ACP- L23, L24 Medical renal diseases (2)

Question 1

What is the most common cause of tubulo-interstitial nephritis?

Answer 1

Acute pyelonephritis

Question 2

Signs and symptoms of acute pyelonephritis? (3)

What is the MC causative agent?

Answer 2

1. Loin pain
2. Dysuria
3. Fever

E.coli (bacterial)

Question 3

What are the 2 main pathogenic pathway for acute pyelonephritis?

Answer 3

1. Ascending (MC)- Lower UTI, outflow obstruction, vesicoureteral reflux (VUR)
2. Descending (hematogenous): suspect if S.aureus is found in urine

Question 4

What are the risk factors of upper and lower UTI? (5) (shared)

Answer 4

1. indwelling urinary catheter
2. female
3. outflow obstruction
4. DM
5. Pregnancy

Question 5

Which of the following are associated with acute pyelonephritis?

A. Enlarged kidneys
B. Polymorphs such as neutrophils in interstitium and tubules
C. Spares the glomeruli and vessels of the kidneys
D. Treated by ciprofloxacin or nitrofurantoin
E. Repair the VUR (vesicoureteral reflux) is needed
F. It is an irreversible process

Answer 5

All except F

• reversible lesion
• recovery/relapse

Question 6

What are the complications of acute pyelonephritis? (3)

Answer 6

1. Renal abscess

2. Recurrent infections > chronic pyelonephritis, papillary necrosis (death of renal papillae)

Question 7

____________ is due to miliary and cavitary TB with hematogenous spread from primary focus.

Answer 7

Tuberculosis nephritis

Question 8

Patient presented with abrupt onset of fever, oliguria, rash, latent eosinophilia.

What is the most possible tubulo-interstitial nephritis?
Caused by?

Answer 8

Drug-induced interstitial nephritis

drug: penicillin, sulphonamide, thiazide
- related to type I/IV HSR

Question 9

Analgesic nephropathy is

• due to the combined chronic use of aspirin and paracetamol

How do they cause nephropathy respectively?
Pathology?

Answer 9

aspirin: inhibits PGE2 > ATII unopposed
paracetamol: oxidative injury

• related to toxicity of drugs (dose dependent)
• papillary necrosis

Question 10

What is the most common cause of acute kidney injury?

Answer 10

Acute tubular necrosis (ATN)

Question 11

What are the 2 major causes of acute tubular necrosis? Explain.

Answer 11

1. Ischemic: hypovolemia caused by shock, MI

2. Nephrotoxic: caused by poisons e.g. ahminoglycosides (MC), heavy metals

Question 12

Is acute tubular necrosis reversible? why?

Answer 12

Yes, tubular basement membrane is intact.

Renal tubular cell necrosis > shedding of granular casts and tubular cells into the urine

Question 13

Which of the following regarding tuberlo-interstitial nephritis are correct?
A. Impaired RFT in both radiation nephritis and immunologic transplant rejection

B. Obstructive nephropathy can be caused by renal stones (intraluminal) or ureteric stricture (mural) or BPH (extramural)

C. Obstructive nephropathy causes hydronephrosis and pyonephrosis

D. Low dose of radiation causes vacillation and focal atrophy while high dose causes desquamation, necrosis and regenerative atypic of the tubular cells

E. Immunogenic transplant rejection of the kidneys causes swollen kidney and tubulitis

Answer 13

All of the above

Question 14

What is hypertensive nephrosclerosis? (3)

Answer 14

Benign HT

1. Hyaline arteriosclerosis of renal arterioles
2. Tubular atrophy, glomerular sclerosis
3. Small kidneys with finely granular surface

Question 15

Thrombotic microangiopathy examples?

They will cause endothelial cell degeneration and thrombosis

Answer 15

• Malignant HT

- HUS (Hemolytic uremic syndrome) / TTP (thrombotic thrombocytes purpura)

Question 16

Which of the following is associated with ANCA vasculitis? (antineutrophil cytoplasmic antibodies)

A. antineutrophil cytoplasmic antibodies stimulate neutrophil infiltration of the vessel walls

B. Cortical infarcts
C. Fibrinoid necorsis
D. Inflammatory cells

Answer 16

All of the above

Question 17

What is the MC cystic disease of adult?

What does it cause ? (4)

Answer 17

Simple cyst.

Intratubular obstruction

• defect in tubular BM matrix
• altered cell growth
• defective fluid secretion

Question 18

What is the MC children renal cyst? (1)

Briefly describe. (2)

Answer 18

Cystic renal dysplasia

• abnormal development of kidney with abnormal structures e.g. cartilage;
• non-functional , a/w with obstruction

Question 19

__________________ is due to AD mutation in PKD1 gene (chr16) for polycystic.

Answer 19

Adult polycystic kidney disease (ADPKD).

Question 20

Pathogenesis:

AD mutation in PKD1 gene (chr16) for polycystic&raquo_space;> ?

Answer 20

1. ciliopathy (Cilia project into the lumina from the apical surface of tubular cells, where they serve as mechanosensors of fluid flow.)
2. aberrant signalling pathway > abnormal cell proliferation and ion secretion
3. formation of cysts
4. progressive kidney enlargement and failure

Question 21

Adult polycystic kidney disease affects unilateral/bilateral kidneys. What other organs are also affected?

Answer 21

Bilateral;

liver; pancreas

Question 22

Juvenile polycystic kidney disease (ARPKD) is due to __________ mutation in ________ gene.

Pathogenesis?

Answer 22

AD;
PKHD1 gene;

for fibrocystin (regulate polycystic-2 expression)

> progress to non-functional sponge kidney

Question 23

Outcome of Juvenile polycystic kidney disease (ARPKD) ?

Answer 23

1. Stillbirth

2. Rapid progression to ESRD

Question 24

Which of the following is incorrect about acquired cystic disease?

A. It occurs in all of the patients on long-term dialysis

B. Tubular obstruction by interstitial fibrosis

C. Oxalate crystals are present

D. It increased risk of RCC

E. It accumulates metabolites and carcinogens

Answer 24

A: 50% only

E explains D