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Renal > 05.19 - Tubulointerstitial 1 (Wall) - PP, No reading > Flashcards

05.19 - Tubulointerstitial 1 (Wall) - PP, No reading Flashcards

1
Q

Granular casts mean that there is what in sediment

A

Renal tubular cells

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1
Q

Acute Interstitial Nephritis is a ___ reaction

A

immune-mediate hypersensitivity

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1
Q

Primary lesions in Arist Acid nephropathy are likely centered in

A

vessel walls –> Ischemia and interstitial fibrosis

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2
Q

PT dysfunction is manifested by

A

Decr reabsorption of Glucose, AA’s, etc

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3
Q

Urine Sediment in Pre-Renal AKI vs ATN

A

Hyaline casts vs Muddy Brown Coarse Granular Casts

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4
Q

Signs of tubular function abnormality w/ interstitial disease

A

GFR, Anemia, Dehydration, HyperK, RTA

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4
Q

Aminoglycosides injure what part of nephrone

A

PT

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4
Q

Earliest functional defect in Hypercalcemic Nephropathy is

A

Inability to concentrate the urine

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5
Q

Lithium typically injures what part of nephron and thus leads to what

A

CD –> Nephrogenic DI

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6
Q

Mechanism of Arist Acid Nephropathy

A

DNA adducts

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7
Q

Goal of interstitial disease treatment is to

A

not let interstitial fibrosis occur

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8
Q

Type of immunity that plays predominant role in Acute IN

A

Cell-mediated –> Sometimes form granulomas

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9
Q

Proteinuria and Pyuria in Interstitial Disease

A

Minimal proteinuria, Sterile pyuria

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9
Q

Type of immunity that plays role in Methicillin-induced AIN

A

Ab-mediated plays role in addition to Cell-mediated

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10
Q

Most frequent cause of Interstitial Nephritis

A

NSAID-associated

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10
Q

As opposed to Analgesic Abuse Nephropathy, Aristolochich Acid Nephropathy is localized to

A

Cortex

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11
Q

Prolonged, severe Hypercalcemia leads to

A

Nephrogenic DI - Can’t concentrate urine

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11
Q

All the heavy metals have been associated with __ injury

A

tubular

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11
Q

Most common genetic kidney disease

A

PCKD

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13
Q

AKI is a rise in serum creatinine of at least __ over a __ period and/or a rise of ___times baseline within previous ___ days

A

0.3 mg/dL over 48 hour period; >1.5 times baseline within previous 7 days

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14
Q

2 methods of injury by contrast

A

Vasoconstriction, Direct nephrotoxicity

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14
Q

__ gets lower with larger volume in PCKD

A

GFR

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15
Q

Time frame of Acute Drug-Induced IN after use of drug

A

15 days

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16
Q

Urinalysis of Contrast-induced Nephropathy

A

Renal Tubular Epithelial Cells and Coarse Granular Casts; No pyuria because non-inflammatory process (nephropathy)

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17
Q

Most common process behind AIN after NSAIDs

A

Viral infections

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18
Q

4 Causes of Papillary Necrosis

A

DM, Analgesic Nephropathy, Sickle-Cell, Obstruction

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19
Q

Origin of uric acid

A

Breakdown of DNA

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20
Q

Urinalysis in PCKD

A

Bland b/c no glomerular disease

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21
Q

Histology of NSAID-assoicated IN

A

Minimal Change Disease

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21
Q

Analgesic Abuse Nephropathy initially was reported with use of

A

Phenacetin

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22
Q

DT dysfunction is manfiest by

A

Decr reabsorption of Na, K, H

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23
Q

Waxy casts in interstitial disease tell you what

A

Chronic

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24
Q

At what age are cysts visible in PCKD

A

20-30 years

25
Q

Description of Arist Acid Nephropathy

A

Chornic, irreversible, scarring, non-inflammatory

26
Q

Clinical presentation of AIN

A

Sudden renal insufficiency, fever, rash, flank pain

27
Q

What cells get damaged in kidney in Hypercalcemia Nephropathy

A

Tubular epithelial cells

29
Q

Prognosis of NSAID-associated IN

A

Usually improves with discontinuation

30
Q

Elevated CPK, myoglobin in urine

A

Rhabdomyolysis (statins, trauma)

31
Q

PCKD can be thought of as a

A

Ciliopathy (genes mutated encode proteins within primary cilia of renal tubular cells)

32
Q

Is Arist Acid Nephropathy acute or chronic

A

Chronic, irreversible, scarring, non-inflammatory

34
Q

Urine Osmolarity in Pre-Renal AKI vs ATN

A

>500 vs 300

35
Q

What does urine specific gravity of 1.010 mean

A

Can’t concentrate or dilute –> urine osmolarity is same as plasma

36
Q

What cytokine plays a critical role in Acute IN

A

TGF-beta

37
Q

Setting in which Acute Phosphate Nephropathy usually occures

A

High doses of oral phosphate for colonoscopy

38
Q

Cause of Balkan Nephropathy

A

Aristolochic Acid Nephropathy

40
Q

What indicates chronic interstitial disease? What indicates allergic?

