#25 Virmani - Non Glomerular Disease Flashcards
Identify
Tubulointerstitial Nephropathy
Neutrophils in interstitia
Identify
Acute Interstitial Nephritis (AIN)
Note acute inflammatory infiltrate
Identify
Chronic Tubulointerstitial Nephropathy
No active renal inflammation with sub-nephrotic proteinuria and pyuria/WBC casts
(Inflammation has occurred, peaked and troughed. Now fibrosis)
Asbsence of RBC casts
Identify
Necrotic papilla
Analgesic Nephropathy
Identify
Lithium Nephropathy
due to long term lithium use
Identify picture on left
ADPKD on left
PKD1 and PKD2 genes
**cerebral aneurysms
Identify and describe
Simple Cyst
anechoic round mass with smooth and sharply demarcated wall
Identify
Medullary Sponge Kidney
“Bouquet of flowers”
A 75 year old man comes in. After taking a history you discover he is on proton pump inhibitors and has been taking NSAIDS for knee pain. You order labs and they return with hematuria, sterile pyuria and leukocytes casts. What is a probable diagnosis?
Acute Interstitial nephritis
TRIAD: fever, skin rash, peripheral eosinophilia (arthralgias)
PPI and NSAIDS are probable offending agents.
Tx: discontinue offending agents
short course of high-dose prednisone (1mg/kg/day) - acute
What syndrome features: phosphaturia, bicarbanaturia, aminoaciduria, uricosuria and glycosuria?
Fanconi’s syndrome
Proximal tubules fail so nothing is reabsorbed
UT’s recurrent urinary tract infections can cause what type of stones?
Triple phosphate stones
Frequent UTI’s lead to scarring as well.
Your patient who has been diagnosed with sickle cell disease presents with fever, flank pain and hematuria. What might lead to acute pyelonephritis?
papillary necrosis and infection
also can be in Analgesic nephropathy
Patient suffers from bi-polar disorder and has been on lithium for 20 years. What must you monitor?
Kidney function
Distal tubular dysfunction
Cystic disease is common
Tx: change meds
65 year old hunter comes in with hypertension, gout and has chronic renal disease. What is the possible etiology of his nephropathy?
Lead bullets
Also offenders:
Lead paint
supplements (tumeric)
Moonshine
Industrial setting
Your patient has chronic tubulointerstitial nephritis due to a metabolic disorder. What might you have seen on labs?
Hypercalcemia (sarcoidosis, 1* hyperPTH, multiple myeloma, polyuria)
Chronic hypokalemia
hyperuricemia
Your ADPKD patient is nearing 45. He was diagnosed 5 years earlier when he came in with chronic flank pain and intermittent hematuria. His blood pressure is starting to be elevated. What other clinical association are relavant in ADPKD?
Hepatic cysts
Mitral valve prolapse
diverticulosis
Cerebral aneurysm
Pancreatic cysts
Sonographic criteria for ADPKD
29 year old patient has 3 cysts on 1 kidney.
ADPKD?
Yes
Less than 30Y: = or > than 2 cysts per kidney
30-60: 4 or more cysts
>60: at least 4 cysts per kidney
You have done a renal sonogram and discovered an obstruction that you believe may be the cause of the renal failure. After removal of the obstruction what must you manage?
Post obstructive diuresis and electrolyte abnormalities.
Patient comes in complaining of hematuria and flank pain. She brought you a rhubarb cobbler becuase it is rhubarb season and she wanted to share. What might have caused her kidney stone?
Hyperoxaluria
Calcium stones
Tx: limiting animal protein
increasing citrate
reducing oxalate containing food
increasing dietary calcium intake (?)
What is the tissue of origin for renal cell carcinoma?
Proximal renal tubular epithelium
von Hippel-Lindau syndrome is associated with what cancers?
Multiple-Cancer Syndrome
Renal cell carcinoma
Pheochromocytoma
Pancreatic islet cell tumors
Retinol angiomaas
CNS hemangioblastoma
Endolymphatic sac tumors
Epididymal cystadenomas
What are a patient’s options if they have renal cell carcinoma?
Surgery
Radiation therapy
Chemotherapy
Hormonal therapy
Immunotherapy
