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Renal Pathology > Diseases of the tubules and interstitium > Flashcards

Diseases of the tubules and interstitium Flashcards

1
Q

What is the most common cause of acute kidney injury?

A

AKI most common cause is acute tubular injury/necrosis

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2
Q

What can acute tubular injury be caused by?

A
  1. Ischemia

2. Direct toxic injury to tubules

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3
Q

Caused by decreased interrupted blood flow

A

Ischemic acute tubular injury (ATI)

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4
Q

Morphology wise, presence of multiple petechial hemorrhages , means there is multi focal severe ischemia, name the disease

A

Ischemic acute tubular injury (ATI)

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5
Q

Name the two types of acute tubular injury

A
  1. ischemic ATI

2. Nephrotic ATI

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6
Q

Caused by direct toxic injury to the tubules

A

Nephrotic acute tubular injury (ATI)

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7
Q

What are the endogenous agents that cause nephrotic ATI?

A

Myoglobin
Hemoglobin
Monoclonal light chains
Bile/bilirubin

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8
Q

What are the exogenous agents that cause nephrotic ATI?

A

Drugs (nephrotoxins)
Radiocontrast dye
Heavy metals
Organic solvents

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9
Q

What disease commonly occurs in patients with different clinical setting

Example: severe trauma, vascular and cardiac surgery, severe burns and pancreatitis, sepsis, chronic liver disease

A

acute tubular necrosis / ischemia

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10
Q

Which parts of the nephron are particularly vulnerable to hypoxic injury?

A

Proximal tubule
&
medullary ascending limb

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11
Q

Pathogenesis of _______________.
Include:
• Loss of cell polarity
◦ Due to abnormal ion transport across cells
• Causing increased sodium delivery to distal tubules
• Which causes VASOCONSTRICTION (tubular feedback)
• Cells express cytokines, and adhesion molecules
◦ Recruit leukocytes

A

Epithelial tubular injury (ischemia)

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12
Q
  • Vacuolization and loss of brush border in proximal tubular cells
  • Sloughing of tubular cells into lumen leads to cast obstruction, manifested by tubular dilation
  • Leukocyte infiltration (may be present)
  • Necrotic cells are UNCOMMON on renal biopsy
A

Acute tubular injury

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13
Q

Key diagnostic features of _________,
Include:
◦ Widespread sloughing of tubular epi cells
◦ Loss of brush border
◦ Flattened, simplified tubular epithelium

A

Acute tubular injury

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14
Q

What form of AKI is reversible in 2-7 days by discontinuation of drug? This form of AKI rarely occurs in healthy people.

A

AKI caused by nephrotoxic agents

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15
Q

Acute tubular injury happens in a three part sequence:

Which phase is described by:
	‣ Last 36 hours
	‣ Acute decrease in GFR to very low levels
	‣ Slight decline in urine output
	‣ Rise in BUN and creatinine
A

Initiation phase

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16
Q

Acute tubular injury happens in a three part sequence:

Which phase is described by:

	‣ Decreased in urine output (oliguria: 40 & 400 mL/day)
	‣ Sustained reduction in GFR
		• Persists for 1-2 weeks
	‣ Salt and water overload
		• Raises BUN conc.
	‣ Hypercalemia
	‣ Metabolic acidosis
	‣ Uremia
A

Maintenance phase

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17
Q

Acute tubular injury happens in a three part sequence:

Which phase is described by:

‣ Tubular function restored
‣ Increased urine volume upto 3L/day
‣ Decrease BUN and serum creatinine
‣ Subtle tubular function impairment may persists for months, but usually if reach this phase there’s recovery
A

Recovery phase

18
Q

What type of cast is observed in small volume of concentrated urine, or diuretic therapy

Conditions where this type of cast is seen:
Normal people
Dehydration
Heavy exercise

A

Hyaline casts

19
Q

What type of cast represent degenerated cellular casts or aggregation of proteins within a cast matrix?

Described as:
Coarse, muddy brown color or hemegranular casts

This type of cast is seen in conditions of:
After strenuous exercise
Chronic renal disease
Acute tubular necrosis

A

Granular casts

20
Q

What type of casts is the last stage in degeneration of granular casts, nonspecific, observed in AKD, or CKD?

Seen in conditions of:
Severe chronic renal disease

Renal amyloidosis

A

Waxy casts

21
Q

What type of casts is wider, formed in large dilated tubules w/ little flow. Typically present in CKD

A

Broad casts

22
Q

What type of casts are described by lipid droplets w/in protein matrix of cast?

