310 - Tubulointerstitial Diseases of the Kidneys Flashcards
We differentiate tubulointerstitial disease into __ and __.
acute
chronic
TIN= ___
tubulointerstitial nephritis
Acute TIN is defined as aggressive ___ infiltration leading to tissue __, damage to __ cells and flow, or obstruction by __/__/__.
inflammatory
edema
tubular
casts/crystals/cell debris
Clinical symptoms of acute TIN include __ due to capsular stretching.
flank pain
Acute TIN urine will contain __ and cellular __.
leukocytes
casts
Chronic TIN will cause __ due to difficulties to __ it.
polyuria
concentrate
Chronic TIN may lead to __ syndrome: 5
Fanconi glycosuria Phosphaturia Amino acids in urine hypokalemia RTA type II (due to HCO3 urine excretion)
Chronic TIN may lead to RTA type __ with non-AG __ acidosis and hyper__ due to __ production.
4
metabolic
kalemia
ammonia
Chronic TIN may present with advanced __ and __ (rarely >2 gr/day).
azotemia
albuminuria
Chronic TIN US may present increased __ and __ (IS __)
echogenic
scarring
fibrosis
Now days, acute TIN is usually caused by drug __. Other reasons may include: 3
allergy
infection
systemic AI disease
obstruction
What are the main drugs causing allergic TIN? 7
anti TB fluoroquinolones sulfonamides Beta lactam NSAID diuretics alopurinol
The classic presentation of allergic TIN includes:4
fever
rash
peripheral eosinophilia
oliguric renal insufficiency
Allergic TIN usually starts - days after __ Abx
7-10
B lactam
The common presentation of allergic TIN includes increased __ in serum or __ symptoms.
Cr
AKI
Allergic TIN due to NSAID will usually not include __ or __, but heavy ___ is possible.
fever
rash+ eosinophilia
proteinuria
__ can cause a severe allergic TIN when resuming its treatment after a long remission.
rifampin
Treating allergic TIN includes: 2
stopping the drug causing it
steroidal treatment- only for severe cases
Sicca syndrome (part of Sjogren syndrome)= ___
dry mouth and eys
__ syndrome is an AI disease with damage to exocrine glands (saliva/tears) that can include __ nephritis.
Sjogren
TIS
TIS nephritis with uveitis is more common in young __. Treatment is with PO __.
women
steroids
Beside Sjogren, name other disease involving TIS nephritis: 3
SLE
granulomatous
IgG4 related systemic disease
Chronic TIS is usually due to renal __ or secondary to primary __ disease. Other reasons include: 2
ischemia
glomerular
reflux nephropathy
sickle cell anemia
VUR=__
Vesicoureteral reflux
VUR is a result of faulty __ or early childhood urological __.
valves
anomalies
Clinical symptoms of VUR include: 4
recurrent UTI
late aged nocturnal enuresis
AKI/HTN/proteinuria
ESRD
VUR should be examined by __ imaging. We usually see __ asymmetric kidneys with __ borders, thin __ and __ areas to compensate.
US small irregular cortex hypertrophic
VUR treatment includes: 3
sterile urine to prevent scarring
operating at an early age when reflux is substantial
aggressive HTN balance (ACE/ARB)
