Tubulointerstitial Diseases, Vascular Diseases, and Chronic Kidney Disease Flashcards Preview

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Flashcards in Tubulointerstitial Diseases, Vascular Diseases, and Chronic Kidney Disease Deck (47):
1

What is acute interstitial nephritis?

Inflammation of renal tubules and interstitium

2

What are some causes of Acute Interstitial Nephritis?

  • Hypersensitivity reaction to drugs (Penicillin derivatives, NSAIDs, sulfonamides, rifampin)
  • Infections
  • Autoimmune diseases (SLE, Sjorgren's)

3

Drug related cases or Acute Interstitial Nephritis are usually _______

reversible

4

Urine analysis for acute interstitial nephritis can show...

WBCs

WBC casts

RBCs

5

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

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

6

What are some morphologic features of acute interstitial nephritis?

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

7

What is acute pyelonephritis?

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

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8

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

Gram negative bacilli

9

What are some predisposing conditions for pyelonephritis?

  • Urinary obstruction -- congenital or acquired
  • Urinary tract instrumentation
  • Vesicoureteral reflux
  • Pregnancy
  • Diabetes

10

How does pyelonephritis appear histologically?

Interstitial inflammation and inflammation within the tubules

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11

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

25

12

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

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

13

How does multiple myeloma lead to cast nephropathy?

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

14

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

Hypercalcemia

Volume depletion

Nephrotoxins

15

How does multiple myeloma present?

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

16

How does myeloma cast nephropathy appear on light microsope?

Crystalline, fractured casts, in tubules with associated cellular reaction

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17

Treatment of myeloma cast nephropathy?

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

18

What are examples of renal vascular diseases?

Hypertensive nephrosclerosis

Renovascular hypertension

Atheroembolic disease

Thrombotic microangiopathy

19

What is hypertensive nephroscleoris?

What symptome is often present?

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

Proteinuria is often present

20

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

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

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

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21

What are morphologic features of malignant hypertension in hypertensive nephrosclerosis?

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

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22

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

Atherosclerosis

Fibromuscular dysplasia

23

How does renal artery stenosis lead to hypertension?

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

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

  • 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

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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%

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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

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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

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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

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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

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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