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Renal > 05.19 - Tubulointerstitial Disease 2 (Nichols) - PP + Handout, no reading > Flashcards

05.19 - Tubulointerstitial Disease 2 (Nichols) - PP + Handout, no reading Flashcards

1
Q

Most common nephrotoxic cause of ATN

A

Radiologic contrast dye

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1
Q

Tx of ATN

A

Dialysis, but after tx of shock and organ failure

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2
Q

Two options for quick tx of Hyperkalemia

A

IV Calcium Gluconate, IV Insulin + Glucose

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2
Q

ATN with Vacuolization and Calcium Oxalate

A

Ethylene Glycol

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3
Q

Common source of hematogenous infection leading to pyelonephritis

A

Central Venous Catheter - Staph Aureus

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4
Q

Male-Female preponderance of Pyelonephritis

A

Males under one, females b/t 1 and 50

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4
Q

Presence of a few renal cortical cysts is clinically significant

A

No, common finding in older adults with no clinical signficance

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5
Q

Mutations in AD (Adult) PCKD

A

Polycystin-1 or -2

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6
Q

Region of kidney most susceptible to ischemia

A

Outer medulla

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6
Q

Kidney injury caused by Rhabdomyolysis

A

Myoglobin precipitates in renal tubules causing ATN

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6
Q

New-onset azotemia w/ oliguria, fever, skin rash, and especially eosinophilia suggests

A

Drug-induced acute interstitial nephritis

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6
Q

Prognosis for AR PCKD

A

Immediate untreatable respiratory failure at birth

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7
Q

Potassium over __ is a medical emergency

A

7 mMol/L

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8
Q

T/F: Biopsy is often needed to dx etiology of AKI

A

False, unlike Nephrotic and Nephritic syndromes

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9
Q

As injury crosses line of irreversibility in ANT, the cells

A

undero coagulative necrosis and slough into the lumen (contributing to casts)

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9
Q

Symptoms of ATN

A

Anorexia progressing thru nausea to vomitting, along with pruritis and confusion

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10
Q

Ascending pyelonephritis in patients >1 is associated with

A

Vesicoureteral Reflux

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10
Q

When do patients with AD PCKD start getting symptoms? Is the progression of this disease rapid?

A

30s, no gradual

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11
Q

Mutation in Fibrocystin

A

AR (Childhood) PCKD

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12
Q

autosomal recessive diseases of cilia components leading to end-stage renal disease in children

A

Nephronopthisis-Medullary Cystic Disease Complex

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12
Q

Analgesic Nephropathy causes

A

Chronic Interstitial Nephritis and Papillary Necrosis

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14
Q

Which is reversible: ATN or Glomerular Necrosis

A

ATN

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15
Q

4 gross complications of Acute Pyelonephritis

A

Pyenephrosis, Perinephric Abcess, Acute Papillary Necrosis, Scars

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17
Q

Most common genetic cause of end stage renal disease in children

A

Nephronopthisis-Medullary Cystic Disease Complex

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19
Q

Gross changes in ATN

A

Kidneys enlarged up to 30%, with pale cortex and congested medulla

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20
Q

most common histopathologic counterpart to moderate-severe acute kidney injury

A

ATN

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21
Q

Acute Pyelonephritis produces what type of necrosis

A

Liquefactive –> Abcessing

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22
Q

Symptoms of ATN are the sames as symptoms of

A

AKI

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22
Q

Primary leukocyte in Acute Pyelonephritis

A

Neutrophils

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23
Q

Patients with Acute Pyelonephritis may have flank pain, with corresponding physical sign of

A

Costovertebral Angle Tenderness

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24
Q

Perinephric Abcess

A

Necrotizing pyelonephritis infection spreads thru renal capsule into surrounding fat

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25
Q

One of the earliers LM findings of ATN

A

Loss of brush border and bleb formation

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27
Q

Most common cause of ischemia leading to ATN

A

Shock, especially septic

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28
Q

Most common cause of ATN

A

Ischemia (75%)

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28
Q

Prognosis for AD PCKD

A

Avg patient needs dialysis or transplant at 50

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29
Q

Why are GI hemorrhage and epistaxis common in ATN

A

Platelets not functioning properly

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29
Q

Common symptoms of AD PCKD

A

Flank pain or dragging sensation in the abdomen

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30
Q

What causes Myoglobin casts

A

Necrosis of skeletal muscle (Rhabdomyolysis)

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30
Q

Abrupt impairment in renal fxn manifested by increased creatinine, BUN, and Oliguria

A

AKI

31
Q

Histology of ATN

A

Blebbing, Vacuolization, Loss of BB, Flattening, Necrosis and Sloughing

32
Q

Why is the percent of AKI represented by ATN not known

A

Rarely biopsied

33
Q

More diffuse gross pyelonephritis rather than foci indicates what route of infection

A

Vesicoureteral Reflux

34
Q

Depressed cortical scars indicates what about Pyelonephritis

A

Hematogenously spread chronic

35
Q

Why does AR (childhood) PCKD lead to immediate untreatable respiratory failure at birth

A

Pulmonary Hypoplasia

36
Q

Diffuse vacuolated tubular cells with no glomeruli or tubules in field

A

Renal Cell Carcinoma

37
Q

Most common cause of acute kidney injury

A

Ischemia –> ATN

37
Q

Muddy Brown Granular Casts or Tubular Epithelial Casts are a diagnostic feature of ___ in up to ___ percent of cases

