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Renal II > Tubulointerstitial disorders > Flashcards

Tubulointerstitial disorders Flashcards

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1
Q

Rapid reduction of renal function and urine flow to <400 ml/day within 24 hrs

A

Acute tubular injury/necrosis

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2
Q

Pre-renal causes of acute tubular injury/necrosis

A

Ischemia –> malignant HTN, microscopic polyangiitis, DIC, HUS, TTP, severe trauma, acute pancreatitis, etc

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3
Q

Renal causes of acute tubular injury/necrosis

A

Direct toxic injury –> drugs, contrast dyes, poisons, heavy metals, organic solvents (CCL4)

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4
Q

Combined ischemic and toxic causes of acute tubular necrosis/injury

A

Hemolytic crises –> hemoglobinuria
Skeletal muscle injuries –> myoglobinuria

Iron is toxic to kidney

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5
Q

Characteristic urine findings in combined causes of acute tubular necrosis/injury

A

Hemoglobin and myoglobin tubular casts

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6
Q

Acute tubular injury type characterized by focal involvement of the tubules at multiple points, tubulorrhexis, and tubular lumen casts. Regeneration is complete

A

Ischemic

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7
Q

Tubular lumen casts seen in ischemic acute tubular injury

A

Hyaline
Pigmented brown granular casts (Tamm-Horsfall protein)

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8
Q

Acute tubular injury type characterized by continuous involvement of the tubule, usually proximal descending, without BM rupture.

A

Toxic

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9
Q

Features of initiation phase of acute tubular injury

A

36 hrs
Dominated by cause
Slight decrease in renal output with increased BUN

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10
Q

Features of maintenance phase of acute tubular injury

A

Sustained oliguria
Salt and water overload
Hyperkalemia
Metabolic acidosis
Increased BUN concentration
Uremia

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11
Q

Treatment of maintenance phase of acute tubular injury

A

Maintain water and electrolyte balance (crucial)
Dialysis

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12
Q

Features of recovery phase of acute tubular injury

A

Steady increase in urine volume
Loss of water and electrolytes in urine
Hypokalemia
Eventually tubular concentrating ability returns

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13
Q

Reason for loss of water and electrolytes in urine in recovery phase in acute tubular injury

A

Tubular damage

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14
Q

Causes of pre-renal acute tubular injury due to decreased effective arterial volume

A

CHF
Hypovolemia
Systemic vasodilation (sepsis)

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15
Q

Causes of pre-renal acute tubular injury due to renal vasoconstriction

A

NSAIDs
ACE inhibitors

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16
Q

Intra-renal manifestations of acute tubular injury

A

Acute interstitial nephritis
Glomerulonephritis
Thrombotic microangiopathy

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17
Q

Post-renal causes of acute tubular injury

A

Kidney stones
BPH
Neurogenic bladder
Neoplasia

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18
Q

When does a post-renal acute tubular injury occur?

A

Bilateral outflow obstruction

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19
Q

Characteristics of acute pyelonephritis

A

Renal lesion associated with UTI caused by bacteria

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20
Q

Parts of kidney affected by pyelonephritis

A

Renal tubules
Interstitium
Renal pelvis

Glomeruli are relatively resistant to infection

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21
Q

Possible causes of chronic pyelonephritis

A

Bacterial infection
Vesicourethral reflux
Obstruction

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22
Q

Reasons that DM predisposes to pyelonephritis

A

Increased susceptibility to infection
Neurogenic bladder dysfunction
More frequent instrumentation

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23
Q

Discrete focal abscesses involving one or both kidneys with haphazard distribution that can extend to form large wedge-shaped areas of suppuration.

