Tubulointerstitial Disease

Question 1

osmotic nephrosis

Answer 1

reversible renal tubular injury seen after admin of agents used to induce osmotic diuresis

Question 2

what is this?

Answer 2

osmotic nephrosis

Question 3

what is this? what does it indicate?

Answer 3

hyaline droplet change = protein resorption droplets in proximal tubular epithelium (results from increased glomerular loss of filtered proteins)

seen in severe proteinuria or nephrotic syndrome

Question 4

clinical definition of acute renal failure

Answer 4

• acute drop in GFR
• oliguria/anuria
• elevated BUN and creatinine

Question 5

pathologic appearance of ischemic AKI

which area is most susceptible?

Answer 5

swollen kidney w/ pale cortex and congested medulla

patchy and multifocal

most susceptible: prox tubule and TAL

Question 6

which cells are most susceptible to toxic AKI

Answer 6

tubular epithelial cells

• tubular reabsorption
• active transport
• concentrationg function

Question 7

clinical course of AKI/ATN

Answer 7

1. initiating phase - 1-2 days w/ mild decrease in urine output
2. maintenance phase: less urine, salt and H20 overload, increased BUN and K, metabolic alkalosis
3. recovery phase

Question 8

2 types of tubulointerstitial disease

Answer 8

1. pyelonephritis
2. tubulointerstitial nephritis

Question 9

which type of bacteria usually causes pyelonephritis

Answer 9

gram neg

Question 10

pathogenetic sequence for ascending pyelonephritis

Answer 10

1. colonixation of distal urethra and introitis
2. introduction into bladder
3. incompetence of vesico-ureteral orifice –> reflux

Question 11

type of infection

Answer 11

ascending pyelonephritis - linear/streaking pattern

Question 12

type of infection

Answer 12

hematogenous pyelonephritis - miliary pattern of microabcesses throughout kidney

Question 13

complications of acute pyelonephritis

Answer 13

1. papillary necrosis
2. pyonephrosis
3. perinephric abcess
4. scarring: broad-basses and u-shaped

Question 14

what is chronic pyelonephritis?

name 2 types

Answer 14

pelvi-calyceal damage

1. obstructive
2. non-obstructive (reflux)

Question 15

sx of drug/toxin-induced tubulointerstitial nephritis

Answer 15

average onset ~15 days after exposure

fever, eosinophilia, skin rash (25%)

ARF w/ oliguria (~50% cases)

Question 16

pathogenetic sequence of drug-induced interstitial nephritis

Answer 16

1. drug acts as a hapten secreted by the tubule
2. drug binds to tubular cell component –> becomes immunogenic
3. IgE and cell-mediated immune reaction to tubular cells or their BMs

Question 17

what is this?

Answer 17

interstitial nephritis

patchy infiltrate w/ no polys (differentiates this from infection)

Question 18

what is this?

Answer 18

tubulointersitial nephritis - inflammatory infiltrate w/ eosinophils

Question 19

analgesic abuse nephropathy - causes

Answer 19

phenacetin, aspirin, caffeine, acetaminophen, codeine

additive dosing

Question 20

pathogenesis of analgesic abuse nephropathy

Answer 20

acetaminophen: covalent binding and oxidative damage
aspirin: inhibits prostaglandin, predisposing papilla to ischemia

Question 21

pathology of analgesic tubulointersitial nephritis

Answer 21

chronic tubulointerstitial nephritis and fibrosis

papillary necrosis

urothelial carcinoma (predisposed)

Question 22

3 types of urate nephropathy

Answer 22

1. acute uric acid nephropathy
2. chronic urate nephropathy
3. nephrolithiasis (in gout)

Question 23

what is this?

Answer 23

myeloma kidney:

brittle casts w/ inflammation

multi-nucleated giant cells