A

ATN, 80%

39
Q

Renal ischemia usually spares the

A

Glomeruli

40
Q

Acute Pyelonephritis characteristically produces

A

Intense neutrophilic infiltration w/ liquefactive necrosis leading to abcess formation

40
Q

Thyroidization

A

Chronic Pyelonephritis

41
Q

Cysts in medulla, which generally do not impair renal fxn or effect prognosis of patient as whole

A

Medullary Sponge Kidney is characterized by

42
Q

Mutation in AR PCKD

A

Fibrocystin

42
Q

Genes mutated in Nephronopthisis-Medullary Cystic Disease Complex are __ components

A

Ciliary

43
Q

Enlarged kidney, Pale cortex, Congested Medulla

A

ATN

43
Q

Most specific cell type for Interstitial Nephritis

A

Eosinophils

45
Q

Interstitial nephritis is either rich in ___ or ___

A

Eosinophils and Neutrophils (Type 1), or Macrophages with Giant Cells and Granulomas (Type 4)

46
Q

Foci of pyelonephritis grossly means what route of infection

A

Hematogenous

47
Q

Pyelonephritis essentially means

A

bacterial infection of kidney

48
Q

Most common histopathologic counterpart of AKI

A

Acute Tubular Necrosis

50
Q

Ascending Pyelonephritis in babies is associated with

A

Congenital malformation of valves b/t ureters and bladder

51
Q

Most common cause of Intersitial Nephritis

A

Immune-mediated reaction to medication

52
Q

Cortical hemorrhages

A

ATN

53
Q

Necrosis –> Liquefaction –> Abcesses

A

Acute Pyelonephritis

54
Q

Mutations in Polycystin-1 or -2

A

AD (Adult) PCKD

56
Q

Second most common cause of ATN after ischemia

A

Nephrotoxins

57
Q

Small kidneys w/ numerous small cysts at corticomedullary junction and chronic tubulointerstitial nephritis and fibrosis

A

NMCDC

59
Q

Most common cause of Acute Pyelonephritis

A

E Coli

61
Q

What presentation suggests drug-induced acute interstitial nephritis

A

New-onset azotemia w/ oliguria, fever, skin rash, and especially eosinophilia

64
Q

BP in ATN

A

Usually low, because usually caused by septic shock

64
Q

Key determinant of which ATN patients need dialysis

A

Potassium (hyperkalemia)

65
Q

Baseline normal renal tubule histology

A

Cuboidal cells with granular eosinophilic cytoplasm

66
Q

Pyenephrosis

A

Infected pus fills and distends the renal calyces, pelvis, and ureter

67
Q

Presence of Small-moderate numbers of globally sclerotic glomeruli is clinicaly significant?

A

No, common finding in older adults with no clinical signficance

68
Q

What causes Thyroidization? What condition has this?

A

Fibrosis and tubules distended with inspissated urine, making them look like thyroid follicles; Chronic Pyelonephritis

69
Q

What percent of AIN is due to drug reactions

A

75%

71
Q

Hematogenous pyelonephritis is most commonly due to

A

Staph Aureus

72
Q

Prognosis for Acute Pyelonephritis

A

Good

72
Q

Two regions of renal tubule most vulnerable to acute ischemic necrosis

A

PST, Ascending Thick Limb

73
Q

Timeline of Intersitial Nephritis after expsoure to offending drug

A

15 days

74
Q

Good evidence that you’re in recovery phase after AKI

A

Mitotic figures

75
Q

Urinalysis feature of ATN

A

Muddy Brown Casts

77
Q

With chronic pyelonephritis, there is usually ___, primarily with __ and ___, primarily involving ___

A

Usually inflammation, primarily involving lymphocytes and plasma cells, primarily involving the interstitium

79
Q

Recurring or chronic Pyelonephritis is associated with

A

Scarring

81
Q

Gross pathology of Acute Pyelonephritis

A

Dark red congestion; Areas of tan suppurative inflammation (some with necrosis, some becoming abcesses)

82
Q

What type of necrosis is seen in ATN

A

Coagulative

83
Q

Area of dark blue in microscopic path of Renal Abcesses

A

Nuclear debris from breakdown of dead cells (especially neutrophils)

85
Q

Electrolytes and Acid Base in ATN

A

Hyperkalemia and Metabolic Acidosis; Sometimes Hyponatremia

86
Q

Is ATN reversible?

A

Yes, because tubules can regenerate their epithelial cells

88
Q

Medullary Sponge Kidney is characterized by

A

Cysts in medulla, which generally do not impair renal fxn or effect prognosis of patient as whole

89
Q

T/F: Most drug reactions cause interstitial nephritis

A

False, but most intersitial nephritis is caused by drug reactions

90
Q

Myoglobin Casts indicate

A

Rhabdomyolysis cause ATN - myoglobin precipitated in renal tubules

91
Q

Classic triad of Intersitial Nephritis

A

Fever, rash, eosinophilia

93
Q

___ is a disease of chronic intersitial nephritis and papillary necrosis

A

Analgesic Nephropathy

94
Q

Ethylene Glycol poisoing causes ATN with what 2 features

A

Prominent cytoplasmic vacuolization and oxalate crystals

95
Q

Why does ATN cause cortical hemorrhages? Why are they triangular?

A

Disease of intrarenal arteries that causes ischemia and then allows reperfusion

96
Q

Infiltrating cells in Acute vs Chronic Pyelonephritis

A

Neutrophils vs Lymphocytes and Plasma Cells

97
Q

Fibrosis + Distended tubules w/ inspissated urine, making them look like thyroid follices

A

Chronic Pyelonephritis

Renal (31 decks)

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