20-4 (Tubulointerstitial Nephritis) Flashcards
What characterizes Tubulointerstitial Nephritis?
Insidious inflammatory injuries + Azotemia
What characterizes Tubulointerstitial Nephritis?
Insidious inflammatory injuries + Azotemia
How does Tubulointerstitial Nephritis differ from glomerular diseases?
- NO nephritic/nephrotic syndrome
- Tubular function defects – urine concentration changes
There are many causes of Tubulointerstitial Nephritis, if they are in this deck they are causes of it. What are the 2 main causes?
- Pyelonephritis
- Drug/toxin induced
Inflammation of tubules, interstitium and renal pelvis
Pyelonephritis
Acute Pyelonephritis is usually associated with?
Bacterial UTI
Chronic Pyelonephritis is usually associated with?
Recurrent episodes, Vesicoureteral Reflux, etc.
What type of bacteria commonly cause Acute Pyelonephritis and give 3 examples?
Gram (-) bacilli
- E. Coli, Proteus, Enterobacter
Bacteria can spread to the kidney from the blood stream or lower urinary tract. Which is more common?
Lower urinary tract spread
Describe how bacteria can ascend the lower urinary tract to cause Acute Pyelonephritis
- 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
What virus can cause Acute Pyelonephritis and when?
Polyomavirus
– Kidney allografts with reactivation of latent infection
If Acute Pyelonephritis is caused by Polyomavirus, what will be seen in cells?
Nuclear enlargement and inclusions (virions)
What 2 things characterize the morphology for Acute Pyelonephritis?
- Patchy interstitial suppurative inflammation
2. Neutrophilic intratubular aggregates
What 2 things characterize Acute Pyelonephritis morphology?
- Patchy interstitial suppurative inflammation
2. Neutrophilic intratubular aggregates
What can be seen in the urine to show that Acute Pyelonephritis is present?
Leukocyte Casts
What are the symptoms of Acute Pyelonephritis?
CVA tenderness (flank pain), systemic symptoms, dysuria, urinary urgency/frequency
What are 3 complications that may result from Acute Pyelonephritis?
- Papillary necrosis
- Pyonephrosis
- Perinephric abscess
Patchy suppurative inflammation and neutrophilic aggregates suggests?
Acute Pyelonephritis
What differentiates Chronic Pyelonephritis from Acute?
With Chronic – inflammation and scarring involves the calyces and pelvis
Inflammation and scarring that involves the calyces and renal pelvis is seen with?
Chronic Pyelonephritis
How will the kidneys look morphologically with Chronic Pyelonephritis?
- Coarse, discrete, irregular scars on outer corticomedullary surface
- Blunted calyx
- Flattened papillae
How will the kidneys look morphologically with Chronic Pyelonephritis?
- Coarse, discrete, irregular scarring on the outer corticomedullary surface
- Blunted calyx
- Flattened papillae
How will the kidneys look grossly with Chronic Pyelonephritis?
Asymmetric and contracted
What is another cause of Chronic Pyelonephritis?
Xanthogranulmatous Pyelonephritis
What cells will be present and what feature will be present with Xanthogranulomatous Pyelonephritis?
- Foamy macrophages present
- Yellow orange nodules present
What infection causes Chronic Xanthogranulomatous Pyelonephritis?
Proteus infection
What drugs may cause Drug/toxin induced Tubulointerstitial Nephritis?
Methacillin or other synthetic antibiotics
NSAIDs
What is the most dangerous form of Drug/toxin induced Tubulointerstitial Nephritis?
Subclinical cumulative tubular injury
– results in CKD
What are the symptoms of Drug/toxin induced Tubulointerstitial Nephritis?
- Fever
- Eosinophilia
- Rash
- Hematura/proteinuria/leukocyturia
What are the symptoms of Drug/induced Tubulointerstitial Nephritis?
- Fever
- EOSINOPHILIA
- Rash
- Hematuria/proteinuria/leukocyturia
Urate Nephropathy can also cause Tubulointerstitial Nephritis. What molecule builds up in the tubules?
Uric acid
Acute Urate nephropathy is seen with what syndrome?
Tumor lysis syndrome
– uric acid crystals in the tubules
Chronic Urate nephropathy is seen with gout. What lesion will be present?
Tophus lesion with giant cells
Hypercalcemia and nephrocalcinosis can also cause Tubulointerstitial Nephritis. What will be deposited?
Calcium stones
Light chain cast nephropathy can also cause Tubulointerstitial nephritis. What disease is that seen with?
Multiple myeloma
What are the 3 features of Light chain cast nephropathy?
Bence jones proteinuria
AL amyloid
Light chain deposition
What are the 3 features of Light chain cast nephropathy?
- Bence jones proteinuria
- AL amyloid
- Light chain deposition
What causes Bile cast nephropathy?
Liver disease
What are the findings with Bile cast nephropathy?
- Elevated bilirubin and jaundice
- Bile casts in distal nephron segments
What are the findings with Bile cast nephropathy?
- Elevated bilirubin and jaundice
- Bile casts in the distal nephron segments
