Intersitial Disease Flashcards
_____ ______ ______ is a renal lesion that causes a decline in creatinine clearance and is characterized by an inflammatory infiltrate in the kidney interstitium.
Acute Interstitial Nephritis (AIN)
Medications result in ____% of AIN.
What is the most common?
What additional medications can be responsible?
75%
ABx (Penicillin, Cephalosporins, Bactrim, Ciprofloxacin)
NSAIDs PPIs (Omeprazole) Diuretics (Furosemide, Bumetamide) Rifampin ASA
What infections are associated with AIN?
Legionella
TB
SMV
EBV
What systemic diseases are associated with AIN?
Sarcoidosis
Sjogrens
SLE
What is the classic triad of AIN?
Onset is 3-5 days
Rash
Fever
Eosinophilia
In AIN, you would see a rise in serum _________ when the offending drug is administered?
Creatinine
Would you expect to see nephrotic ranges of proteinuria in AIN?
No it usually only elevated to about 1g/day
Fractional elevation of sodium excretion above 1% is indicative of _______ damage?
tubular damage
T/F: Radiographic studies are diagnostic for AIN
False
What would be seen on histology of AIN?
Is the glomerulus involved?
Diffuse interstitial infiltrate with many red-staining eosinophils
No glomerular involvement
How is AIN treated?
Remove causative agent
Glucocorticoids can be considered
What are examples of processes that result in chronic interstitial nephritis (CIN)?
Analgesic Nephropathy
Lithium
Balkan Nephropathy
Tubulointerstitial Nephritis and Uveitis
Sjogrens syndrome
Sarcoidosis
Arostolochic Acid containing herbs
Lead
In a a patient with analgesic nephropathy….
What may be seen on lab work?
UA?
Imaging of the kidneys?
Labs: Elevated Creatinine
UA: Hematuria, Sterile Pyuria, Mild Proteinuria
Imaging: Smaller kidneys, Clacifications
Chronic Interstitial Nephritis (CIN) as a result of ______ exposure usually presents with polyuria and polydipsia and a result of ________ channel degradation.
Lithium
Aquaporin
Is CIN due to lithium exposure a nephrotic or nephritic syndrome?
Nephrotic (Minimal Change Disease)
Other than polyuria and polydipsia, what additional clinical manifestations may be seen in CIN as a result of lithium exposure?
Hyperparathyroidism
Hyprecalcemia
________ _______ ________ 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
Balkan Endemic Nephropathy (BEN)
What is BEN most likely caused by?
Chronic exposure to low concentrations of aristolochic acid
How is BEN diagnosed?
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
Inflammation in Tubulointerstitial Nephritis and Uveitis (TINU) is primarily __-lymphocyte driven
T-Lymphocyte
What Sxs may a patient with TINU present with?
What may be found on lab work/UA?
Flank Pain
UA: Sterile Pyuria, Hematuria, Subnephrotic Proteinuria
Renal Insufficiency/ARF
T/F: TINU is typically self-limited and spontaneously resolves
True
________ is a cause of CIN as a result of interstitial infiltrates that invades and damages the tubules with granuloma formation
Sjogrens
What antibodies are specific to Sjogrens?
Anti-Ro (SSA)
Anti-La (SSB)
What can be used to treat CIN as a reult of Sjogrens if severe enough?
Glucocorticoids
What is commonly seen with renal involvement in sarcoidoisis?
Hypercalciuria
Hypercalcemia
On renal biopsy in a patient with sarcoidosis, would you expect to see caseating or non-caseating granulomas in the interstium?
Non-caseating
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
Arostolochic Acid (AA)
Arostolochic Acid (AA) has been linked to interstitial fibrosis, atrophy, and loss of the ______
Tubules
T/F: Arostolochic Acid (AA) is linked to a high incidence of uroepithelial CA
True
Lead exposure for extensive amounts of time (5-30 years) with blood levels _________ is linked to renal pathology
> 60 mcg/dL
In patients with renal disease linked to lead, a PMHx of ____ is often seen.
Gout
Glucosuria
Aminoaciduria
Renal phosphate wasting
Are all associated with a _______-type syndrome linked to lead exposure and renal disease
Fanconi-Type Syndrome
Is proteinuria common in patients with lead exposure and renal disease?
No
How can lead exposure and renal disease treated?
Minimize further lead exposure
Chelation therapy
When would chelation therapy be indicated for patients with lead poisoning and renal disease?
If exposure is acute, lead levels, and Sx
