Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

13. Urogenital Pathology > 4. Tubular & interstitial diseases > Flashcards

4. Tubular & interstitial diseases Flashcards

1
Q

Types of tubular & interstitial diseases

A
  1. Acute tubular necrosis
  2. Acute interstitial nephritis
  3. Acute pyelonephritis
  4. Chronic pyelonephritis
  5. Xanthogranulomatous pyelonephritis
  6. Renal tuberculosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Definition of acute tubular necrosis

A

Clinicopathologic entity characterized by acute diminution of renal function & often morphologic evidence of tubular injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of acute tubular necrosis

A
  1. Ischemic causes:
    - Shock, hemorrhage, major surgery, severe burns
  2. Toxic causes:
    - Endogenous products (haemoglobin released in hemolysis; myoglobin released in crush injuries & rhabdomyolysis)
    - Drugs
    - Heavy metals (lead, mercury)
    - Organic solvents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Phases of acute tubular necrosis

A 
1. Oliguric phase 
Results in:
- Na+ & H2O overload
- Metabolic acidosis
- Hyperkalemia
- Increased serum creatinine & BUN
  1. Polyuric phase
    i. Clearance of sloughed off epithelial cells which allows for glomerular filtration rate to revert back to normal; however tubular epithelium is still not fully recovered, hence reabsorption of filtrate is impaired
    ii. Results in:
    - Dehydration
    - Hypokalemia
  2. Recovery phase
    - Renal function recovering back to normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Morphology of acute tubular necrosis

A
  1. Tubular epithelial cells show varying degree of swelling, vacuolation, flattening, sloughing, loss of PAS-positive brush border, necrosis
  2. Tubular dilation
    - Contains eosinophilic casts (principally plasma proteins + Tamm-Horsfall protein, a urinary glycoprotein normally secreted by the cells of the thick ascending limb & distal tubule)
  3. Interstitial edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pathological effects & complications of acute tubular necrosis

A

Acute renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Definition of acute interstitial nephritis

A

Also known as acute tubulointerstitial nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of acute interstitial nephritis

A
  1. Drugs
    - NSAIDs
    - Antibiotics (methicillin, ampicillin, rifampicin)
    - Diuretics (thiazides)
    - Allopurinol
    - Cimetidine
  2. Toxins
  3. Metabolic causes
  4. Autoimmune
  5. Non-renal infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Morphology of acute interstitial nephritis

A
  1. Interstitial edema
  2. Leukocytic infiltrate
  3. Focal tubular necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pathological Effects & complications of acute interstitial nephritis

A

Varying degree of renal function impariment

  • Mild proteinuria
  • Polyuria, nocturia
  • RBCs, WBCs & eosinophils in urine (may be accompanied by fever & rash)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Definition of acute pyelonephritis

A

Acute infection of the kidney & collecting systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causes of Acute Pyelonephritis

A
  1. Typically coliforms
    - Escherichia coli, Proteus, Klebsiella, Enterobacter
  2. In immunocompromised:
    - Polyomavirus, CMV, adenovirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Routes of infection in pyelonephritis

A
  1. Ascending (retrograde) spread from lower urinary tract, predisposed by:
    - Lower urinary tract obstruction (stone, benign prostatic hyperplasia, neoplasms etc)
    - Vesicoureteric reflux
    - Diabetes mellitus (increased susceptibility to infections; autonomic neuropathy can result in neurogenic bladder promoting urinary stasis)
    - Pregnancy
  2. Hematogenous spread
    - Septicemic episode from distant
    - Infective endocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Morphology of acute pyelonephritis

A
  1. [Grossly]
    - Cortical surface shows grey-white areas of inflammation & abscess formation
    - Cut surface shows foci of abscesses within renal parenchyma
    - Papillary necrosis (seen mainly in diabetics & NSAID use) – cut surface reveals tips or distal 2/3 of pyramids with areas of grey white/yellow necrosis
  2. [Histologically]
    - Patchy interstitial suppurative inflammation
    - Tubular aggregates of neutrophils
    - Tubular necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Clinical features of acute pyelonephritis

A
  1. Fever, chills, malaise
  2. Flank tenderness & pain
  3. Signs of lower urinary tract infection:
    - Dysuria
    - Increased frequency of micturition
  4. Pyuria (may have pus casts, which indicates renal involvement as casts are only formed in renal tubules)
  5. Detection of bacteria in urine (often >100000/ml)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pathological Effects & Complications of acute pyelonephritis

A
  1. Acute renal failure
  2. Septicemia
  3. Pyonephrosis
  4. Perinephric abscess
  5. Papillary necrosis
    - Mainly seen in diabetics & NSAID use
17
Q

Definition of chronic pyelonephritis

A

Disorder in which chronic tubulointerstitial inflammation & renal scarring are associated with pathologic involvement of the calyces & pelvis; categorized into 2 main forms based on etiology

18
Q

Causes of chronic pyelonephritis

A
  1. Vesicoureteric reflux (reflux nephropathy)
    - Predisposes to recurrent renal inflammation & progressive scarring (most prominent at renal poles)
    - Usually begins in childhood (congenitally short intravesical ureter – ureter takes a short route through the muscular wall of the bladder, hence rendering this physiological valve incompetent)
  2. Obstruction (chronic obstructive pyelonephritis)
    - Obstruction may be at any level below level of kidney, due to stones, BPH, neoplasms, etc
    - Predisposes to recurrent renal inflammation & progressive scaring
19
Q

Morphology of chronic pyelonephritis

A
  1. [Grossly]
    - Irregular scarring
    - Dilated, blunted, deformed calyces
    - Flattened papillae
  2. [Histologically]
    - Atrophy of some tubules with dilation of others
    - Dilated tubules filled with colloid casts, giving them a thyroid follicular appearance (thyroidization)
    - Interstitial fibrosis & inflammation
    - Periglomerular fibrosis
20
Q

Pathological effects & complications of chronic pyelonephritis

A

Chronic renal failure

21
Q

Definition of xanthogranulomatous pyelonephritis

A

Rare form of chronic pyelonephritis causes by Proteus spp. often in the setting of urinary tract obstruction

22
Q

Morphology of xanthogranulomatous pyelonephritis

A
  1. Grossly:
    - Enlarged kidney, replaced by yellow nodules with firm grayish white tissue
  2. Histologically:
    - Macrophages with vacuolated cytoplasm (foam cells)
    - Giant cells, lymphocytes, plasma cells
23
Q

Causes of renal tuberculosis

A

Hematogenous spread from pulmonary tuberculosis

- Occurs in 5% of cases of pulmonary TB

24
Q

Morphology of renal tuberculosis

A
  1. Grossly:
    - Initially: lesions in the medulla & papillae
    - Later on: caseous foci enlarged in medulla & cortex to destroy the entire kidney
  2. Histologically:
    - Caseating granulomatous inflammation
25
Q

Pathological Effects & complications of renal tuberculosis

A
  1. Renal destruction & renal failure
  2. Spread to ureter with subsequent fibrosis & obstruction
  3. Spread to bladder (TB cystitis) & epididymis

13. Urogenital Pathology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions