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MHD V: Renal > 10.30: Renal IV > Flashcards

10.30: Renal IV Flashcards

1
Q

What are the 3 types of AKI?

A

“Acute Kidney injury”

  • **AKA: “ATI” “ATN”
    1. Ischemic
    2. Toxic
    3. Combined
  • **Often stated as: Usually referred to AKI due to ATI
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2
Q

Presentation of ATI?

A

“Acute tubular injury “

  • Rapid reduction in renal function
  • Uremia
  • Fluid overload
  • Electrolyte abnormalities
  • Acidosis
  • Oliguria
  • Increased creatinine
  • ***50% may not show oliguria
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3
Q

Pathogenesis of ATI?

A
  • Tubular injury with disturbance in blood flow
  • Reduced GFR, vasoconstriction, low nutrient delivery
  • Toxic from waste products and lack of O2
  • Necrosis, exfoliation, and regeneration of cells
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4
Q

Difference between ischemic and toxic ATI?

A

Ischemic: Patchy areas of damage along tubule
Toxic: Diffuse damage along tubule
***Both begin in proximal tubules with necrotic cells detaching and damaging / obstructing later parts of tubules

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5
Q

Classic presentation of ATI?

A
  • Younger person in accident w/ loss of blood
  • Drop in BP and urine output
  • Increase creatinine
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6
Q

What is common during recovery from ATI?

A
  • Ptn. accumulated excessive fluid and waste
  • Will need to undergo weeks of dialysis
  • Marked polyuria as renal function returns to normal
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7
Q

Common causes for ischemic ATI?

A
  1. Trauma
  2. Sepsis
  3. Pancreatitis
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8
Q

Common causes of toxic ATI?

A
  1. Antibiotics
  2. Contrast dyes
  3. Poisons
  4. Organic solvents: Mercury, antifreeze
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9
Q

Common presentation of combined ATI?

A
  • Trauma causing large release of myoglobin in blood and urine: toxic to tubules
  • Oliguria with dark brown urine
  • Dipstick positive for RBC: is actually myoglobin
  • Microscopic negative for RBC
  • Increase in BUN
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10
Q

Why is polyuria seen in recovery phase of ATI?

A
  • GFR increase more rapidly than tubule epithelium recovers
  • Thus tubules cannot fully resorb leading to polyuria
  • Once cells recover, urine output is normal
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11
Q

3 categories of tubulointerstitial nephritis?

A
  1. Infectious: acute or chronic pyelonephritis
  2. Drug related
  3. Other: Metabolic or neoplastic
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12
Q

Difference between primary and secondary tubulointerstitial nephritis?

A

Primary: only renal tubules and epithelium
Secondary: Often associated with autoimmune or glomerulonephritis as well

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13
Q

2 types of infectious tubulointerstitial nephritis?

A
  1. BACTEREMIC: circulating bacteria settles in kidney causing nephritis
  2. ASCENDING: infection in lower tract (bladder / urethra) with obstruction or other reason for retention allowing urine to flow backwards to kidney = nephritis
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14
Q

Main cause of urinary reflex leading to ascending movement?

A
  • Ureter does not fully close during voiding allowing for backwards flow of urine
  • Common cause of htn. in children
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15
Q

Signs of acute pyelonephritis?

A
  1. Sudden onset
  2. Costovertebral pain
  3. Fever / malaise
  4. Increase frequency and urgency
    * **Chronic is more insidious
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16
Q

What is acute inflammation with PMNs in tubules and interstitium characteristic of?

A

Acute pyelonephritis

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17
Q

Dispersion of blood between medulla and cortex?

A

Cortex: 90%
Medulla: 10%
***When there is ischemia the papillary tip of medulla is first to go

18
Q

Predisposing factors of papillary necrosis?

A
  1. Analgesics
  2. Sickle Cell
  3. Diabetes
  4. Obstruction
  5. TB
19
Q

Who is interstitial nephritis common in?

A
  • Immunosuppressed patients: transplantees

- Mimics rejection of kidneys

20
Q

Characteristics of chronic pyelonephritis?

A
  • Slow, scarring onset
  • Gradual insufficiency with nocturia / polyuria
  • Dilated tubules
  • Obliterated glomeruli
21
Q

What is xanthogranulomatous pyelonephritis?

A
  • Mimicks tumor, caused by proteus

- Large stones lead to obstruction and scarring

22
Q

Presentation of drug induced interstitial nephritis?

A
  • 25% rash
  • Renal failure: more prevalent in elderly
  • Blood and eosinophils in urine
23
Q

Cause of drug induced interstitial nephritis?

A
  • IgE T cell mediated response to:
    1. NSAIDS
    2. Diuretics
    3. Antibiotics
24
Q

How to treat drug induced interstitial nephritis?

A
  • Withdrawal of drug
25
Q

Typical presentation of drug induced interstitial nephritis?

A
  • Fever
  • Rash
  • Eosinophils in urine
  • Recent diuretic, NSAID, antibiotic administered
  • **Not dosage dependent
26
Q

What are fever rash and eosinophils in urine characteristic of in a ptn. who recently began to take new drug?

A

Drug induced interstitial nephritis

27
Q

What is pathology of NSAID induced interstitial nephritis?

A
  • NSAIDs inhibit prostaglandin formation
  • Demonstrates podocyte effacement seen in MCD
  • Renal failure with increased serum creatinine
28
Q

Difference and similarity between MCD and NSAID interstitial nephritis?

A

BOTH: show podocyte effacement
NSAIDs: show increased serum creatinine

29
Q

What is chinese herb nephropathy?

A
  • Caused by aristolochic acid
  • Rapidly progressing interstitial fibrosis and failure
  • Seen in chinese women using herbs for slimming
  • Increased urothelial carcinoma
30
Q

When is acute uric acid nephropathy seen?

A
  • Ptn. with leukemia or lymphoma on chemotherapy
  • Massive degradation of tumor nuclei leads to release of toxic uric acid
  • Mainly tubular in acute, chronic is interstitial
31
Q

When is chronic oxalate nephropathy seen?

A
  • Bariatric surgery
  • Crohn’s disease
  • Leads to interstitial nephritis
32
Q

What is multiple myeloma?

A
  • Plasma cell malignancy
  • Light chain IG from plasma cell precipitate in distal tubules
  • Can lead to renal failure
  • Uric acid and hypercalcemia seen as well
33
Q

When are subepithelial deposits seen?

A

Post infectious state

34
Q

When is increased creatinine seen?

A

ATI

35
Q

What does benign htn cause?

A
  • Hyaline arteriolosclerosis

- Narrows lumen

36
Q

Difference between benign and malignant htn.?

A

Benign: leads to hyaline arteriolosclerosis
Malignant: Fibrinoid necrosis and hyperplasia of smooth muscle leading to “onion skin” appearance

37
Q

Common cause of renal artery stenosis?

A
  • Post vascular surgery dislodging clot
38
Q

What is thrombotic microangiopathy?

A
  • Endothelial injury from many microthrombi in arterioles
  • Microangiopathic hemolytic anemia
  • Thrombocytopenia from platelet consumption
39
Q

What can cause thrombotic microangiopathy?

A
  1. HUS
  2. TTP
  3. Drugs
  4. Malignant htn.
40
Q

Presentation of thrombotic microangiopathy?

A
  • Microangiopathic hemolytic anemia
  • Thrombocytopenia
  • Renal failure
  • Diarrhea in kids
  • Often caused by E Coli shiga toxin
41
Q

What is HUS often associated with?

A
  • Child eating hamburger and getting E Coli

- Leads to HUS and diarrhea

MHD V: Renal (28 decks)

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