Tubulointerstitial Dz Pathology

Question 1

Answer 1

Acute TID; characterized by active inflammation; see eosinophils and lymphocytes (left) and neutrophils (right)

Question 2

Answer 2

Normal kidney tubules and glomerulus

Question 3

Answer 3

Tubular necrosis; necrotic cells slough off into the tubular lumen; seen in Acute TID

Question 4

Answer 4

Edema; seen in interstitium as foamy/vacuoles between tubules. Characteristic of Acute TID

Question 5

Answer 5

Interstitial fibrosis; seen in Chronic TID; fibrinous tissue is very pale and separates the renal tubules

Question 6

Answer 6

Tubular atrophy; tubules shrink in diameter, the epithelium simplifies and the basement membrane thickens; seen in Chronic TID where tubules atrophy in response to slow ischemia

Question 7

Answer 7

Chronic inflammation; uniform small lymphocytes which are remnants of a previous active inflammation. Seen in Chronic TID.

Question 8

Answer 8

Acute TID; active inflammatory cells in interstitium: lymphocytes, neutrophils, plasma cells, macrophages

Question 9

Answer 9

Chronic TID; fibrosis of interstitium; tubular atrophy

Question 10

Answer 10

Interstitial Nephritis; inflammation localized to interstitum primarily, with minor involvement of the tubules

Question 11

Answer 11

Acute interstitial nephritis; infiltration of plasma cells, eosinophils, lymphyocytes, macrophages; also see edema

Question 12

Answer 12

Acute interstitial nephritis; diffuse infiltration of inflammatory cells; tubules relatively unaffected.

Question 13

Answer 13

Acute allograft rejection; form of acute interstitial nephritis; where lymphyocytes actually infiltrate the tubules

Question 14

Answer 14

Acute Tubular Necrosis (main photo); normal photo in bottom Right corner; ATN most commonly affects the Prox. CT and can be caused by ischemia or toxins

Question 15

Answer 15

Ischemic ATN; caused by shock, hypovolemia, and hypoxemia; usually milder than toxic ATN, the tubular epi. cells fall off individually.

Question 16

Answer 16

ATN urine sediment; contains epithelial cells and necrotic debris

Question 17

Answer 17

Ascending Acute Pyelonephritis; with white-pus streaks located in the renal medulla.

Question 18

Answer 18

Acute Ascending Pyelonephritis; with pus-streaks within the medulla; also see papillary necrosis

Question 19

Answer 19

Hematogenous pyelonephritis; has “flea-bitten” appearance

Question 20

Answer 20

Acute pyelonephritis; neutrophil infiltration

Question 21

Answer 21

Bacteria in Acute Pyelonephritis; look like pale blue smudges

Question 22

Answer 22

Fungus (arrow) in Acute Pyelonephritis

Question 23

Answer 23

WBC casts in the medulla in acute pyelonephritis

Question 24

Answer 24

Chronic interstitial nephritis; with fibrosis, atrophy and chronic inflammation

Question 25

Answer 25

**Chronic interstitial nephritis**; tubular atrophy, interstitial fibrosis, chronic inflammation, glomeruli unaffected

Question 26

Answer 26

**Chronic interstitial nephritis**; tubular atrophy, interstitial fibrosis, chronic inflammation, glomeruli unaffected

Question 27

Answer 27

Lithium induce chronic tubulointerstitial nephropathy; causes atrophy and fibrosis, but can also cause tubular dilatation and cyst formation in the distal tubule and CD.

Question 28

Answer 28

Papillary necroses develops in obstructed acute pyelonephritis as well as in pt's wtih DM (and acute pyelo).

Question 29

Answer 29

Chronic pyelonephritis, obstructed type; see dilated pelvis and calyxes as well as thinning of the renal cortex; generally uniform involvement.

Question 30

Answer 30

Chronic pyelonephritis, reflux type; appears as focal, often polar changes

Question 31

Answer 31

Chronic pyelonephritis; see dilated calyx, destruction of papilla, and scarring of overlying cortex.

Question 32

Name the type of kidney dz; also identify the regions indicated by the arrows on the right

Answer 32

Chronic pyelonephritis

Question 33

Answer 33

Chronic pyelonephritis; focal fibrosis, chronic inflammation, and tubular loss

Question 34

Answer 34

Light chain cast nephropathy, due to multiple myeloma; Ig light chains made by neoplastic plasma cells are filtered/precipitate in the renal tubules forming angula/fractured appearing casts; the casts obstruct and can injure epithelial cells; see macrophage-rich inflammatory response

Question 35

Answer 35

Light chain casts seen in the Multiple Myeloma kidney; casts are angular and fractured appearing.