20-4 (Tubulointerstitial Nephritis)

Question 1

What characterizes Tubulointerstitial Nephritis?

Answer 1

Insidious inflammatory injuries + Azotemia

Question 2

What characterizes Tubulointerstitial Nephritis?

Answer 2

Insidious inflammatory injuries + Azotemia

Question 3

How does Tubulointerstitial Nephritis differ from glomerular diseases?

Answer 3

• NO nephritic/nephrotic syndrome

- Tubular function defects – urine concentration changes

Question 4

There are many causes of Tubulointerstitial Nephritis, if they are in this deck they are causes of it. What are the 2 main causes?

Answer 4

• Pyelonephritis

- Drug/toxin induced

Question 5

Inflammation of tubules, interstitium and renal pelvis

Answer 5

Pyelonephritis

Question 6

Acute Pyelonephritis is usually associated with?

Answer 6

Bacterial UTI

Question 7

Chronic Pyelonephritis is usually associated with?

Answer 7

Recurrent episodes, Vesicoureteral Reflux, etc.

Question 8

What type of bacteria commonly cause Acute Pyelonephritis and give 3 examples?

Answer 8

Gram (-) bacilli

- E. Coli, Proteus, Enterobacter

Question 9

Bacteria can spread to the kidney from the blood stream or lower urinary tract. Which is more common?

Answer 9

Lower urinary tract spread

Question 10

Describe how bacteria can ascend the lower urinary tract to cause Acute Pyelonephritis

Answer 10

• Colonizes urethra
• Enters bladder
• Obstruction or urinary stasis allows accumulation
• Vesicoureteral reflux or valve issue allows access to ureter
• Intrarenal reflux allows access to kidney

Question 11

What virus can cause Acute Pyelonephritis and when?

Answer 11

Polyomavirus

– Kidney allografts with reactivation of latent infection

Question 12

If Acute Pyelonephritis is caused by Polyomavirus, what will be seen in cells?

Answer 12

Nuclear enlargement and inclusions (virions)

Question 13

What 2 things characterize the morphology for Acute Pyelonephritis?

Answer 13

1. Patchy interstitial suppurative inflammation

2. Neutrophilic intratubular aggregates

Question 14

What 2 things characterize Acute Pyelonephritis morphology?

Answer 14

1. Patchy interstitial suppurative inflammation

2. Neutrophilic intratubular aggregates

Question 15

What can be seen in the urine to show that Acute Pyelonephritis is present?

Answer 15

Leukocyte Casts

Question 16

What are the symptoms of Acute Pyelonephritis?

Answer 16

CVA tenderness (flank pain), systemic symptoms, dysuria, urinary urgency/frequency

Question 17

What are 3 complications that may result from Acute Pyelonephritis?

Answer 17

• Papillary necrosis
• Pyonephrosis
• Perinephric abscess

Question 18

Patchy suppurative inflammation and neutrophilic aggregates suggests?

Answer 18

Acute Pyelonephritis

Question 19

What differentiates Chronic Pyelonephritis from Acute?

Answer 19

With Chronic – inflammation and scarring involves the calyces and pelvis

Question 20

Inflammation and scarring that involves the calyces and renal pelvis is seen with?

Answer 20

Chronic Pyelonephritis

Question 21

How will the kidneys look morphologically with Chronic Pyelonephritis?

Answer 21

• Coarse, discrete, irregular scars on outer corticomedullary surface
• Blunted calyx
• Flattened papillae

Question 22

How will the kidneys look morphologically with Chronic Pyelonephritis?

Answer 22

• Coarse, discrete, irregular scarring on the outer corticomedullary surface
• Blunted calyx
• Flattened papillae

Question 23

How will the kidneys look grossly with Chronic Pyelonephritis?

Answer 23

Asymmetric and contracted

Question 24

What is another cause of Chronic Pyelonephritis?

Answer 24

Xanthogranulmatous Pyelonephritis

Question 25

What cells will be present and what feature will be present with Xanthogranulomatous Pyelonephritis?

Answer 25

• Foamy macrophages present

- Yellow orange nodules present

Question 26

What infection causes Chronic Xanthogranulomatous Pyelonephritis?

Answer 26

Proteus infection

Question 27

What drugs may cause Drug/toxin induced Tubulointerstitial Nephritis?

Answer 27

Methacillin or other synthetic antibiotics

NSAIDs

Question 28

What is the most dangerous form of Drug/toxin induced Tubulointerstitial Nephritis?

Answer 28

Subclinical cumulative tubular injury

– results in CKD

Question 29

What are the symptoms of Drug/toxin induced Tubulointerstitial Nephritis?

Answer 29

• Fever
• Eosinophilia
• Rash
• Hematura/proteinuria/leukocyturia

Question 30

What are the symptoms of Drug/induced Tubulointerstitial Nephritis?

Answer 30

• Fever
• EOSINOPHILIA
• Rash
• Hematuria/proteinuria/leukocyturia

Question 31

Urate Nephropathy can also cause Tubulointerstitial Nephritis. What molecule builds up in the tubules?

Answer 31

Uric acid

Question 32

Acute Urate nephropathy is seen with what syndrome?

Answer 32

Tumor lysis syndrome

– uric acid crystals in the tubules

Question 33

Chronic Urate nephropathy is seen with gout. What lesion will be present?

Answer 33

Tophus lesion with giant cells

Question 34

Hypercalcemia and nephrocalcinosis can also cause Tubulointerstitial Nephritis. What will be deposited?

Answer 34

Calcium stones

Question 35

Light chain cast nephropathy can also cause Tubulointerstitial nephritis. What disease is that seen with?

Answer 35

Multiple myeloma

Question 36

What are the 3 features of Light chain cast nephropathy?

Answer 36

Bence jones proteinuria
AL amyloid
Light chain deposition

Question 37

What are the 3 features of Light chain cast nephropathy?

Answer 37

• Bence jones proteinuria
• AL amyloid
• Light chain deposition

Question 38

What causes Bile cast nephropathy?

Answer 38

Liver disease

Question 39

What are the findings with Bile cast nephropathy?

Answer 39

• Elevated bilirubin and jaundice

- Bile casts in distal nephron segments

Question 40

What are the findings with Bile cast nephropathy?

Answer 40

• Elevated bilirubin and jaundice

- Bile casts in the distal nephron segments