05.19 - Tubulointerstitial 1 (Wall) - PP, No reading Flashcards
Granular casts mean that there is what in sediment
Renal tubular cells
Acute Interstitial Nephritis is a ___ reaction
immune-mediate hypersensitivity
Primary lesions in Arist Acid nephropathy are likely centered in
vessel walls –> Ischemia and interstitial fibrosis
PT dysfunction is manifested by
Decr reabsorption of Glucose, AA’s, etc
Urine Sediment in Pre-Renal AKI vs ATN
Hyaline casts vs Muddy Brown Coarse Granular Casts
Signs of tubular function abnormality w/ interstitial disease
GFR, Anemia, Dehydration, HyperK, RTA
Aminoglycosides injure what part of nephrone
PT
Earliest functional defect in Hypercalcemic Nephropathy is
Inability to concentrate the urine
Lithium typically injures what part of nephron and thus leads to what
CD –> Nephrogenic DI
Mechanism of Arist Acid Nephropathy
DNA adducts
Goal of interstitial disease treatment is to
not let interstitial fibrosis occur
Type of immunity that plays predominant role in Acute IN
Cell-mediated –> Sometimes form granulomas
Proteinuria and Pyuria in Interstitial Disease
Minimal proteinuria, Sterile pyuria
Type of immunity that plays role in Methicillin-induced AIN
Ab-mediated plays role in addition to Cell-mediated
Most frequent cause of Interstitial Nephritis
NSAID-associated
As opposed to Analgesic Abuse Nephropathy, Aristolochich Acid Nephropathy is localized to
Cortex
Prolonged, severe Hypercalcemia leads to
Nephrogenic DI - Can’t concentrate urine
All the heavy metals have been associated with __ injury
tubular
Most common genetic kidney disease
PCKD
AKI is a rise in serum creatinine of at least __ over a __ period and/or a rise of ___times baseline within previous ___ days
0.3 mg/dL over 48 hour period; >1.5 times baseline within previous 7 days
2 methods of injury by contrast
Vasoconstriction, Direct nephrotoxicity
__ gets lower with larger volume in PCKD
GFR
Time frame of Acute Drug-Induced IN after use of drug
15 days
Urinalysis of Contrast-induced Nephropathy
Renal Tubular Epithelial Cells and Coarse Granular Casts; No pyuria because non-inflammatory process (nephropathy)
Most common process behind AIN after NSAIDs
Viral infections
4 Causes of Papillary Necrosis
DM, Analgesic Nephropathy, Sickle-Cell, Obstruction
Origin of uric acid
Breakdown of DNA
Urinalysis in PCKD
Bland b/c no glomerular disease
Histology of NSAID-assoicated IN
Minimal Change Disease
Analgesic Abuse Nephropathy initially was reported with use of
Phenacetin
DT dysfunction is manfiest by
Decr reabsorption of Na, K, H
Waxy casts in interstitial disease tell you what
Chronic
At what age are cysts visible in PCKD
20-30 years
Description of Arist Acid Nephropathy
Chornic, irreversible, scarring, non-inflammatory
Clinical presentation of AIN
Sudden renal insufficiency, fever, rash, flank pain
What cells get damaged in kidney in Hypercalcemia Nephropathy
Tubular epithelial cells
Prognosis of NSAID-associated IN
Usually improves with discontinuation
Elevated CPK, myoglobin in urine
Rhabdomyolysis (statins, trauma)
PCKD can be thought of as a
Ciliopathy (genes mutated encode proteins within primary cilia of renal tubular cells)
Is Arist Acid Nephropathy acute or chronic
Chronic, irreversible, scarring, non-inflammatory
Urine Osmolarity in Pre-Renal AKI vs ATN
>500 vs 300
What does urine specific gravity of 1.010 mean
Can’t concentrate or dilute –> urine osmolarity is same as plasma
What cytokine plays a critical role in Acute IN
TGF-beta
Setting in which Acute Phosphate Nephropathy usually occures
High doses of oral phosphate for colonoscopy
Cause of Balkan Nephropathy
Aristolochic Acid Nephropathy
What indicates chronic interstitial disease? What indicates allergic?
Waxy casts if chronic. Eo’s if allergic.
Most sensitive indication of PT dysfunction
Glucose in urine with normal blood sugar
Histology of Uric Acid Nephropathy
Uric Acid crystals in tubules
Anemia in Glomerular disease vs Tubular
Worse in tubular because tubule produce the EPO
Timeline of clinical presentation after starting drug that causes AIN
within 3 weeks
Unusual finding/symptom of NSAID-associated IN
Nephrotic Range proteinuria
Triad of Acute Drug-Induced Interstitial Nephritis
Fever, Eosinophilia, Rash
Inflammatory infiltrate in Arist Acid Nephropathy
Minimal, more direct injury
Urine Na concentration in Pre-renal AKI vs ATN
< 20 vs >40
Causes of Hyperkalemia and RTA in Interstitial Diseas
Impaired K secretion in cortical CD, Impaired H+ secretion
In Analgesic Abuse Nephropathy, drug accumulates in ___
Renal Medullary Interstitium
Medullary dysfunction is manifested by
Impaired urine concentrating ability
__ stones are not visible w/ plain radiographs
Uric Acid Stones
Clinical manifestation of Aminoglycoside Nephrotoxicity
Progressive incr serum creatinine, Renal K and Mg wasting, Renal Glucosuria
Papillary dysfunctin is manifested by
Impaired urine concentrating ability
Hallmark in urinalysis of Interstitial Disease
Concentrating defect –> Sp Gravity of 1.010 (urine osmolarity of 300 mOsm/kg)
Time course of papillary necrosis from DM
10 years
Plasma BUN/Creatinine Ratio in Pre-Renal AKI vs ATN
>20 vs
Exposure to Arist Acid
Soil
Analgesic Abuse Nephropathy may progress to
Papillary Necrosis
Urine Specific Gravity in Pre-Renal AKI vs ATN
> 1.018 (high) vs 1.010 (low)
Chinese Herb Nephropathy is due to
Rapid IN from Aristolochic Acid
Heavy metals typically injure what part of nephron
Proximal Tubule
What types of patients are likely to get contrast nephropathy
Preexisting renal insuff; DM; Volume depleted
2 causes of free iron in urine that damages tubules
Rhabdomyolysis, Intravascular Hemolysis
2 conditions with high frequency of uro-epithelial cancer
Analgesic Abuse Nephropathy, Aristocholic Acid Nephropathy
Papillary necrosis is mostly associated with
infection
Eosinophils in pyuria indicated what
Allergic reaction
Study of choice for kidney stone evaluation
CT w/out contrast
Acute Phosphate Nephropathy presents with
Renal insufficiency several weeks after exposure
Tx of Contrast-Induced Nephropathy
Usually reversible and can be managed with supportive care, not dialysis
2 most common causes of Papillary Necrosis
DM w/ infection, Obstruction w/ infection
3 Tubular Dysfunction from Analgesic Abuse Nephropathy is characterized by
Hyperkalemic, Hyperchloremic RTA (Medulla and CD injury); Nephrogenic DI (Medulla injury)
PCKD is associated with what CNS finding
Intra-cranial Aneurysms
Acute Uric Acid Nephropathy is due to
AKI caused by patients with cancer