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Renal > Tubulointerstitial Diseases, Vascular Diseases, and Chronic Kidney Disease > Flashcards

Tubulointerstitial Diseases, Vascular Diseases, and Chronic Kidney Disease Flashcards

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1
Q

What is acute interstitial nephritis?

A

Inflammation of renal tubules and interstitium

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2
Q

What are some causes of Acute Interstitial Nephritis?

A
  • Hypersensitivity reaction to drugs (Penicillin derivatives, NSAIDs, sulfonamides, rifampin)
  • Infections
  • Autoimmune diseases (SLE, Sjorgren’s)
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3
Q

Drug related cases or Acute Interstitial Nephritis are usually _______

A

reversible

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4
Q

Urine analysis for acute interstitial nephritis can show…

A

WBCs

WBC casts

RBCs

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5
Q

What features associated with hypersensitivity reactions are clues to diagnosis of acute interstitial nephritis?

A
  • fever, arthralgias, maculopapular rash
  • peripheral blood eosinophilia
  • Eosinophils in the urine
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6
Q

What are some morphologic features of acute interstitial nephritis?

A
  • Inflammation and edema of interstitium with involvement of tubules
    • Spares glomeruli and vessels
  • Lymphocytes, plasma cells, eosinophils
  • May see granulomas
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7
Q

What is acute pyelonephritis?

A

Acute inflammation of the kidney due to a bacterial infection through a urinary or hematogenous route

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8
Q

Urinary tract pathogens in acute pyelonephritis are usually what type of bacteria?

A

Gram negative bacilli

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9
Q

What are some predisposing conditions for pyelonephritis?

A
  • Urinary obstruction – congenital or acquired
  • Urinary tract instrumentation
  • Vesicoureteral reflux
  • Pregnancy
  • Diabetes
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10
Q

How does pyelonephritis appear histologically?

A

Interstitial inflammation and inflammation within the tubules

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11
Q

Multiple myeloma can lead to renal failure in __% of patients

A

25

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12
Q

Chronic renal failure in Multiple myeloma results from…(3)

A
  • Direct tubular toxicity of light chains
  • Tubular obstruction by casts
  • Interstitial inflammation
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13
Q

How does multiple myeloma lead to cast nephropathy?

A
  • Due to excessive production and urinary exretion of light chains
  • Presents as acute kidney injury
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14
Q

What factors favor intratubular precipitation nad cast formation in multiple myeloma?

A

Hypercalcemia

Volume depletion

Nephrotoxins

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15
Q

How does multiple myeloma present?

A
  • Older patients (usually over 40)
  • Renal insufficiency and proteinuria
  • History of bone pain, fractures
  • Hypercalcemia
  • Monoclonal light chains in blood or urine
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16
Q

How does myeloma cast nephropathy appear on light microsope?

A

Crystalline, fractured casts, in tubules with associated cellular reaction

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17
Q

Treatment of myeloma cast nephropathy?

A
  • Acutely, hydration and urinary alkalinization to prevent tubular obstruction by casts
  • Chemotherapy or stem cell transplantation
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18
Q

What are examples of renal vascular diseases?

A

Hypertensive nephrosclerosis

Renovascular hypertension

Atheroembolic disease

Thrombotic microangiopathy

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19
Q

What is hypertensive nephroscleoris?

What symptome is often present?

Study These Flashcards
A

Chronic kidney disease in a patient with long-standing, poorly controlled HTN

Proteinuria is often present

20
Q

What are some morphologic features of hypertensive nephrosclerosis? (grossly and on light microscope)

Study These Flashcards
A

Gross: normal to slightly small kidney with finely granular subscapular surface

Light: Subscapular glomerular sclerosis, tubular atrophy, interstitial fibrosis, arteriolar hyaline

21
Q

What are morphologic features of malignant hypertension in hypertensive nephrosclerosis?

Study These Flashcards
A

Mucoid intimal thickening of arteries, glomerular capillary wrinkling, GBM duplication

22
Q

What are 2 main causes associated with renal artery stenosis as a secondary cause of hypertension?

Study These Flashcards
A

Atherosclerosis

Fibromuscular dysplasia

23
Q

How does renal artery stenosis lead to hypertension?