Seen in conditions of:
Tubular degeneration
Nephrotic syndrome
Hypothyroidism

A

Fatty casts

23
Q

What type of casts are underlying proliferative glomerulonephritis?

Conditions:
Pyelonephrosis
Glomerulonephritis
Acute interstitial nephritis
Lupus nephritis
A

RBC casts

24
Q

What type of casts are in interstitial or glomerular inflammation?

Conditions:
Pyelonephritis

A

WBC casts

25
Q

What type of casts are observed when there’s flakes(scales) of tubular epithelium, included in ATN, acute interstitial nephritis, proliferative glomerulonephritis?

Conditions:
Renal tubular necrosis
Viral diseases
Kidney transplant rejection

A

Renal tubular epithelial cell casts

26
Q

Inflammatory injuries of tubules and interstitium

The onset is insidious and manifests azotemia

MOST COMMON IN: women in 6th and 7th decades of life, can occur acute or chronic

HALLMARKS:
• Absence of nephrotic and nephritis syndrome
• Presence of defects in tubular function
◦ Impaired concentrate urine (polyuria or nocturia)
◦ Salt wasting
◦ Decreased ability to excrete acids
◦ Isolate defects in tubular reabsorption/secretion

A

Acute interstitial nephritis (tubular interstitial nephritis)

27
Q

Inflammation affecting the tubules, interstitium, and renal pelvis

Can occur acute or chronic

Etiology:
• 85% UTI caused by gram-negative bacilli
◦ Normal flora
• MOST COMMON: escherichia coli, followed by:
‣ Proteus
‣ Klebsiella
‣ Enterobacter

A

Pyelonephritis

28
Q

What type of pyelonephritis is caused by:

Usually caused by bacterial infection, associated w/ lower UTI

A

Acute pyelonephritis

29
Q

What type of pyelonephritis is caused by:

• Bacterial infection
• Other factors:
	◦ Vesicoureteral reflux
	◦ Obstruction
	◦ Repeat acute pyelo
A

Chronic pyelonephritis

30
Q

Infection that comes from the blood, it is less common?

A

Hematogenous infection

31
Q

Infection that comes from the bladder and moves up?

A

Ascending infection

32
Q

Caused by congenital absence, shortening of intravesical portion of ureter, and inflammation by bacteria

A

Vesicoureteral reflux

33
Q

How do you see vesicoureteral reflux?

A

Voiding cystourethrogram

34
Q

Hallmarks of ________:
Include:

  • Patchy interstitial suppurations inflammation
  • Aggregates of neutrophils
  • Neutrophil is tubulitis, and tubular necrosis
  • Suppurations may be discrete focal abscesses
A

Acute pyelonephritis

35
Q

Morphology of _________:

Include:
• Early stages:
◦ Neutrophilic infiltration limited to tubules
• Tubular lumens conduit extension of infection
◦ Infection extends to interstitium and produce abscesses which destroy tubules

A

Acute pyelonephritis

36
Q

Clinical features of __________:

Include:

• Sudden pain at CVA
• Systemic symptoms
	◦ Fever 
	◦ Malaise
• Bladder and urethral inflammation:
	◦ Dysuria
	◦ Frequency
	◦ Urgency
A

Acute pyelonephritis

37
Q

Disorder where chronic tubulointerstitial inflammation and scarring involve the calyces and pelvis, causes pelvocalyceal damage

A

Chronic pyelonephritis

38
Q

•MOST COMMON of chronic pyelonephritic scarring

• Occurs early in childhood:
◦ As a result superimposition of urinary infection on congenital vesicoureteral reflux and intrarenal reflux.

A

Reflux nephropathy

39
Q

• Recurrent infections superimposed on diffuse or localized obstructive lesions:
‣ Cause: repeated renal inflammation and scarring

Result in chronic pyelonephritis

A

Chronic obstructive pyelonephritis

40
Q

Morphology can be irregularly SCARRED, or extensive SCARRING due to chronic inflammation from recurrent UTI

A

Chronic pyelonephritis

41
Q

Clinical features of _________:

Include:

• Silent onset or manifestations of acute recurrent pyelonephritis such as:
	◦ Back pain
	◦ Fever
	◦ Pyuria
	◦ Bacteriuria

• Loss of tubular function:
◦ Loss of ability of concentrating causing:
‣ Polyuria
‣ Nocturia

• HPI:
◦ HTN
◦ Failure to thrive in children
◦ Flank tenderness

A

Chronic pyelonephritis

Renal Pathology (4 decks)

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