Tubulointerstitial Disease Flashcards
(26 cards)
What is the most common cause of acute renal failure?
Acute tubular necrosis
What is the root cause of most tubulointerstitial diseases?
Inflammatory causes
What can cause kidney ischemia?
Marked hypotension/shock
Hemolysis (also mismatched transfusion)
Skeletal muscle degradation (rhabdomyolysis)
What are some causes of nephrotoxic kidney damage?
Drugs
Heavy metals
Contrast Dyes
Organic solvents
How do ischemia and toxin mediated nephropathy differ for the nephron damage?
Ischemia is more patchy
Toxin is more focal
Why is damage reversible in ATN?
Patchiness
Intact BM
EGF, Insulin-type GF I
What is often in the urine that is associated with ATN?
Granular and hyaline casts
What is the BUN ratio in ATN?
Less than normal because BUN is unable to be reabsorbed.
What is needed for treatment while in the middle of ATN?
Dialysis
What is the mortality for ATN when initial event is survived? Associated with shock?
95%
50%
What are some causes of tuberointerstitial nephritis?
Pyelonephritis Multiple myeloma Chronic UT obstruction Radiation Transplant rejection
What cells may be seen in the urine during acute interstitial nephritis?
Eosinophils
PMN’s?
What cells are associated with chronic tuberointerstitial nephritis?
lymphocytes, monocytes
What is chronic pyelonephritis usually due to?
Chronic obstruction
Chronic reflux
(not necessarily bacterial infx)
What is a unique microscopic feature to Chronic pyelonephritis?
Thyroidization
How long after using a drug will you see drug-induced interstitial nephritis?
15 days
What are the symptoms of Drug induced interstitial nephritis?
Fever
Rash
Eosinophilia
Nephritic problems
How does drug induced interstitial nephritis look on microscopic exam?
TONS of cells Eosinophils PMNs Lymphocytes Macrophages
What is the pathogenesis of Acute drug associated interstitial nephritis?
Mix of Type I and IV hypersensitivity
What are Bence Jones proteins oftentimes seen in?
Multiple-myeloma induced renal disease
What do bence-jones casts look like on stain?
Large (much larger than other casts)
No nuclei
What are the four most common causes of thrombotic microangiopathies?
Typical hemolytic uremic syndrome
Atypical HUS
Familial HUS
Idiopathic thrombotic thrombocytopenic purpura
What is the most common cause of typical HUS?
Verocytotoxin producing E. coli
What are the common causes of atypical HUS?
Antiphospholipid syndrome
Pregnancy
Vascular renal diseases: Malignant HTN, systemic sclerosis
Drug related: chemo
