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REGUB > 5. Infective and Inflammatory Tubulo-Interstitial Kidney Diseases > Flashcards

5. Infective and Inflammatory Tubulo-Interstitial Kidney Diseases Flashcards

1
Q

How can acute pyelonephritis be seen on histology?

A

Pus cells in lumen of tubule
Preferentially infecting poles
Heals by fibrosis

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2
Q

What is chronic pyelonephritis?

A

Repeated acute infections causing fibrosis or a continued episode of acute pyelonephritis
Can cause end stage kidney disease in children

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3
Q

What can be seen on histology in chronic pyelonephritis?

A 
Acute and chronic inflammation
Thyroidisation of tubules
Glomerular hypertrophy and FSGS as scarring causes increased workload on remaining nephrons
Thickening of vascular walls
Struvite stones
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4
Q

What does thyroidisation mean?

A

Tubules become filled with proteinaceous fluid

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5
Q

What are struvite stones made of and how is their shape commonly described?

A

Ammonium phosphate

‘Staghorn’ as they hold the shape of the collecting system

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6
Q

What are less common appearances of chronic pyelonephritis?

A

In xanthogranulomatous pyelonephritis there is an accumulation of foamy macrophages
Malakoplakia there are eosinophilic macrophages

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7
Q

What are the main causes of acute tubulointerstitial nephritis?

A

Hypersensitivities (2, 3, 4) to drugs
Lupus, sjogrens, uveitis, sarcoid
Familial

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8
Q

What drugs can cause acute tubulointerstitial nephritis?

A

PPIs
Antibiotics
NSAIDs
TNF inhibitors

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9
Q

What is seen on histology in acute tubulointerstitial nephritis?

A

Eosinophils in interstitium

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10
Q

What are the causes of hydronephritis?

A

Congenital obstruction eg. lacking neuromuscular function in ureter
Tumours
Calculi
Obstruction from outside

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11
Q

How does hydronephritis affect the appearance of the kidney?

A

Dilatation of renal pelvis and calyces
Flattened papillae
Atrophy of renal cortex

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12
Q

What effect does one kidney with hydronephritis have?

A

Lose kidney and increased BP

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13
Q

What are the results of bilateral hydronephritis?

A

Patient needs dialysis or will die

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14
Q

What are oxalate stones produced from?

A

Ethylene glycol antifreeze ingestion

Malabsorption

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15
Q

What is one way oxalate stones can be differentiated form others?

A

Colourful under polarised light

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16
Q

Which patient group is most likely to get kidney stones?

A

Men in 20s-30s

17
Q

What are the types of kidney stones?

A

Majority are calcium
Magnesium ammonium phosphate ie struvite in infections
Uric acid a/w gout
Cysteine

18
Q

What percentage of gallstones vs kidney stones are visible on x ray?

A

10% of gallstones

90% of kidney stones

19
Q

What are the clinical features of renal calculi?

A

Renal colic
Haematuria
Pyelonephritis
Hydronephritis

20
Q

What is the treatment for renal calculi?

A

Lithotripsy: ablation with ultrasound beams

Rehydration if calcium stones

21
Q

What is acute renal failure?

A

Increase in serum creatinine and loss of glomerular filtration over a week

22
Q

What is the clinical course of acute renal failure?

A

Fatal without dialysis
Recovery requires regeneration of tubule epithelial cells: 3-21 days
Chronic renal failure occurs if it lasts >6-8 weeks

23
Q

What are the pre-renal causes of acute renal failure?

A

All types of shock: hypovolaemia, CCF, sepsis
Hepatorenal syndrome
Bilateral renal artery stenosis
NSAIDs

24
Q

What are the renal causes of acute renal failure?

A 
Acute glomerulonephritis
Vascular: ANCA vasculitis, thrombosis, emboli
Tubulointerstitial nephritis
Acute tubular necrosis
Obstruction to tubules within kidney
25
Q

What is an example of obstruction to tubules within the kidney?

A

Myoglobin in a crush injury

26
Q

What are the post renal causes of acute renal failure?

A

Any cause of urinary tract obstruction

27
Q

On urinalysis, what does dysmorphic RBCs suggest?

A

Glomerulonephritis

28
Q

On urinalysis, what does non dysmorphic RBCs suggest?

A

Calculi
Tumour
Infection

29
Q

On urinalysis, what does WBCs suggest?

A

Tubulointerstitial nephritis

30
Q

On urinalysis, what does granular casts suggest?

A

Acute tubular necrosis

31
Q

On urinalysis in acute renal failure, what does normal urine suggest?

A

Pre or post renal causes

32
Q

What description is given to thrombotic lesions caused by malignant hypertension?

A

Onion-skin lesions

REGUB (31 decks)

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