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Year2 Renal > Exam 2 Tubular and Interstitial Diseases > Flashcards

Exam 2 Tubular and Interstitial Diseases Flashcards

1
Q

What are causes of primary tubulointerstitial Nephritis

A 
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
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2
Q

tubulointerstitial npehritis has was general presentations almost always

A

well inability to concentrate urine so have abnormal specific gravity and polyuria

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3
Q

what is the damage from ischemic acute tubulo injury on cell processes

A

damage to the proximal tubule brush borders

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4
Q

what will mercuric chloride poisoning look like in tubules

A

cell shave large acidophilic inclusions

totally necrotic calcification

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5
Q

what are the morphologic changes in kidneys after carbon tetrachloride poisoning

A

accumulation of neutral lipids in the cells

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6
Q

majority of UTI are due to what bacteria?

A 
enteric bacteria (gram neg)
E coli, proteus, klebsiella, enterobacter, strep faecalis, staph
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7
Q

cystitis is what and usually caued by what

A

inflammation of urinary bladder mucosa

95% bacterial

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8
Q

What is acute pyelonephritis

A

acute bacterial infection of kidney

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9
Q

what is the biggest risk with chronic pyelonephritis

A

can lead to ESRD

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10
Q

what does chronic pyelonephritis damage

A

the pelvis, calyceal system and parenchyma resulting in anatomic distortion

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11
Q

What is a predisposing anatomic defect to pyelonephritis

A

vesicoureteral reflux and assoc with intrarenal reflux

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12
Q

what are predisposing medical conditions for pyelonephritis

A

DM, pregnancy

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13
Q

what is the most common mechanism of pyelonephrtisis

A

ascending infection from lower urinary tract

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14
Q

describe cases where acute pyelonephritis might occur via hematogenous infection

A

due to septicemia or infective endocarditis

more likely if there is a ureteral obstruction, or immunocompromised

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15
Q

What is the infrarenal reflux

A

open ducts at tip of papillae
most common in upper and lower poles of kidney
papillae are flattened or concave tips at these spots

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16
Q

what are complications of acute pyelonephritis

A

papillary necrosis, pyonephrosis, perinephric abscess

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17
Q

what is bladder outlet obstruction assoc with

A

prostatic hypertrophy

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18
Q

what type of necrosis is papillary necrosis

A

coagulative
gray white yellow necrosis
tubule outlines preserved

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19
Q

What is pyonephrosis

A

when there is complete obstruction high in tract.

the pus cannot drain and fills the renal pelvis, calyces and ureter with pus

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20
Q

what is a perinephric abscess

A

pus moves through renal capsule to the perinephric tissue

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21
Q

What occurs in the healing phase of acute pyelonephritis

A

Neutrophils are replaced by macrophages, plasma cells and lymphocytes

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22
Q

What is the problem with a scar after pyelonephritis

A

associated with inflammation, fibrosis and deformation of underlying calyx and pelvis

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23
Q

what is clinical presentation of acute pyelonephritis

A

sudden onset pain at CVA, systemic evidence of infection (fever, malaise)

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24
Q

what types of nephropathies affect the calyces

A

chronic pyelonephritis and analgesic nephropathy

25
on a contrast scan what is pretty indicative of vesicoureteral reflex
dilated ureters
26
What does papillary necrosis look like in DM
pale gray necrosis limited to papilla
27
what does analgesic nephropathy look like
red brown necrotic papilla sloughed into Calyx
28
Xanthogranulmatous pyelonephritis is assoc with wat bacteria
proteus sp
29
What types of drugs can cause acute drug induced interstitial nephritis
Sulfonamides, synthetic penicillins (methicillin, ampicillin) rifampin, diuretics(thiazides), NSAIDs misc (allopurinol, cimetidine
30
what are the clinical features of acute drug induced interstitial nephritis
fever, eosinophilia, interstitial renal parenchymal infiltrates, usually 15 days after exposure
31
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
32
what are morphologicsigns of analgesic nephropathy
chronic tubulointerstitial nephritis and renal papillary necrosis(occurs 1st)
33
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
34
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
35
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 ```
36
Why do COX2 inhibitors still affect kidney but not GI symptoms
because COX2 works in kidneys
37
What does Xanthogranulomatous pyelonephrtisi look like morphologically
foamy macrophages and plasma cells lymphocytes and PMNs yellowish orange nodules looks like RCC
38
How would a child present with reflux nephro[athy
HTN polyuria and nocturia asymmetrically contracted kidneys with coarse scars, blunting, deformation of calyces
39
What do the kidneys scars look like if b/l chronic pyelonephritis
asymmetric
40
What are the 3 types of nephropathy assoc with hyperuricemic disorder
acute uric acid nephropathy chronic urate nephropathy nephrolithiasis
41
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
42
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
43
describe occurences of uric acid stones
``` 5-10% americans 80% unilateral men more than women hereditary predispositions onset 20-30 y/o ```
44
what are worse small or large kidney stones
small because can enter ureter and cause spasms and extreme pain
45
What is nephrocalcinosis sometimes caused by
hyperCa, hyper PTH, multiple myeloma, vitamin D intoxication, metastatic cancer, excess Ca intake(milk alkali syndrome"
46
Ca oxalate and phosphate are in what percentage of stones
70%
47
where are Ca deposits in the tubules
in the mitochondria, cytoplasm and BM
48
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 %) ```
49
what is the composition of the second most common types of kidney stones
magnesium ammonium phosphate
50
what is the most common cause of acute phosphate nephropathy
patients consuming high doses of oral phosphate solutions for colonoscopy prep
51
what is the clinical course of acute phosphate nephropathy
dehydration, precipitate Ca phosphate leading to renal insufficiency after several weeks
52
What can cause Myeloma kidney, or light chain cast nephropathy
``` non renal malignancie hypercaemia, hyper uricemia amyloidosis multiple myeloma chemotherapy or irradiation ```
53
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
54
Amyloidosis is deopsition of what light chain in kdiney
gamma
55
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
56
what percentage of multiple myeloma patients with myeloma kidneys progress to overt renal insufficiency
50%
57
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
58
What percentage of multiple myeloma patients have bence jones proteins
70%
59
What are signs of cholemic nephrosis
tubular bile casts that are yellow green-pink with increased serum bilirubin

Year2 Renal (20 decks)

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