Study These Flashcards
A

Due to decrease in pressure to kidney, compensation mechanism is activated which increases angiotensin II production

Angiotensin II leads to vasoconstriction and aldosterone release which increase blood pressure

24
Q

A physician should suspect renal artery stenosis in patients with…(4)

Study These Flashcards
A
  • early or late onset HTN
  • difficult to control HTN
  • abdominal or flank bruit
  • Renal failure after starting ACE inhibitor
25
What are some morphologic features associated with atheroscleoris in renal artery stenosis?
* Stenosis usually in proximal renal artery * Eccentric plaque - fibrosis, cell debris, lipid and foam cells (plaque may hemorrhage or dissect) * Medial and adventitial fibrosis * Calcification may occur
26
What locations are you more likely to find fibromuscular dysplasia in renal artery stenosis?
Renal artery - 60-75% (bilateral 35%) Cervicocranial arteries - 25-30% Visceral arteries - 9% Extremity arteries - 5%
27
How does medial fibroplasia in FMD present?
* Alternating thinned media and thickened fibromuscular ridges * Forms "string of beads" radiographically * Beading is larger than caliber of artery * Middle to distal artery
28
What is the treatment for renal artery stenosis?
* Surgical revascularization * Angioplasty and stenting * Medical management only
29
What are some thromboembolic diseases?
* Cortical infarcts * Renal cholesterol microembolism syndrome * Thrombotic microangiopathy
30
What are morphologic features of a cortical infarct?
* Renale artery occlusion (extensive parenchymal infarction) * Smaller branch - wedge shaped infarct * Fibrosis
31
What is atheroembolic disease and when can it occur?
Disruption of athersclerotic plaques that can cause acute and subacute renal failure Occurs after procedures that disrupt plaques in the aorta, leading to a shower of cholesterol emboli that lodge in the renal microvasculature
32
Aside from acute renal failure, other common manifestations of atheroembolic disease include...(3)
bowel infarction Digital infarction (fingers and toes turn blue) Stroke
33
Cholesterol atheroemboli affect which size arteries?
any size artery
34
How does eosinophilia occur with cholesterol atheroemboli?
Eosinophilia may be related to activation of C5a which is chemotactic for eosinophils
35
What are different outcomes associated with atheroembolic disease?
* Stabilized or normal renal function in mild, isolated cases * Chronic, progressive deterioration in renal function in subacute cases * End stage renal disease in severe cases * Permanent dialysis may be necessary
36
Thrombotic microangiopathy is characterized by thrombosis in __________ and \_\_\_\_\_\_\_\_
capillaries; arterioles
37
Consequences of thrombotic microangiopathy?
Microangiopathic hemolytic anemia Thrombocytopenia Renal failure
38
What are some other manifestations of thrombotic microangiopathy?
Hemolytic uremic syndrome (associated with E Coli) TTP (thrombotic thrombocytopenic purpura)
39
What is the pathogenisis of thrombotic microangiopathy?
Endothelial injury and activation Platelet aggretation leading to vascular obstruction and vasoconstriction
40
What is Chronic Kidney Disease and what is the last stage of its progression?
Progressive irreversible renal insufficiency that develops over months to years Ultimately leads to end stage renal disease
41
What are the main causes of CKD?
Diabetes (#1) Hypertension Glomerular nephritis Cystic diseases
42
What are some consequences of CKD?
* Anemia (decreased erythropoietin production) * Hypertension * 2º hyperparathyroidism (decreased synthesis of vitamin D and decreased phosphate excretion)
43
What are some other findings associated with CKD?
* Metabolic acidosis * Hyperkalemia * Inability to maintain sodium/water balance * Coagulopathy * Sensorimotor neuropathy
44
What are some physical symptoms of chronic uremia?
* Lethargy * Anorexia * Pruritus * Restless legs syndrome * Uremic pericarditis * Day-night sleep reversal
45
What are the management goals for CKD?
* Preserve renal function and delaty ESRD * Prevent of minimize adverse effects * Institute renal replacement therapy when necessary
46
How can we slow the progression of CKD?
* Control blood sugar * Smoking cessation * Reduce proteinuria * Control hypertension
47
ESRD is treated with ______ or ______ \_\_\_\_\_\_\_\_
dialysis; renal transplantation

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