A

Waxy casts if chronic. Eo’s if allergic.

41
Q

Most sensitive indication of PT dysfunction

A

Glucose in urine with normal blood sugar

42
Q

Histology of Uric Acid Nephropathy

A

Uric Acid crystals in tubules

44
Q

Anemia in Glomerular disease vs Tubular

A

Worse in tubular because tubule produce the EPO

45
Q

Timeline of clinical presentation after starting drug that causes AIN

A

within 3 weeks

45
Q

Unusual finding/symptom of NSAID-associated IN

A

Nephrotic Range proteinuria

45
Q

Triad of Acute Drug-Induced Interstitial Nephritis

A

Fever, Eosinophilia, Rash

46
Q

Inflammatory infiltrate in Arist Acid Nephropathy

A

Minimal, more direct injury

47
Q

Urine Na concentration in Pre-renal AKI vs ATN

A

< 20 vs >40

49
Q

Causes of Hyperkalemia and RTA in Interstitial Diseas

A

Impaired K secretion in cortical CD, Impaired H+ secretion

51
Q

In Analgesic Abuse Nephropathy, drug accumulates in ___

A

Renal Medullary Interstitium

52
Q

Medullary dysfunction is manifested by

A

Impaired urine concentrating ability

53
Q

__ stones are not visible w/ plain radiographs

A

Uric Acid Stones

54
Q

Clinical manifestation of Aminoglycoside Nephrotoxicity

A

Progressive incr serum creatinine, Renal K and Mg wasting, Renal Glucosuria

56
Q

Papillary dysfunctin is manifested by

A

Impaired urine concentrating ability

58
Q

Hallmark in urinalysis of Interstitial Disease

A

Concentrating defect –> Sp Gravity of 1.010 (urine osmolarity of 300 mOsm/kg)

59
Q

Time course of papillary necrosis from DM

A

10 years

60
Q

Plasma BUN/Creatinine Ratio in Pre-Renal AKI vs ATN

A

>20 vs

62
Q

Exposure to Arist Acid

A

Soil

63
Q

Analgesic Abuse Nephropathy may progress to

A

Papillary Necrosis

64
Q

Urine Specific Gravity in Pre-Renal AKI vs ATN

A

> 1.018 (high) vs 1.010 (low)

65
Q

Chinese Herb Nephropathy is due to

A

Rapid IN from Aristolochic Acid

66
Q

Heavy metals typically injure what part of nephron

A

Proximal Tubule

67
Q

What types of patients are likely to get contrast nephropathy

A

Preexisting renal insuff; DM; Volume depleted

68
Q

2 causes of free iron in urine that damages tubules

A

Rhabdomyolysis, Intravascular Hemolysis

69
Q

2 conditions with high frequency of uro-epithelial cancer

A

Analgesic Abuse Nephropathy, Aristocholic Acid Nephropathy

71
Q

Papillary necrosis is mostly associated with

A

infection

73
Q

Eosinophils in pyuria indicated what

A

Allergic reaction

74
Q

Study of choice for kidney stone evaluation

A

CT w/out contrast

75
Q

Acute Phosphate Nephropathy presents with

A

Renal insufficiency several weeks after exposure

76
Q

Tx of Contrast-Induced Nephropathy

A

Usually reversible and can be managed with supportive care, not dialysis

77
Q

2 most common causes of Papillary Necrosis

A

DM w/ infection, Obstruction w/ infection

78
Q

3 Tubular Dysfunction from Analgesic Abuse Nephropathy is characterized by

A

Hyperkalemic, Hyperchloremic RTA (Medulla and CD injury); Nephrogenic DI (Medulla injury)

79
Q

PCKD is associated with what CNS finding

A

Intra-cranial Aneurysms

80
Q

Acute Uric Acid Nephropathy is due to

A

AKI caused by patients with cancer

Renal (31 decks)

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