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PATHOLOGYY2S2 > Interstitial and tubular disease > Flashcards

Interstitial and tubular disease Flashcards

1
Q

what are intersitital and tubular disease ?

A

Tubulointerstitial nephritis

Acute tubular injury

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2
Q

what is interstetium ?

A

Connective tissue between tubules and glomeruli

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3
Q

what is tubulointerstitial nephritis?

A

Inflammatory disease that primarily involves the tubules and interstetium

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4
Q

when do we call Tubulointerstitial nephritis Pyelonephritis?

A

1- TIN caused by infection

2- renal pelvis is prominently involved

So if its infection + renal pelvis = pyelonephritis

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5
Q

when do we call tubulointerstitial nephritis a interstitial nephritis?

A

TIN caused by non infection

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6
Q

what are the types of tubulointerstitial nephritis? TIN?

A

Acute

Chronic

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7
Q

what is acute pyelonephritis ?

A

Suppurative inflammation of kidney + Renal pelvis

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8
Q

what is the cause of acute pyelonephritis ?

A

we said that its pyelo when its INFECTION + RENAL PELVIS

So its caused by bacterial infection ,associated with Lower UTI

organisms : Gram negative bacilli —?

E. coli, proteaus , klebsiella, pseudomonas

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9
Q

what are the routes by which bacteria reach kidney?

A

Hematogenous spread ( blood ) —> septicemia ( bacteria and toxins in blood ) or infective endocarditis

or

Ascend from the lower UT- —> most common

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10
Q

how does the infection colonizes distal urethra?

A

colonization usually from perineum and due to poor hygeine

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11
Q

how does the infection go from urethra to bladder?

A

Growth of colonies + moving against flow of urine via:

Urethra instruments ( catheter ) if not that then the patient is female cuz :

Close proximity of urethra to rectum

Short urethra + Trauma to urethra during sex

Hormonal changes in women, which affect adherence of bacteria

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12
Q

how does the Bladder keep the infection?

A

usually the bladder is washed ( cuz urine come and leave and repeat )

but if theres outflow obstruction = urine stuck = contamination

OR

Bladder dysfunction —-> abnormal contraction —-> cant properly expel urine —> contamination ( usually due to diabetes cuz it affects autonomic NS )

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13
Q

how does bacteria go from urinary bladder to ureter?

A

vesicoureteral reflex

bacterai from contaminated urine ascend upward

the main cause for this is congenital abnormality

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14
Q

how does the infection go from ureter to kidney?

A

same reflex

once inside the kidney it will move by intrarenal reflux

renal pelvis is the first part affected by infection ( pyelonephritis )

and papilla

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15
Q

what is the gross feature of acute pyelonephritis?

A

Unilateral or bilateral

ABSCESSES = SMALL AND YELLOW

Pelvic and calyces = COVERED BY PUS

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16
Q

what are the micrscopic features of acute pyelonephritis ?

A

Interstitium : Interstitial neutrophilic infiltration

Tubules : Intralobular aggregation of neutrophils + tubular necrosis

Glomeruli : normal cuz its tubular interstitium only

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17
Q

what are the complication of acute pyelonephritis?

A

3 Ps

Papillary necrosis ( IN diabetes )

Pyenphorsis : Accumulation of pus within renal pelvis, calyces, ureter

Perinephric abscess :

suppurative infection break the renal capsule and spread to peri nephric tissue

SEVERELY HIGH FEVER CUZ LARGE INFECTION

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18
Q

what are the urinary findings of acute pyelonephritis ?

A

Pus cells : Urine shows many leuokocytes ( PYURURIA ) could be upper or lower urinary tract infection

Wbc casts : Casts are formed only in tubules ( IF YOU SEE IT = ACUTE PYELONEPHRITIS ( RBC CASTS WERE FOUND AT NEPHRITIC SYNDROME )

Diagnosed by culture and sensitivity

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19
Q

what is chronic pyelonephritis?

A

interstitial inflammation
+
Fibrosis of renal parenchyma
+
Grossly visible scarring and deformity of the pelvicalyceal system in patients with history of UTI

IMPORTANT CAUSATIVE OF END STAGE RENAL DISEASE

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20
Q

what are 2 types of chronic pyelonephritis?

