Exam 2 Tubular and Interstitial Diseases Flashcards
What are causes of primary tubulointerstitial Nephritis
Infections: acute, chronic, other toxins: even acute Hypersensitivity interstitial nephritis Metabolic diseases physical factors: chronic obstruction Neoplasms: bence jones proteins Immunologic reactions vascular diseases misc
tubulointerstitial npehritis has was general presentations almost always
well inability to concentrate urine so have abnormal specific gravity and polyuria
what is the damage from ischemic acute tubulo injury on cell processes
damage to the proximal tubule brush borders
what will mercuric chloride poisoning look like in tubules
cell shave large acidophilic inclusions
totally necrotic calcification
what are the morphologic changes in kidneys after carbon tetrachloride poisoning
accumulation of neutral lipids in the cells
majority of UTI are due to what bacteria?
enteric bacteria (gram neg) E coli, proteus, klebsiella, enterobacter, strep faecalis, staph
cystitis is what and usually caued by what
inflammation of urinary bladder mucosa
95% bacterial
What is acute pyelonephritis
acute bacterial infection of kidney
what is the biggest risk with chronic pyelonephritis
can lead to ESRD
what does chronic pyelonephritis damage
the pelvis, calyceal system and parenchyma resulting in anatomic distortion
What is a predisposing anatomic defect to pyelonephritis
vesicoureteral reflux and assoc with intrarenal reflux
what are predisposing medical conditions for pyelonephritis
DM, pregnancy
what is the most common mechanism of pyelonephrtisis
ascending infection from lower urinary tract
describe cases where acute pyelonephritis might occur via hematogenous infection
due to septicemia or infective endocarditis
more likely if there is a ureteral obstruction, or immunocompromised
What is the infrarenal reflux
open ducts at tip of papillae
most common in upper and lower poles of kidney
papillae are flattened or concave tips at these spots
what are complications of acute pyelonephritis
papillary necrosis, pyonephrosis, perinephric abscess
what is bladder outlet obstruction assoc with
prostatic hypertrophy
what type of necrosis is papillary necrosis
coagulative
gray white yellow necrosis
tubule outlines preserved
What is pyonephrosis
when there is complete obstruction high in tract.
the pus cannot drain and fills the renal pelvis, calyces and ureter with pus
what is a perinephric abscess
pus moves through renal capsule to the perinephric tissue
What occurs in the healing phase of acute pyelonephritis
Neutrophils are replaced by macrophages, plasma cells and lymphocytes
What is the problem with a scar after pyelonephritis
associated with inflammation, fibrosis and deformation of underlying calyx and pelvis
what is clinical presentation of acute pyelonephritis
sudden onset pain at CVA, systemic evidence of infection (fever, malaise)
what types of nephropathies affect the calyces
chronic pyelonephritis and analgesic nephropathy
on a contrast scan what is pretty indicative of vesicoureteral reflex
dilated ureters
What does papillary necrosis look like in DM
pale gray necrosis limited to papilla
what does analgesic nephropathy look like
red brown necrotic papilla sloughed into Calyx
Xanthogranulmatous pyelonephritis is assoc with wat bacteria
proteus sp
What types of drugs can cause acute drug induced interstitial nephritis
Sulfonamides, synthetic penicillins (methicillin, ampicillin) rifampin, diuretics(thiazides), NSAIDs
misc (allopurinol, cimetidine
what are the clinical features of acute drug induced interstitial nephritis
fever, eosinophilia, interstitial renal parenchymal infiltrates, usually 15 days after exposure
What is the pathogenesis behind drug induced acute interstitial nephritis
immune most likely
many have elevated IgE and IgE containing plasma cells and basophils in the lesions
making it Type I HS
some have granulomatous so type IV HS
what are morphologicsigns of analgesic nephropathy
chronic tubulointerstitial nephritis and renal papillary necrosis(occurs 1st)
What is the mech that phenacetin & aspirin mixtures cause papillary necrosis
depletes cell of glutathione and generates ROS
aspiring then inhibits vasodilation so susceptible to ischemia
How do you differentiate papillary necrosis in DM compared to analgesic nephropathy
papillary in analgesic are at different states
DM caused necrosis the papillae are all at the same stage
describe clinical course of analgesic nephropathy
more common in women can't concentrate urine, can lead to renal tubular acidosis, renal stones HA anemia, GI symptoms, HTN UTI complications! often gross hematuria if papillae sloughed off
Why do COX2 inhibitors still affect kidney but not GI symptoms
because COX2 works in kidneys
What does Xanthogranulomatous pyelonephrtisi look like morphologically
foamy macrophages and plasma cells
lymphocytes and PMNs
yellowish orange nodules
looks like RCC
How would a child present with reflux nephro[athy
HTN
polyuria and nocturia
asymmetrically contracted kidneys with coarse scars, blunting, deformation of calyces
What do the kidneys scars look like if b/l chronic pyelonephritis
asymmetric
What are the 3 types of nephropathy assoc with hyperuricemic disorder
acute uric acid nephropathy
chronic urate nephropathy
nephrolithiasis
what is acute uric acid nephropathy and what patients is it common in
uric acid crystal precipitate in renal tubules (mainly collecting ducts) causing obstruction leading to renal failure
common in leukemia, lymphoma and assoc with chemotherapy
What is chronic urate nephropathy
gouty. monosodium urate crystals in distal tubules and collecting ducts deposit (needle like crystals)
urates induce tophus of foreign body giant cells
describe occurences of uric acid stones
5-10% americans 80% unilateral men more than women hereditary predispositions onset 20-30 y/o
what are worse small or large kidney stones
small because can enter ureter and cause spasms and extreme pain
What is nephrocalcinosis sometimes caused by
hyperCa, hyper PTH, multiple myeloma, vitamin D intoxication, metastatic cancer, excess Ca intake(milk alkali syndrome”
Ca oxalate and phosphate are in what percentage of stones
70%
where are Ca deposits in the tubules
in the mitochondria, cytoplasm and BM
What are the predisposing conditions to Ca oxalate and phosphate stones
idiopathi hypercalciuria 50% no known abnormality 15-20% hyperuricosuria 20% hypercalciuria and hyper Ca 10% hyperoxaluria, enteric, primary (the rest %)
what is the composition of the second most common types of kidney stones
magnesium ammonium phosphate
what is the most common cause of acute phosphate nephropathy
patients consuming high doses of oral phosphate solutions for colonoscopy prep
what is the clinical course of acute phosphate nephropathy
dehydration, precipitate Ca phosphate leading to renal insufficiency after several weeks
What can cause Myeloma kidney, or light chain cast nephropathy
non renal malignancie hypercaemia, hyper uricemia amyloidosis multiple myeloma chemotherapy or irradiation
What do bence jones proteins do in kdineys
combine with urinary glycoprotein Tamm Horsfall protein in acidic conditions which form large distinct casts that obstruct lumen
Amyloidosis is deopsition of what light chain in kdiney
gamma
what do bence jones tubular casts look like
pink or blue amorphous masses that are concentrically laminated and fractured
soemtimes surrounded by giant cells from phagocytes
what percentage of multiple myeloma patients with myeloma kidneys progress to overt renal insufficiency
50%
what is the overall clinical course of myeloma kidneys
chronic renal fialure is slowly progressive
acute renal failure will present with oliguria, dehydration hyper Ca, acute infection
What percentage of multiple myeloma patients have bence jones proteins
70%
What are signs of cholemic nephrosis
tubular bile casts that are yellow green-pink with increased serum bilirubin
