11. Tubular & Interstitial Diseases

Question 1

A 39 year old obese women with history of HTN and 20 year smoking history. Two week ago she was put on a drug regime of Albuterol, Lisinopril, Propranolol Chlorothiazide.
She has been complaining of fever. Urine microscopy is done and is notable for Eosinophils, WBC cast and mild Proteinuria. What is the proper method to treat this patient?

A. Make her quit smoking 
B. Give her steroids 
C. Make her lose weight 
D. Replace Propranolol with Atenolol  
E.  Have her stop all her drugs and treat with steroids 

RFA

Answer 1

Ans. E- From the history Acute Drug induced interstitial Nephritis AIN, is most likely which the treatment calls for first stopping drug treatment and give steroids for recovery

Question 2

A 29 year old man is a abuser of the drug codeine what condition has he put himself at risk of?

A.  Pyelonephritis 
B. Papillary Necrosis 
C. Renal Stone Disease 
D. Obstructive Uropathy
E.  AIN 

RFA

Answer 2

Ans. B Papillary Necrosis- ingestion of large quantities of analgesic drugs leads to papillary damage due to direct toxic effect of ASA

A. Pyelonephritis- risk factors for women are foley catherization and sexaul intercourse
In men- BPH, catheterization and urine stasis

C. Renal Stone Disease- is usually idiopathic but is associated with: gout, cystinuria, hyperoxaluria

D. Obstructive uropathy- BPH, Bladder cancer, Kidney Stone and Papillary necrosis can lead to this so this could be secondary issue after the papillary necrosis

E. AIN- Acute Drug Induced Interstitial Nephritis is more associated with prescription drugs such as Penicillins, NSAIDS ect.

Question 3

Which condition are you likely to see atrophy of the kidneys? (MG)

A. Polycystic kidney disease
B. Uric acid kidney stone
C. Rapidly progressive glomerulonephritis
D. Alport syndrome

Answer 3

B. Uric acid kidney stone

Obstructive uropathy can lead to hydronephrosis, where high pressure in the renal pelvis is transmitted through the collecting tubules into the renal cortex, causing renal atrophy

Question 4

A 22 year old graduate student has been cramming for her final, causing a lot of neck strain. She has been taking 10 Motrin pills a day to compensate for the soreness. Within a few days, she starts feeling febrile and notices she has been passing less urine that normal. Urinalysis shows sterile pyruia, WBC casts, mild proteinuria, and eosinophils in the urine. What else are you likely to find in her urine? (MG)

A. Secrets
B. Elevated K+ levels
C. RBC casts
D. Fat droplets/fatty casts
E. High bicarb levels

Answer 4

B. Elevated K+ levels

Condition: Acute interstitial nephritis

Elevated K+ levels and decreased bicarb are indicative off tubular dysfunction that you would see in this disease.

Question 5

Which of the following stones would not be present on US?

A. Calcium
B. Ammonium magnesium phosphate
C. Struvite
D. Uric Acid
E. Cystine 

SZ

Answer 5

Ans. D. Uric Acid

Ammonium magnesium phosphate and Struvite are the same thing.

Question 6

A woman is put on a new medication for an acute bacterial infection. She develops a fever, rash, hyperkalemia, and elevated BUN and Creatinine. Which of the following would be present on H&E?

A. Mast cells
B. Thyroidization of the kidney
C. Eospinophils
D. Fibrin
E. Lipids 

SZ

Answer 6

Ans C. Eospinophils

This is Acute Drug Induced Interstitial Nephritis