Tubulointerstitial/Vascular/Chronic Kidney disease

Question 1

cast nephropathy in multiple myeloma due to

factors favoring intratubular percipitation and cast formation (3)

Answer 1

due to excessive production and urinary excretion of light chains

factors: hypercalcemia

volume depletion

nephrotoxins

Question 1

2 findings in chronic kidney disease, due to uremic toxin buildup

Answer 1

coagulopathy > platelet dysfunction

sensorimotor neropathy

Question 2

cortical infarct morpholhy

Answer 2

renal artery occlusion > extensive parenchymal infarction

smaller branch - wedge shaped infarct, pale with yperremic baorder and coagulation necrosis, hemorrhage+acute inflam at edge

later fibrosis

Question 3

predisposing conditions pyelonephritis

Answer 3

urinary obstruction

UT instrumentation

vesicoureteral reflux

pregancy

diabetes

Question 3

often occurs after artial angiography

histopathologic evidence of clefts in vascular lumen

causes both acute and progressive kidney dysfunction

Answer 3

aheroembolic dieseases

Question 3

mechanism of secondary hyperparathyroidism in chronic kidney disease

Answer 3

decreased renal synth of 1,25-dihyrdroxy D3 AND decreased phosphate excretion lead to:
hypocalcemia

hyperphosphatemia

renal osteodystrophy

Question 4

treatment myeloma cast nephropathy

Answer 4

hydration and urinary alkalinization to prevent tubular obstruction by casts

chemo or stem cell transplant

Question 5

kidney transplant at what point?

Answer 5

GFR

Question 7

typical bacteria of pyelonephritis

Answer 7

gram neg bacilli

Question 7

renal artery stensosis from atherosclerosis morpholohy

Answer 7

proximal stenosis

excentric plaque with intimal fibrosis, cell debris, lipid+foam cells

medial and adventitial fibrosis

plaque may hemorrhage or disect

calcification

Question 9

presenting features multiple myeloma

Answer 9

>40

renal insuffciency+proteinuria

hx of bone pain and fractures

hypercalcemia

monoclonal light chains in blood/urine

Question 9

thrombotic microangiopathy characterized by (3)

Answer 9

thrombosis in capillaries+arterioles (microangiopathic hemolytic anemia, thromboytopenia, renal failure)

Hemolytic uremic syndrome

thrombot thrmbocytopenic purpura

Question 10

mechanism of HTN in renal artery stenosis

Answer 10

not enough pressure to kidney > increased renin production due to perceived hypotension

Question 11

causes acute interstitial nephritis

Answer 11

drug hypersensitivity (PCN, NSAIDs. sulfonamides, rifampin)

infection

autoimmune - SLE, sjogrens

Question 11

suspect renal artery stenosis in:

Answer 11

elderly or late onset HTN

difficult to control HTN

abdominal or flank bruit

renal failure after starting ACEi

Question 11

anemia in chronic kidney disease results from ___

occurs at which point?

Answer 11

decreased EPO production

occurs below GFR of 60ml/min

Question 13

characterized by interstitial and tubular inflammation and the precense of bacteria on urine culture

often due to ascending UTI

Answer 13

pyelonephritis

Question 14

2 main casuses renovacualr hypertension

Answer 14

atherosclerosis

fibromuscular dysplasia

(also trauma, dissection, extrinsic compression from neoplasms)

Question 15

acute inflammation of kidney due to bacterial infection

(usually via bacterial route or hematogenous route)

Answer 15

acute pyelonephritis

Question 16

charactreized by fractured tubular casts with either lambda or kappa light chain predominance

Answer 16

myeloma cast neuropatyh

Question 17

physical exam symptoms of chromic in chronic kidney disease

Answer 17

lethary/fatigue

day-night sleep reversal

anoerixia, nausea, vomitng

pruritis

restless leg syndrome

uremic pericarditis

Question 18

comorbid infection related to thrombotic microangiopathy Hemolytic uremic syndrome

Answer 18

E coli 0157:H7

Question 19

mechanism of metabolic acidosis presenting in chronic kidney disease

Answer 19

decreased secretion of ammonium and retention of phosphate and sulfates

Question 21

morphologic features myeloma cast nephropathy

Answer 21

LM: crystalline, **fractured casts **in tubules with associated cellular reaction

IF: light chain predominance

EM: electron dense fractured casts

Question 23

characteized by interstitial infalmmation with eosinophil predomiance, eosinophilia, eosinophiluria, often caused by drugs

Answer 23

acute interstitial nephritis

Question 23

renal artery stenosis stemming from fibromuscular dysplasia morphology

Answer 23

younger women alternating thinned media and thicken fibromuscular ridges **string of beads** middle to distal artery

Question 24

chronic renal failure in multiple myeloma results from (3)

Answer 24

direct tubular toxicity of light chains tubular obstruction by casts interstitial inflammation

Question 25

measure of ESRD

Answer 25

GFR

Question 26

to slow progression of chronic kidney disease

Answer 26

control HTN reduce proteinuria control blood sugar smoking cessation (and other disease specific therapy0

Question 28

morphological features acute interstitial nephritis

Answer 28

inflammation+edema of interstitium+tubules (spraing of glomeruli and vessels) lymphocytes, plasma cells, eosinophils possible granulomas

Question 30

along with renal failure, other manifestations of atheroembolic disease event

Answer 30

bowel infarct digital infarct stroke (eosinophils in blood or urine)

Question 31

pathogenesis thromobotic microangiopatyh

Answer 31

endothelial injury and activation \> intravscualr thrombosis or platelet aggregation \> vascular obstruction and constriction

Question 32

presentation acute interstitial nephritis

Answer 32

**hypersensitivity signs key: **fever, arthalgias, macuopapular rash peripheral blood eosinophilia, eosinophils in urine urine: **WBCs WBC casts, RBCs**

Question 34

morphology renal malignant hypertension

Answer 34

mucoid intimal thickening of arteries glomerular capillary wringling gbm duplication

Question 35

treatment renal artery stenosis

Answer 35

surgical revacularization angioplasty and stenting

Question 36

consequences of chronic kidney disease (3)

Answer 36

Anemia HTN secondary hyperparathyroidism

Question 37

morphology hypertensive nephrosclerosis

Answer 37

gross: normal-small size, finely granualr subcapsular surface LM: subcapsu;lar glomerular scleorisis, tubular atrophy, interstitial fibrosis arteriolar hyaline

Question 38

chemotactic for eosinophils seen in atheroemboli eosinophilia

Answer 38

C5a activation