Dobson Renal Path 4

Question 1

What is the most common reason for nephrology consult?

Answer 1

AKI

Question 2

What is the most common cause of AKI?

Answer 2

acute tubular injury characterized by acute renal failure seen on histology with tubular injury in form on necrosis of tubular epithelial cells

Question 3

What causes ischemic ATI?

Answer 3

decreased or interrupted blood flow

Question 4

Nephrotoxic ATI?

Answer 4

endogenous agents

Question 5

What is the initiation phase in ATI?

Answer 5

lasts 36 hours dominated by inciting medical surgical or obstretic event Only indication for renal involvement is slight decreasae in urine output with a rise in BUN

Question 6

Maintenance phase of ATI?

Answer 6

characterized by decreses in urine output btw 40 and 400 mL/day associated with salt and water overload Rising BUN hyperkalemia metabolic acidosis and other manifestations of uremia

Question 7

Recovery phase of ATI?

Answer 7

steady increase in urine output tubules are damaged so large amounts of Na water and K are lost in urine Hypokalemia becomes a problem Increased infection risk Renal tubular function is restored and concentrating ability of the kidney is restored BUN and creatinine regturn to normal

Question 8

How are tubulointerstitial disorder distiguished from glomerular disease?

Answer 8

Absence of nephritic or nephrotic syndrome Presence of defects in tubular function like the inability to concentrate urine, polyuria, nocturia, salt waisting, metabolic acidosis

Question 9

What is acute vs chronic pyelonephritis?

Answer 9

acute is due to a bacterial infection associated with UTI chronic has bacterial infections, but also other factors such as VSR or obstruction

Question 10

What is associated with acute pyelonephritis?

Answer 10

UTI obstruction Catheterization VSR Pregnancy Gender and aage Renal lesions Diabetes Immunosuppression

Question 11

How does acute pyelonephritis present?

Answer 11

CVA tenderness Systemic features such as fever and elevated WBC Dysuria with frequency and urgency

Question 12

What virus is the cause of kidney allograft failure?

Answer 12

Polyomavirus

Question 13

Complications of pyelonephritis?

Answer 13

Papillary necrosis: seen in diabetics, Sickle cell, and UTI obstruction. One or more pyramids involved with necrosis, leukocytic response is limited to junctions btw preserved and destroyed tissue Pyonephrosis:total or almost complete obstruction when it is high in urinary tract suppurative exudate cant drain and fills renal pelvis pyramids with pus Perinephric abscess: extension of suppurative inflammation through renal capsule into perinephric tissue

Question 14

Chronic pyelonephritis?

Answer 14

Chronic tubulointersitial inflammation and scarring involves calyces and pelvis Only chronic pyelonephritis and analgesic nephropathy affect the calyces

Question 15

Gram negative facultative aerobe causing a staghorn calculus, dilated calyces, cystic cavities, and yellow tissue on a removed kidney. Histology showed fibrosis and chronic granulomatous inflammatory infiltrate with lipid laden foamy macrophages and necrotic debris. What organism is likely?

Answer 15

Proteus mirabilus, which grows on blood agar in concentric circles Treatment with Trimethoprim/sulfamethoxazole or oral flouroquinolone

Question 16

How do toxins and drugs injure the kidneys? (3 ways)

Answer 16

trigger intersitial immune reaction with acute hypersenitivity nephritis induced by methicilin Cause ATI Cause subclinical but cumulativeinjury to tubules that progresses to CKD over the years

Question 17

When does drug induced acute intersitial nephritis begin and how does it present?

Answer 17

2-40 days after exposure Fever eosinophilia rash and renal abonrmalities usch as hematuria proteinuria leukocyturia Risking creatinine or AKI with oliguria develops in 50% of cases

Question 18

What three types of nephropathy are associated with hyperuricemia?

Answer 18

Acute uric acid nephropathy Chronic urate nephropathy Nephrolithiasis (stones) Tumor lysis syndrome due to chemo can cause these

Question 19

What renal issues occur in those with multiple myeloma?

Answer 19

Renal insufficiency occurs in half of those patients and related lymphoplasmacytic disorders

Question 20

What factors contribute to those with multiple myeloma getting renal insufficiency?

Answer 20

Bence jones proteinuria Amyloidosis of AL type Light chain depositon hypercalcemia and hyperuricemia