Interstitial and Vascular disease

Question 1

intrinsic renal 3 forms

Answer 1

1. acute tubular necrosis
2. allergic interstitial nephritis
3. other glomerular/vascular

Question 2

Acute tubular necrosis

1. caused by the
2. most common
3. causes (2)

Answer 2

1. caused by the destruction of tubular epithelial cells leading to acute loss of renal function
2. most common cause of acute kidney injury
3. causes: (a) ischemia 50%: hypotension, shock and sepsis (b) toxins 35% drugs, radiocontrast

Question 3

Allergic interstitial nephritis

1. what type of reaction
2. common?
3. clinical findings
4. management
5. treatment

Answer 3

1. hypersensitivity reaction
2. common
3. acute kidney injury + fever, rash - urine analysis includes WBCs and eosinophils
4. discontinue suspected agent
5. antibiotics, diuretics and NSAIDs

Question 4

Acute pyelonephritis

1. what is it?
2. caused by
3. most cases it is a _________ infection
4. affects who in particularly
5. predisposing factors
6. presentation

Answer 4

1. acute inflammation of the renal parenchyma
2. bacterial
3. ascending infection
4. infants, pregnant women, older men
5. predisposing factors include urinary reflux disease and DM
6. UTI: fever, malaise and back pain; Urine analysis: pyuria, granular casts and hematuria; positive urine cultures

Question 5

common bacterial agents ofr acute pyelonephritis

Answer 5

1. Staphyloccocus
2. E.coli

Question 6

chronic diseases affecting tubules and interstitium

Answer 6

1. analgesic nephropathy
2. chronic pyelonephritis
3. granulomatous disease
4. myeloma kidney
5. Gout (uric acid related)

Question 7

Analgesic nephropathy

1. what is it?
2. chronic and massive ingestion of
3. causes
4. what is a complication

Answer 7

1. chronic tubulointerstitial inflammation with frequently papillary necrosis
2. chronic and massive ingestion of analgesics in particular mixtures
3. chronic kidney disease
4. urothelial carcinoma as a complication

Question 8

chronic pyelonephritis

1. what is it
2. leads to _______ with (2)

Answer 8

1. chronic disease of tubules, interstitium, calyces and renal pelvis
2. leads to chronic interstitial inflammation with parenchymal scarring and severe distortion of pelvis and calyces

Question 9

myeloma kidney

1. what is it
2. _______ is filtered and excreted
3. paraprotein precipitates in in tubules as _____ leading to _______
4. myeloma kidney is a consequence of

Answer 9

1. neoplastic plasma cells produce excess immunoglobulins or light chains
2. paraprotein is filtered and excreted
3. paraprotein precipitates in in tubules as tubular casts leading to tubular obstruction
4. myeloma kidney is a consequence of tubular obstruction by paraprotein

Question 10

granulomatous interstitial inflammation:

1. the two main causes and how do we differentiate them

Answer 10

1. TB- caseating necrosis
2. sarcoidosis- small non-caseating

Question 11

Kidney stones

1. location of the formation of the stones (2)
2. most stones contain
3. can lead to

Answer 11

1. location in the collecting ducts (nephrolithiasis) and in the urinary tract (urolithiasis)
2. contain calcium oxalate
3. can lead to obstructive uropathy

Question 12

uric acid nephropathy

1. acute:
   - precipitation of uric acid in the
   - results in
2. chronic
   - =
   - deposition of
3. what does it lead to

Answer 12

1. acute:
   - precipitation of uric acid in the renal tubules
   - results in AKI
2. chronic
   - = Gout
   - deposition of urate crystals in the renal parenchyma
3. nephrolithiasis (uric acid stones)

Question 13

Renal vascular disease

1. what are the two types?

which of these fall under what type

• arteriosclerosis and renal artery stenosis
• fibromuscular dysplasia
• benign arteriolosclerosis
• hypertensive arteriolopathy

Answer 13

1. Macrovascular:
   a. rteriosclerosis and renal artery stenosis
   b. fibromuscular dysplasia
2. Microvascular
   a. benign arteriolosclerosis
   b. hypertensive arteriolopathy

Question 14

Answer 14

malignant hypertension

Question 15

Answer 15

malignant hypertension

Question 16

Answer 16

hypertensive arteriolopathy (vasculopathy

Question 17

Answer 17

flea bite kidney in benign arteriolosclerosis

Question 18

Answer 18

benign hyaline arteriolosclerosis

Question 19

Answer 19

fibromuscular dysplasia

Question 20

Answer 20

urate nephropathy-gou

Question 21

Answer 21

sarcoidosis granulomatous interstitial inflammation

Question 22

Answer 22

TB granulomatous interstitial inflammatio

Question 23

Answer 23

myeloma cast nephropathy notice that this is a stain for kappa light chain

Question 24

Answer 24

myeloma cast nephropathy notice that this is a stain for lambda light chain

Question 25

Answer 25

myeloma cast nephropathy

Question 26

Answer 26

myeloma cast nephropathy

Question 27

Answer 27

chronic pyelonephritis

Question 28

Answer 28

chronic pyelonephritis

Question 29

Answer 29

analgesic nephropathy

Question 30

Answer 30

acute pyelonephritis

Question 31

Answer 31

microabscess from acute pyelonephritis- disseminated punetate lesions

Question 32

Answer 32

allergic intersitial nephritis notice the eosinophils- the pink dots

Question 33

Answer 33

## Footnote allergic intersitial nephritis notice the thick and wrinkled BM and the inflmmation of the parenchyma

Question 34

Answer 34

allergic intersitial nephritis notice the eosinophils

Question 35

Answer 35

tubular casts as seein in acute tubular necrosis

Question 36

Answer 36

muddy brown casts