A

Chronic obstruction pyelonephritis

Chronic reflux-associated pyelonephritis ( reflux nephropathy )

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21
Q

describe chronic obstructive pyelonephritis ?

A

Obstruction lead to infection

This obstruction will cause narrowing

urine accumulates

becomes site of infection

Recurrent infection lead to recurrent bouts of inflammation and scaring

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22
Q

describe chronic reflux associated pyelonephritis ( Reflux nephropathy )?

A

Most common cause

Congenital vesicoureteral reflux and internal reflux

leading to ascending of infection to kidney ( js like acute for prolonged time )

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23
Q

what is the grossly morphology of chronic pyelonephritis ?

A

Key word —> Scar and fibrosis

Unilateral or bilateral

When bilateral the kidneys are not equally damaged or equally contracted ( asymmtic )

Scarring of the pelvis, calyces leading to deformities

24
Q

what are the microscopic features of chronic pyelonephritis ?

A

Interstitium = fibrosis and chronic inflammation

Tubules :

ATROPHY
+
THRYOIDIZATION = DILATED TUBULES FILLED WITH EOSINOPHILIC MATERIAL

25
what is acute kidney injury ?
acute tubular necrosis Acute tubular injury Acute kidney injury ---> Acute decline in renal functions Acute tubular necrosis = Acute kidney injury resulting from damage to tubules Etiology : Prerenal, Renal , Post renal
26
compare what happens if you treat it fast and when you dont?
If prerenal Acute renal failure treated in time = reversible damage IF prerenal acute kidney injury is not treated = LEAD TO ACUTE TUBULAR NECROSIS
27
what are the causes of acute tubular injury?
Either hypoxia ( ischemia ) or Toxic ( nephrotoxic ATI )
28
why does acute tubular injury affect the PCT mainly?
High intracellular conce of molecules ( re-absorbed / secreted ) High exposure to conce of luminal solutes High rate oxygen consumption ( كل الشغل فيها )
29
how dos ischemia disturb cell polarity and worsen the ischemia?
Na/K atpase is at the basolateral which takes Sodium from the epithelial to the blood and take potassium from blood to the epithelium During ischemia : The Na/K atpase will be moved to luminal side and it will stop functioning After it stops it will result in decreased sodium reabsorption meaning : High sodium in urine Low sodium in blood then the macula densa cells will see the increased sodium level in urine and assume its high GFR ------------> will send impulses and CONSTRICT the afferent arterioles ----> WORSENS THE ISCHEMIA
30
how does the kidney worsens Hypertension?
in hypertension : Afferent and efferent arterioles will suffer from hyaline arteirosclerosis -----> basement membrane thickening ---> NARROWER LUMEN ----> less blood flow ---> less sodium in urine ----> macula densa sense this ---> activate RAAS ---> WORSE HTN
31
what happens to the ischemic cells ?
express cytokines and adhesions molecules ----> Recruit leukocytes ---> interstitial inflammation Injury to epithelial cells will be followed by detachment of damged cells into lumen ---> OBSTRUCTION OF LUMEN BY CASTS ---> reduce urine output Glomerular filtrate in the lumen of the damaged tubules leak back to interstetium resulting in reduced urine output + interstitial edema which further damage tubule
32
what is the evidence of injury in the morphology of acute tubular injury?
PCT are columnar with brush border so : Flattening of tubular epithelial ( from columnar to cuboidal ) Brush border: blebbing loss of microvilli Vacuoulization and necrosis of cell Detachment of dead cells and accumulate in lumen Proteinaceous cast in the tubular lumen Vacuolization cuz the Na/K will be disrupted ---> Wont be able to get rid of sodium ---> sodium accumulates ---> bring water with it and chloride Interstetium : Edema + inflammatory infiltrate
33
what are the characteristics of ischemic Acute tubular injury?
