#8 Zaman - Tubulointerstitial Diseases Flashcards
In Acute Tubular Necrosis, what event can compound ischemic damage and lower GFR in the kidney?
MI (causes systemic hypotension)
What is the main cause of ATN?
Ischemia
Patient had a MI what is happening in his kidneys?
Acute Tubular Necrosis
Tubuloglomerular feedback will activate what system and will cause what type of response to the intrarenal vessels?
RAS will decrease the GFR and causes vasoconstriction.
Damage to the endothelial cells results in release of what vasoconstrictor?
endothelin
How would you differentiate between Ischemic and Nephrotoxic ATN?
Ischemic: tubular damage is patchy and affects the straight portion of the proximal convoluted tubule (PCT) and ascending loop of Henle.
Nephrotoxic : tubular damage is extensive and major portion is in PCT.
Patient comes in with fever, rash, eosinophilia, and proteinuria 2-40 days after being treated for muscle pain. What is occurring?
Acute tubulointerstitial injury
Patient was on NSAIDS.
Patient has pure oxalate stones. What could be a possible cause?
Ethylene glycol poisoning
Patient has been diagnosed with ATN and is currently oliguric. What kind of acidosis does this patient have?
Metabolic acidosis (associated with uremia)
What are the three most important causes of Tubulo-interstitial nephritis?
Infection
Toxins
Metabolic diseases (can look like ATN)
Patient complains of fever, flank pain and pyuria. BP is 120/80 and PMNs = 12 hpf. Diagnosis?
Acute Pyelonephritis
Neutrophils > 10
Predisposed: pregnancy, VUR, DM
Patient has had a history of recurrent infections. BP is 160/100 and xray’s show blunted calyces. Diagnosis?
Chronic Pyelonephritis
Hypertension is present. (Not in Acute)
VUR may be involved
What is thyroidization of tubules?
Tubules distended with fluid that is full of proteins.
What can Chronic Pyelonephritis lead to and how would you treat it?
FSGS - hard to treat
On a renal biopsy there are yellow nodules with foamy macrophages and lymphocytes. You do a culture with the hope that it what organism? (and not RCC)
Proteus
Xanthogranulomatous CP
Identify the urolithiasis.
Calcium oxalate
white
Associated with hyperparathyroidism, sarcoidosis, milk-alkali syndrome, excessive Vitamin D, multiple myeloma
Tx: hydration and citrate
Identify the urolithiasis.
Staghorn
Magnesium ammonium phosphate salts
Struvite stones
Proteus pyelonephritis
Identify the urolithiasis.
Uric Acid Crystals
Hyperuricemia, gout, Lesch-Nyhan Syndrome
chemotherapy
Identify the urolithiasis.
Pure oxalate stone
Ethylene glycol poisoning
Maltese cross
Identify the urolithiasis.
Cystine stone
Yellow
Hexagonal clear
Defect in transport of amino acids
