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Clinical Med - Nephrology > Intersitial Disease > Flashcards

Intersitial Disease Flashcards

1
Q

_____ ______ ______ is a renal lesion that causes a decline in creatinine clearance and is characterized by an inflammatory infiltrate in the kidney interstitium.

A

Acute Interstitial Nephritis (AIN)

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2
Q

Medications result in ____% of AIN.

What is the most common?

What additional medications can be responsible?

A

75%

ABx (Penicillin, Cephalosporins, Bactrim, Ciprofloxacin)

NSAIDs
PPIs (Omeprazole) 
Diuretics (Furosemide, Bumetamide)
Rifampin
ASA
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3
Q

What infections are associated with AIN?

A

Legionella
TB
SMV
EBV

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4
Q

What systemic diseases are associated with AIN?

A

Sarcoidosis
Sjogrens
SLE

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5
Q

What is the classic triad of AIN?

Onset is 3-5 days

A

Rash
Fever
Eosinophilia

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6
Q

In AIN, you would see a rise in serum _________ when the offending drug is administered?

A

Creatinine

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7
Q

Would you expect to see nephrotic ranges of proteinuria in AIN?

A

No it usually only elevated to about 1g/day

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8
Q

Fractional elevation of sodium excretion above 1% is indicative of _______ damage?

A

tubular damage

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9
Q

T/F: Radiographic studies are diagnostic for AIN

A

False

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10
Q

What would be seen on histology of AIN?

Is the glomerulus involved?

A

Diffuse interstitial infiltrate with many red-staining eosinophils

No glomerular involvement

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11
Q

How is AIN treated?

A

Remove causative agent

Glucocorticoids can be considered

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12
Q

What are examples of processes that result in chronic interstitial nephritis (CIN)?

A

Analgesic Nephropathy

Lithium

Balkan Nephropathy

Tubulointerstitial Nephritis and Uveitis

Sjogrens syndrome

Sarcoidosis

Arostolochic Acid containing herbs

Lead

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13
Q

In a a patient with analgesic nephropathy….

What may be seen on lab work?

UA?

Imaging of the kidneys?

A

Labs: Elevated Creatinine

UA: Hematuria, Sterile Pyuria, Mild Proteinuria

Imaging: Smaller kidneys, Clacifications

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14
Q

Chronic Interstitial Nephritis (CIN) as a result of ______ exposure usually presents with polyuria and polydipsia and a result of ________ channel degradation.

A

Lithium

Aquaporin

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15
Q

Is CIN due to lithium exposure a nephrotic or nephritic syndrome?

A

Nephrotic (Minimal Change Disease)

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16
Q

Other than polyuria and polydipsia, what additional clinical manifestations may be seen in CIN as a result of lithium exposure?

A

Hyperparathyroidism

Hyprecalcemia

17
Q

________ _______ ________ is a chronic tubulointerstitial disease associated with a high frequency of urothelial atypia, occasionally culminating in tumors of the renal pelvis and urethra.

This is common in Southeastern Europe

A

Balkan Endemic Nephropathy (BEN)

18
Q

What is BEN most likely caused by?

A

Chronic exposure to low concentrations of aristolochic acid

19
Q

How is BEN diagnosed?

A

Patient with slowly progressive chronic kidney disease who is living in or recently moved from an endemic area, particularly if the family history is positive for BEN

20
Q

Inflammation in Tubulointerstitial Nephritis and Uveitis (TINU) is primarily __-lymphocyte driven

A

T-Lymphocyte

21
Q

What Sxs may a patient with TINU present with?

What may be found on lab work/UA?

A

Flank Pain

UA: Sterile Pyuria, Hematuria, Subnephrotic Proteinuria

Renal Insufficiency/ARF

22
Q

T/F: TINU is typically self-limited and spontaneously resolves

A

True

23
Q

________ is a cause of CIN as a result of interstitial infiltrates that invades and damages the tubules with granuloma formation

A

Sjogrens

24
Q

What antibodies are specific to Sjogrens?

A

Anti-Ro (SSA)

Anti-La (SSB)

25
Q

What can be used to treat CIN as a reult of Sjogrens if severe enough?

A

Glucocorticoids

26
Q

What is commonly seen with renal involvement in sarcoidoisis?

A

Hypercalciuria

Hypercalcemia

27
Q

On renal biopsy in a patient with sarcoidosis, would you expect to see caseating or non-caseating granulomas in the interstium?

A

Non-caseating

28
Q

Exposure to _____ _____ was first discovered in women presenting near ESRD after being at weight lose clinic.

This has been linked to a more rapid decline in renal function when compared to other forms of interstitial nephritis

A

Arostolochic Acid (AA)

29
Q

Arostolochic Acid (AA) has been linked to interstitial fibrosis, atrophy, and loss of the ______

A

Tubules

30
Q

T/F: Arostolochic Acid (AA) is linked to a high incidence of uroepithelial CA

A

True

31
Q

Lead exposure for extensive amounts of time (5-30 years) with blood levels _________ is linked to renal pathology

A

> 60 mcg/dL

32
Q

In patients with renal disease linked to lead, a PMHx of ____ is often seen.

A

Gout

33
Q

Glucosuria
Aminoaciduria
Renal phosphate wasting

Are all associated with a _______-type syndrome linked to lead exposure and renal disease

A

Fanconi-Type Syndrome

34
Q

Is proteinuria common in patients with lead exposure and renal disease?

A

No

35
Q

How can lead exposure and renal disease treated?

A

Minimize further lead exposure

Chelation therapy

36
Q

When would chelation therapy be indicated for patients with lead poisoning and renal disease?

A

If exposure is acute, lead levels, and Sx

Clinical Med - Nephrology (7 decks)

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