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Unit 5: Path - The Kidney > Diseases of Tubules and Interstitium > Flashcards

Diseases of Tubules and Interstitium Flashcards

1
Q

What is acute renal failure?

A

Acute rise in serum creatinine

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2
Q

What are the three types of ARF?

A

Prerenal, intrarenal, postrenal

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3
Q

What is prerenal ARF?

A

Reduced BF to the kidneys

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4
Q

What is the more commonly used name for intrarenal ARF?

A

Acute kidney injury

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5
Q

How is AKI characterized?

A

By portion of the kidney that is primarily injured (glomeruli, tubules, vessels, interstitium)

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6
Q

What is postrenal ARF?

A

ARF caused by urinary tract obstruction

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7
Q

What is the most common cause of AKI?

A

Ischemic acte tubular injury

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8
Q

If ischemia is severe enough to cause histologic tubular epithial injury, what is the Dx?

A

Considered intrarenal ARF or ischemic AKI

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9
Q

T or F: Most ischemic acute tubular injury has widespread tubular epithelial necrosis

A

FALSE

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10
Q

What causes ischemic ATN acute tubular injury?

A

Reduced renal perfusion associated with hypotension

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11
Q

What is the typical histologic finding in Ischemic ATN acute tubular injury?

A

Flattening (simplification) of tubular epithelium due to sloughing of apical cytoplasm into urine

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12
Q

What is nephrotoxic ATN caused by?

A

Chemically induced injury to epithelial cells

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13
Q

What are the two general processes leading ATN AKI?

A

Dcreased glomerular filtration and tubular epithelial dysfunction

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14
Q

A patient with ischemic acute tubular injury is shown. Describe the typical findings.

A

Necrosis of tubular epithelial cells is evident.

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15
Q

Toxic acute tubular necrosis is shown. How is this different than ischemic tubular necrosis?

A

Widespread necrosis of proximal tubular epithelial cells.

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16
Q

What is the leading cause of acute renal failure?

A

ATN ischemia

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17
Q

What is characteristic of ATN ischemia?

A

Rapidly rising serum creatinine and decreased urine output (oliguria)

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18
Q

What are “dirty brown” granular casts a marker of?

A

Acute renal failure

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19
Q

What is the fractional excretion of sodium in a patient with prerenal ischemic acute tubular injury?

A

< 1%

20
Q

What is the fractional extretion of sodium in a kidney with tubular damage?

A

> 2%

21
Q

What are signs of kidney recovery?

A

Increased urine output and fall in serum creatinine

22
Q

What area the urinalysis sediment findings in acute tubular injury?

A

Dirty brown casts and epithelial cells

23
Q

What are the urinarlysis sediment findings in acute glomerulonephritis?

A

Red blood cell casts and proteinuria

24
Q

What are the urinalysis sediment findings in acute tubulointerstitialnephritis?

A

WBC casts and pyuria

25
Q

What is pyelonephritis?

A

Bacterial infection of the kidney

26
Q

What type of bug typically causes UTIs and acute pyelonephritis?

A

Uropathogenic E. coli

27
Q

What is a major virulence factor for uropathogenic E. coli?

A

Pyelonephritis-associated pili gene

28
Q

Following micturition, why is a minimal volume of urine preferable?

A

New sterile urine from kidneys can easily dilute remaining bacteria and decrease the likelihood of bacterial infection

29
Q

What type of renal papilla is this? What is the risk of having such a papilla?

A

Compound papilla; The peripheral compound papillae allow easier access for bacteria to the collecting system

30
Q

What is a typical finding that supports Dx of pyelonephritis?

A

Leukocyte casts

31
Q

What causes chronic pyelonephritis?

A

Recurrent/persistent bac infections due to urinary tract obstruction/urine reflux

32
Q

What can chronic pyelonephritis lead to?

A

Atrophy and scarring of papillary tip and caliectasis (calyx dilation)

33
Q

What do only chronic pyelonephritis and analgesic nephropathy lead to?

A

Caliectasis and overlying corticomedullary scarring

34
Q

A patient with acute pyelonephritis is shown. What does the infiltrate primarily consist of?

A

Neutrophils are present w/I the collecting tubules and interstitial tissue

35
Q

A kidney with polar scars is shown. What caused this injury? Why were the poles injured? Vesiculoureteral reflux

A

Vesiculoureteral reflux resulting in chronic pyelonephritis; Poles injured because their papillae are the most susceptible (compound papillae)

36
Q

A kidney with papillary necrosis in all papillae is shown. What is the cause of severe papillary necrosis caused by high pressure backflow?

A

Obstruction of the urinary tract leading to chronic pyelonephritis and papillary necrosis

37
Q

What is Xanthogranulomatous pyelonephritis?

A

Uncommon pyelonephritis caused by Proteus, E. coli, Klebsiella and Pseudomonas

38
Q

What is the ultimate result of analgsic nephropathy?

A

Papillary necrosis

39
Q

Drug -induced acute tubulointerstitial nephritis is shown below. What type of reaction is it?

A

It is a type IV hypersensitivity rxn with T cell and eosinophil infiltrates

40
Q

What proteins are deposited in light-chain cast nephropathy?

A

AL Amyloid

41
Q

Light chain cast nephropathy is shown. What determines the three subtypes? What are the three subtypes?

A

Light chain structure; Light-chain cast nephropathy, AL amyloidosis, or light-chain deposition disease

42
Q

Urate nephropathy is shown below. What are some conditions that can lead to this renal disease?

A

Increased cell turnover leading to high blood levels of uric acid

43
Q

What is the diagnostic feature of chronic urate nephropathy?

A

Gouty tophus

44
Q

What two conditions can hypercalciuria cause?

A

Nephrocalcinosis and nephrolithiasis

45
Q

What is the term used to describe nephrocalcinosis caused by hypercalcemia?

A

Metastatic calcification

46
Q

What is the term used to describe nephrocalcinosis at sites of renal parenchymal injury?

A

Dystrophic calcification

Unit 5: Path - The Kidney (11 decks)

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