17.6 Pathology: Tubulo-interstitial disease

Question 1

Which are more common, tubulointerstitial or glomerular disease?

Answer 1

Tubulointerstitial diseases

Question 2

What are 3 causes of tubulointerstitial injury?

Answer 2

Acute tubular necrosis (ischaemia of tubular epithelial cells)

Acute pyelonephritis (tubule/interstitial infection)

Acute/chronic tubulointerstitial nephritis

Question 3

What is the most common cause of acute renal failure?

Answer 3

Acute tubular necrosis (ischaemia, usually to tubular epithelial cells)

Question 4

What happens in ATN?

Answer 4

Tubule can’t function, GFR falls, creatinine/urea accumulate

Question 5

What are the outcomes of ATN?

What is recovery often associated with?

Answer 5

Reversible (dialysis?)

Recovery often associated with diuresis

Question 6

What do we see on a histological section in ATN?

Answer 6

Massive necrosis, sloughing

Question 7

What is the difference between hypoperfusion and ischaemic ATN?

Answer 7

Hypoperfusion (pre-renal): GFR falls, perfusion restored? GFR starts again

ATN: Severe/protracted hypoperfusion, necrosis of tubular epithelium

Question 8

What is toxic ATN?

Answer 8

Similar to ischaemic, seen with:
Heavy metals (esp. mercury)
Some antibiotics
Some cancer chemo drugs

Question 9

How does Toxic ATN often occur?

Answer 9

Many toxins disturb mitochondria and Ox Phos

Question 10

In what organs is inflammation mediated by lymphocytes?

Answer 10

Liver, kidney

Question 11

What is acute interstitial nephritis?

Answer 11

Interstitium/tubules infiltrated by inflammatory cells (incl. eosinophils), fever, maybe a rash

Question 12

What is acute interstitial nephritis very often due to?

Answer 12

Drug allergy

Question 13

What is pyelonephritis?

Answer 13

A bacterial infection of the kidney that affects:
Parenchyma
Calyces
Renal pelvis

Question 14

What kind of infection is pyelonephritis? What might we see?

Answer 14

Acute or chronic

May occur with/without obstruction to urine flow

Question 15

How does acute pyelonephritis present in adults vs. children?

Answer 15

Adults: acute onset, fever/chills/lumbar tenderness/pain

Children: Abdominal pain, vomiting, fever

Question 16

What happens to renal function and urine in acute pyelonephritis?

Answer 16

Renal function usually preserved

Urine: contains organisms, WBCs

Question 17

What commonly causes acute pyelonephritis?

Answer 17

Gram negative bacteria:
E. Coli
Kelbsiella
Proteus
Psuedomonas

Question 18

What may or may not be associated with chronic pyelonephritis?

Answer 18

May be obstructive or non-obstructive

Question 19

What does chronic pyelonephritis often result in (seen on histological section)?

Answer 19

Interstitial scarring,
tubular atrophy,
‘Saddle scars’

Question 20

What is reflex nephropathy?

Answer 20

Renal damage due to backflow of urine

Question 21

What is analgesic nephropathy?

Answer 21

Chronic, associated with ‘compound analgesics’

less common now

Question 22

What is chronic renal failure defined as?

Answer 22

Insufficient GFR

Question 23

What are the common causes of chronic renal failure?

Answer 23

Diabetic nephropathy
Glomerulonephritis
Hypertension