9 CKD, Vascular, and Interstitial disease Flashcards
Interstitial Nephritis labs
UA- WBCs, WBC casts, RBCs
Acute interstitial nephritis Causes
*Drug hypersensitivity (PCN, NSAIDs, Sulfonamides, Rifampin)
Fever, arthralgia, maculopapular rash, peripheral blood eosinophilia, eosinophilic urine
- Infections
- Autoimmune- SLE- Sjogrens
Acute interstitial nephritis histo
- Inflammation and edema of tubules and interstitum- spares glomerulis/vessels
- Lymphocytes, Plasmacytes, eosinophils
- granulomas
Acute pyelonephritis
- Urinary or hematogenous
- acute inflammation of kidney
- Typical gram - urinary pathogens
Pyelo risk factors
- Urinary obstruction
- Catheters etc
- Vesicoureteral reflux
- Pregnancy
- beetis
Pyelo histo
Interstitial inflammation with very few eosinophils
Multiple myeloma
- usually >40 y.o.
- renal insuficiency and proteinuria
- bone pain/fractures
- hypercalcemia
- light chains in blood/urine
- 25% of patients with renal failure
- Direct toxicity of light chains
- Tubular cast obstruction
- interstitial inflammation
Multiple myeloma cast nephropathy
- urinary excreation of light chains
- AKI presentation
- Cast formation promoted by
- Hypercalcemia
- Volume depletion
- nephrotoxins
MM Cast neohropath histo
LM: Fractured crystalline casts with cellular reaction
IF: light chain predominance
EM: Electron dense fractured casts
MM cast nephropathy tratments
- Hydration and urinary alkylization to precent cast obstruction
- Chemo and BMT
Renal Vascular Diseases
- Hypertensive nephrosclerosis
- Renovascular hypertension
- renal artery artherosclerosis
- fibromuscular dysplasia
- atheroembolic disease
- Thrombotic microangiopathy
HTN Nephrosclerosis
- CKD from longstanding HTN
- Usually other organs affected
- Proteinuria common
HTN Nephrosclerosis histo
Gross appearance: Small kidney with fine granular subcapsular surface
LM:Subcapsular glomerular sclerosis, tubular atrophy, interstitial fibrosis, atertiolar hyaline
MALIGNANG HTN:
*mucoid intimal thickening (onion skinning) of the arteries, glomerular capillary wrinkling, GBM duplication
Renovascular HTN
- Renal artery stenosis causing HTN
- Atherosclerosis
- fibrmuscular dysplasia
- Trauma, dssection, or extrinsic compression
Clues its Renovascular HTN
Late or early onset HTN
HArd to control HTN
Bruit
Renal failure after ACEi
RA stenosis: Fibromuscular dysplasia
- Younger women
- Mainly renal arteries, also 25-30% head and neck, two vvvascular beds in 28% of patients
Histo: Medial FMD- string of pearls renal artery- alternating tthickening and thinning of media
RA stenosis: fibromuscular dysplasia treatment
- surgical revascularization
- angioplasty/stent
- medical management
Thromboembolic/atheroembolic kidney disease
- Cortical infarcts wedge shaped- pale with hyperemic border
- atheroembolic- usually aortic plaque disruption and showeing of cholesterol emboli also see:
- Digital infarction
- Bowel infarction
- Stroke
- Eosinophilia
Atheroembolic outcomes
- Stable/normal function
- chronic progession in subacute cases
- ESRD
- Permanent dialysis
Thrombotic microangiopathy
- thrombosis n capilaries and arterioles
- microangiopic hemolytic anemia
- thrombocytoopenia
- renal failure
- Hemolytic uremic syndrome (frequently after e.coli infection)
- Thrombotic thrombocytopenic purpura
TMA (thrombotic microangiopathy) histo
Fibrin stain positive for clot in capillary lumen
CKD
- Progressive irreversablerenal insufficieency that develops over months to years.
- May lead to ESRD
- Causes
- HTN
- DM
- GN
- Cystic diseases
CKD consequenses
*Anemia- loss of EPO (GFR Hypocalcemia, hyperphosphatemia, renal osteodystrophy
CKD findings
- Metabolic acidosis
- Decreased ammonium secretion- retention of phosphates and sulfates
- hyperkalemia
- disruption of Na/H20 balance
- Coagulopathy (platelette dysfunction)
- neuropathy
CKD: Uremia symptoms
Lethargy/fatigue Sleep disturbances Anorexia NV Pruritis RLS Uremic pericarditis
CKD treatment
Delay progression of ESRD *RAS blockade for HTN/ proteinuria *DM control *smoking cessation *other disease specific treatment Prevent or minimize adverse effects Renal replacement therapy when necessary