Lesions are in PCT and ascending thick limbs Focal tubular epithelial necrosis WITH SKIP AREAS in between ( Ischemic with I has INTERUPPTING NECROSIS PATTERN ) RUPTURE OF TUBULAR BASEMENT MEMBRANE
34
What are the characteristics of TOXIC ATI?
Lesions in PCT js like ischemic NO SKIP/INTERUPPTING NECROSIS AREA NO RUPTURE OF TUBULAR MEMBRANE ( ischemic had both ) NEPHROTOXIC WITH THE N HAS NO INTERUPPTING AND NO RUPTURE
35
what are the clinical features of ATI?
Oliguria Increased plasma BUN, creatinine ( cuz reduced function ) Hyperkalemia HYPOnatremia Hyperphosphatemia METABOLIC ACIDOSIS MUDDY BROWN CASTS of the epithelial cells in urine Diagnosis = Fena more than 3%
36
what are the types of urinary tract obstruction ?
Hydroureter ---> in the ureter Hydronephrosis ----> in the pelvis Depending on the lvl of the obstruction !! could be Pyo as well, instead of urine it will be pus Ultrasound is useful for diagnosis
37
what is urolithaisis?
Renal calculi Stones
38
what are the locations of stone?
maybe formed anywhere Nephrolithiasis ( RENAL STONES ) ---> Within the collecting system of the kidney Urolithiasis ---> Urinary calculi/stones ---> stones anywhere in the collecting system of the tract anywhere but kidney
39
what is primary stone?
formed in the sterile urine and usually in kidney
40
what is secondary stone?
Formed in infection or obstruction
41
what are etiology of stones ?
Familial predisposition ---> most imp Diet : deficiency of vitamin A Infection Urinary Stasis Changes in urinary pH ( if acidic can cause stones n if basic can also form stones ) ---> acidity causes many stones but basic cause only one stone Altered urinary solutes ( increased conce of solutes ) Decreased urinary citrate ( which prevents STONES)
42
what are the type of renal stones?
Calcium Triple stones Uric acid stones Cystine stones
43
composition of calcium renal stones?
Calcium oxalate Calcium phosphate both
44
composition of triple stones/ struvite stones?
MAP Magnesium Ammonium Phosphate
45
Complications of stones? MIMO?
M ---> migration lead to pain Infection ---> pyelonephritis and pyonephrosis Malignancy ---> Stones lead to squamous metaplasia and later squamous cell carcinoma Obstruction ---? Hydronephrosis
46
describe calcium stones on X-ray?
Radiopaque ---> WHITE COLOR
47
what is the etiology of calcium stones?
Hypercalciruira without hypercalcemia Hypercalcemia and hypercalciuria (Hyperparathyroidism , Sarcoidosis, squamous cell carcinoma ) Hyperuricosuria ( Gout ) Hyperoxaluria ( Crohn disease affecting terminal ileum ) Idiopathic
48
what is morphology of calcium stones?
Ca-Oxalate stone ---> irregular sharp, hard, spikes and Black ( BLACK CUZ BLOOD COMING FROM INJURY) Ca-phosphate ---> soft and pale
49
describe struvite stones/triple stones on xray?
Radiopaque = white Formed from MAP --> mag, ammonium, phosphate Biggest cuz formed of 3
50
what are the causes of struvite stones?
Infection of UT by urea spliting bacteria ( PROTEUS ) which then forms ammonia ---> MAKES URINE ALKALINE PH struvite is the only stone that forms in alkaline ph --> cannot be formed acidity
51
describe morphology of struvite stones?
Solitary ---> Single Yellow- WHITE large stone ( 3 component ) Sometimes fill the pelvis and calyces ---> staghorn calculus
52
describe uric acid and urtate stones on xray?
Radiolucent cuz it doesnt have calcium
53
what is the etiology of urice acid stones?
Hyperuricemia --> Gout Leukemia ---> cuuz malignant cells keeps proliferating and dying ---> DNA content leak ---> purines ---> uric acid Stones form at low urinary ph ( acidic )
54
what is the morphology of uric acid stones?
Smooth Hard Multiple Show lamination on cut sections
55
describe cystine stones on xray?
Radiopaque --> has calcium
56
what is the etiology of cystine stones?
Very rare Cystinuria ---> genetic defect in renal reabsorption of cystine and other amino acids low urine pH (like uric acid stones )
57
whats the morphology of cystine stones?
Smooth hard multiple Yellow and waaxy

PATHOLOGYY2S2 (12 decks)

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