103114 tubulointerstitial, vascular, CKD

Question 1

acute interstitial nephritis

Answer 1

inflam of renal tubules and interstitium

Question 2

causes of acute interestitial nephritis

Answer 2

hypersensitivity rxn to drugs (fever, arthralgias, maculopapular rash, peripheral blood eosinohphilia, eosinphils in urine, UA with WBCs or RBCs)

infections

autoimmune diseases

Question 3

morphologic features of acute interstitial nephritis

Answer 3

inflam and edema of interstitium with involvement of tubules sparing gomeruli and vessels

lymphocytes, plasma cells, eosinophils
may see granulomas

Question 4

acute pyelonephritis

Answer 4

acute inflam of kidney due to a bacterial infec (urinary route or hematogneous route)

typical urinary tract pathogens are gram negative bacilli

Question 5

histology of pyelonephritis

Answer 5

similar to interstitial nephritis but inflam is also within tubules

Question 6

multiple myeloma

Answer 6

renal failure develops in 25% of pts

chronic renal failure

Question 7

multiple myeloma can cause nephropathy how?

Answer 7

excessive production and urinary excretion of lights chains

presents as AKI

Question 8

morphology of multiple myleoma nephropathy

Answer 8

LM: fractured casts in tubules

IF: may see light chain predominance (lambda or kappa)

Question 9

pyelonephritis is often due to

Answer 9

ascending UTI

Question 10

renal vascular disease ex

Answer 10

hypertensive nephrosclerosis
renovascular HTN (renal artery atherosclerosis, fibromuscular dysplasia)
atheroembolic disease
thrombotic microangiopathy

Question 11

tubulointerstitial diseases

Answer 11

acute tublointerstitial nephritis
pyelonephritis
myeloma kidney

Question 12

hypertensive nephrosclerosis

Answer 12

chronic kidney disease in pt with long standing poorly controlled HTN

proteinuria often present

Question 13

morphologic features of hypertensive nephrosclerosis

Answer 13

hypertensive neprhosclerosis:
gross: granular cortical surface
LM-subcapsular glomerular sclerosis, tubular atrophy, interstitial fibrosis, arteriolar hyaline

malignant HTN:
mucoid intimal thickening of arteries, glomerular capillary wrinkling, GBM duplication similar to thrombotic microangiopathy

Question 14

renal artery stenosis leading to renovascular HTN can be caused by

Answer 14

atherosclerosis
fibromuscular dysplasia (beads on string)

Question 15

thromboembolic diseases

Answer 15

cortical infarcts

renal cholesterol microembolism syndrome (atheroembolic disease)

thrombotic microangiopathy

Question 16

thrombotic microangiopathy

Answer 16

thrombosis in capillaries and arterioles:
microangiopathic hemolytic anemia
thrombocytopenia
renal failure

hemolytic uremic syndrome (often with E coli)
thrombotic thrombocytopenic purpura

Question 17

pathogenesis of thrombotic microangiopathy

Answer 17

endothelial injury and activation–intravascular thrombosis

platelet aggregation causing vascular obstruction and vasoconstriction

Question 18

renal artery stenosis presents clinically as

Answer 18

resistant HTN or kidney dysfxn (often after ACEi or ARB)

Question 19

chronic kidney disease

Answer 19

progressive irreversible renal insufficiency developing ove rmonths to years

may ultimately lead to ESRD

Question 20

main causes of CKD

Answer 20

diabetes
HTN
glomerular diseases
cystic diseases

Question 21

what happens with CKD?

Answer 21

kidney size usually reduced

normal or large kidneys may be seen with diabetes, amyloidosis, HIV, cystic kidney diseases

Question 22

why does CKD cause anemia?

Answer 22

decreased erythropoietin production

Question 23

physical symptoms of chronic uremia

Answer 23

lethargy
day night sleep reversal
anorexia, nausea, vomiting
pruritis
restless legs syndrome
uremic pericarditis

Question 24

main cause of CKD and ESRD in US

Answer 24

diabetes

Question 25

CKD can cause

Answer 25

HTN
metabolic acidosis
increased risk of hyperkalemia
secondary hyperPTH
anemia