A

Acute pyelonephritis

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24
Q

Areas of the kidney most commonly affected in reflux associated pyelonephritis

A

Lower and upper poles

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25
Biopsy of kidney shows patchy suppurative interstitial inflammation, intratubular aggregates of neutrophils, and tubular necrosis.
Acute pyelonephritis
26
Complications of pyelonephritis
Papillary necrosis Pyonephrosis Perinephric abscess
27
Conditions associated with papillary necrosis
DM Urinary tract obstruction Analgesic nephropathy Sickle cell disease
28
Gray-white or yellowish areas of coagulative necrosis in distal renal pyramids
Papillary necrosis
29
Changes in surface of kidney in papillary necrosis
Depressed areas that overly necrotic papillae
30
Complication of papillary necrosis
Transitional cell carcinoma of renal pelvis
31
Post-pyelonephritis finding almost always associated with inflammation, fibrosis, and deformation of the underlying calyx and pelvis
Pyelonephritic scar
32
Chronic tubulointerstitial inflammation and scarring with pathologic involvement of the renal calyces and pelvis.
Chronic pyelonephritis
33
Important cause of kidney destruction in children with severe LUT abnormalities
Chronic pyelonephritis
34
Two types of chronic pyelonephritis
Reflux nephropathy Chronic obstructive pyelonephritis
35
Coarse, discrete corticomedullary scars overlaying dilated blunted calyces with flattening of papillae, mostly in the upper and lower poles. Results in asymmetric, irregular, scarred kidneys.
Chronic pyelonephritis
36
Microscopy shows atrophic or dilated tubules filled with colloid casts (thyroidization of tubules) with variable amounts of inflammatory cells in the interstitium. Normal glomeruli with periglomerular fibrosis or fibrous glomeruli can be seen.
Chronic pyelonephritis
37
Possible complication of chronic pyelonephritis
FSGS
38
Rare variant of chronic pyelonephritis characterized by presence of foamy macrophages, plasma cells, lymphocytes, PMN, and giant cells. Often associated with Proteus.
Xanthogranulomatous pyelonephritis
39
Gross appearance of kidney in xanthogranulomatous pyelonephritis
Yellowish-orange nodules
40
Differential diagnosis with same gross appearance as xanthogranulomatous pyelonephritis
Renal cell carcinoma
41
Urine finding in chronic pyelonephritis that affects the tubules and why
Polyuria and nocturia --> loss of concentrating ability
42
Poor prognostic sign in chronic pyelonephritis
Proteinuria and FSGS
43
Causes of acute drug induced interstitial nephritis
Sulfonamides Methicillin and ampicillin Rifampicin Thiazide diuretics NSAIDs Allopurinol Cimetidine
44
Clinical features of acute drug induced interstitial nephritis
Fever Skin rash Eosinophilia Hematuria, proteinuria, and WBCs in urine Rising serum creatinine or ARF with oliguria (50%)
45
Analgesics that can cause nephropathy when used in combination
Phenacetin, aspirin, caffeine, and codeine
46
How does acetominophen injure cells?
Depletes glutathione --> injury occurs by generation of oxidative metabolites
47
AKI due to decreased synthesis of vasodilatory prostaglandins 2/2 COX-2 inhibition
NSAID associated nephropathy
48
Precipitation of uric acid crystals in the tubules due to acidic pH in the collecting ducts leading to obstruction of nephrons and renal failures.
Acute uric acid nephropathy
49
3 types of urate nephropathy
Acute uric acid nephropathy Chronic urate (gouty) nephropathy with hyperuricemia Nephrolithiasis
50
Deposition of monosodium urate crystals in the acidic distal tubules and collecting ducts leading to giant cell reaction and fibrosis (gouty tophus). Birefringent needle-like crystals in tubular lumen or interstitium.
Chronic urate (gouty) nephropathy with hyperuricemia
51
Another name for light-chain cast nephropathy
Myeloma kidney
52
Factors that contribute to kidney damage in light-chain cause nephropathy
Bence Jones proteinuria and cast nephropathy Amyloidosis (AL type) Light chains deposits Hypercalcemia and hyperuricemia
53
Tubular casts seen in light-chain cast nephropathy
Bence Jones protein and Tamm-Horsfall protein combine and obstruct tubular lumina
54
Pink to blue amorphous masses that fill and distend the lumen in light-chain neuropathy
Casts
55
Earliest functional defect in nephrocalcinosis
Inability to concentrate urine (hyposthenuria)
56
Pt present with renal insufficiency several weeks after colonoscopy
Acute phosphate nephropathy
57
Features of type 1 (distal) renal tubular acidosis
Distal acidification Serum bicarbonate <10 Serum potassium reduced Urine pH >5.3
58
Features of type 2 (proximal) renal tubular acidosis
Proximal bicarbonate reabsorption Serum bicarbonate 12-20 Serum potassium reduced Urine pH can be <5.3
59
Features of type 4 (hypoaldosteronism) acute tubular acidosis
Decrease in or resistance to aldosterone Serum bicarbonate >17 (varies) Serum potassium increased Urine pH can be <5.3
60
Type of hypersensitivity in hyperacute transplant rejection
Type II --> recipient antibodies
61
Type of hypersensitivity in acute transplant rejection
IV --> recipient T-cells
62
Type of hypersensitivity in chronic transplant rejection
III and IV --> T-cell and deposition
63
Transplant rejection mediated by donor T-cells
GVHD
64

Renal II (15 decks)

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