Intra-renal kidney disease

Question 1

Acute interstitial nephritis may also be called _

Answer 1

Acute interstitial nephritis may also be called tubulointerstitial nephritis

Question 2

Inflammation of the tubulointerstitium describes _ whereas tubular cell death describes _

Answer 2

Inflammation of the tubulointerstitium describes acute interstitial nephritis whereas tubular cell death describes acute tubular necrosis

Question 3

Acute interstitial nephritis involves tubulointerstitial damage from _ , _ , or _

Answer 3

Acute interstitial nephritis involves tubulointerstitial damage from type IV hypersensitivity reaction , tubular obstruction , or inflammatory infiltration

Question 4

Four types of hypersensitivity reactions (ABCD)

Answer 4

Hypersensitivity reactions- ABCD

Type 1: Anaphylactic and atopic
Type II: AntiBody-mediated
Type III: Immune Complex
Type IV: Delayed, cell-mediated (T cells)

Question 5

The most common cause of AIN is _ however, it can also be secondary to infection or autoimmune diseases

Answer 5

The most common cause of AIN is medication-induced however, it can also be secondary to infection or autoimmune diseases

Question 6

Medications that can cause AIN:

Answer 6

Medications that can cause AIN: 5 P’S
* Pain killers (NSAIDs)
* Pee pills (diuretics)
* Penicillin
* PPIs (omeprazole)
* RifamPin
* Sulfa medications

Question 7

AIN will show _ on urine testing

Answer 7

AIN shows:
* Urine osmolarity < 350
* Sterile pyruia (WBCs with no sign of infection)
* WBC casts
* Microscopic hematuria
* Mild proteinuria

Question 8

Clinical signs of AIN:

Answer 8

Clinical signs of AIN:
* Morbilliform rash
* Fever
* Hematuria
* Flank pain & CVA tenderness
* Can sometimes be asymptomatic

Question 9

Serum studies for AIN will show an increase in _ , _ , and _

Answer 9

Serum studies for AIN will show an increase in creatinine , BUN , and eosinophils

Question 10

Name four classic autoimmune conditions that are associated with AIN

Answer 10

Name four classic autoimmune conditions that are associated with AIN:
1. Multiple myeloma
2. Lupus
3. Sarcoidosis
4. Sjogren

Question 11

Renal biopsy for AIN will show:

Answer 11

Renal biopsy for AIN will show:
* Interstitial inflammation with lymphocyte predominance
* Interstitial neutrophils and eosinophils

Question 12

The most common subtype of intrarenal AKI is _

Answer 12

The most common subtype of intrarenal AKI is acute tubular necrosis

Question 13

Pathogenesis of ATN:

Answer 13

Pathogenesis of ATN:
1. Decreased renal blood flow causing ischemia or toxic injury to tubular cells
2. Cells slough off into the tubular lumen
3. Obstruction
4. Decrease in GFR, increase in BUN and Cr

Question 14

The most common location on the nephron for ischemic ATN to occur is in the _

Answer 14

The most common location on the nephron for ischemic ATN to occur is in the straight PCT and thick ascending limb

Question 15

The most common location on the nephron for nephrotoxic ATN to occur is in the _

Answer 15

The most common location on the nephron for nephrotoxic ATN to occur is in the convoluted PCT

Question 16

Name the common nephrotoxins

Answer 16

Name the common nephrotoxins:
* Contrast
* Aminoglycosides
* Cisplatin
* Amphotericin
* Lead
* Myoglobin
* Hemoglobin

Question 17

The maintenance phase of ATN involves (oliguria/polyuria) and increased risk of (hypokalemia/hyperkalemia)

Answer 17

The maintenance phase of ATN involves oliguria and increased risk of hyperkalemia

Question 18

The recovery phase of ATN involves (oliguria/polyuria) and increased risk of (hypokalemia/hyperkalemia)

Answer 18

The recovery phase of ATN involves polyuria and increased risk of hypokalemia
* Excessive urine loss takes along a lot of electrolytes

Question 19

(Maintenance/ recovery) phase of ATN is associated with a risk of uremia and metabolic acidosis

Answer 19

Maintenance phase of ATN is associated with a risk of uremia and metabolic acidosis
* We are retaining electrolytes due to the decreased GFR

Question 20

_ phase is characterized by tubular epithelialization

Answer 20

Recovery phase is characterized by tubular epithelialization

Question 21

Clinical presentation of ATN:

Answer 21

Clinical presentation of ATN:

Can sometimes be asymptomatic
* Oliguria
* Anuria
* Volume depletion
* Edema

Question 22

Urine sediment will show _ for ATN

Answer 22

Urine sediment will show muddy brown casts for ATN

Question 23

Pathogenesis of renal papillary necrosis

Answer 23

Pathogenesis of renal papillary necrosis:
1. Ischemia
2. Necrosis of papilla and renal pyramids
3. Renal obstruction and scarring

Question 24

Renal papillary necrosis is most often (unilateral/bilateral)

Answer 24

Renal papillary necrosis is most often bilateral

Question 25

Causes of renal papillary necrosis

Answer 25

Causes of renal papillary necrosis:
* Sickle cell
* Acute pyelonephritis
* NSAIDs
* Diabetes mellitus
* Nephrolithiasis

Question 26

Renal papillary necrosis presents with _ acute sx

Answer 26

Renal papillary necrosis presents with (acutely):
* Colicky flank pain
* Hematuria
* Proteinuria

Chronic renal papillary necrosis is often mild or asymptomatic

Question 27

Renal papillary necrosis is associated with _ BUN and Cr

Answer 27

Renal papillary necrosis is associated with high BUN and Cr
* Back pressure causes a decrease in GFR and filtration

Question 28

AKI signs + livedo reticularis may be caused by _

Answer 28

AKI signs + livedo reticularis may be caused by atheroembolic renal disease
* Acute worsening of renal function due to showering of emboli
* Hollenhorst plaques
* Causes nephritic sediment, eosinophilia, low C3

Question 29

_ is a form of nephrotoxic acute tubular necrosis due to myoglobin

Answer 29

Pigment nephropathy is a form of nephrotoxic acute tubular necrosis due to myoglobin