia
Uremia (increased BUN)
Na+/H2O retention--pulmonary edema, heart failure
Growth retardation
EPO failure (anemia)
Renal osteodystrophy from decreased VIT D activation

20

What are the consequences of uremia in renal failure?

nausea and anorexia
pericarditis
asterixis
encephalopathy
platelet dysfunction

21

Describe what the deal is with renal osteodystrophy.

failure of Vit D hydroxylation, hypocalcemia and hyperphosphatemia.
hyperparathyroidism.
Causes subperiosteal thinning of bones
supplement w/ Vit D and Ca++