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Y4R3 - Medicine II 🩺 > L2: Tubulointerstitial Diseases > Flashcards

L2: Tubulointerstitial Diseases Flashcards

1
Q

Def of Acute Tubulointerstitial Nephritis

A
  • Acute inflammation of the renal interstitium and tubules that causes a decline in renal function over a period of days to weeks.
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2
Q

Etiology of Acute Tubulointerstitial Nephritis

A
  • Drugs
  • Systemic Disease
  • Infections
  • Idiopathic
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3
Q

Etiology of Acute Tubulointerstitial Nephritis

  • Drugs
A
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4
Q

Etiology of Acute Tubulointerstitial Nephritis

  • Most Common Causes
  • Most Common Specific Cause
A

DRUGS (MOST COMMON)

  • Antibiotics (most important) e.g., β-lactams (methicillin) - Sulfonamides
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5
Q

Etiology of Acute Tubulointerstitial Nephritis

  • is it dose-dependent?
A

Development of drug-induced AIN is not dose-dependent.

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6
Q

Etiology of Acute Tubulointerstitial Nephritis

  • causes pf recurrence
A

Recurrence or exacerbation of AIN can occur with a second exposure to the same or a related drug.

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7
Q

Etiology of Acute Tubulointerstitial Nephritis

  • Systemic Diseases
A

① Sarcoidosis.
② Sjögren’s disease.
③ Systemic lupus erythematosus (SLE).

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8
Q

Etiology of Acute Tubulointerstitial Nephritis

  • Infectious
A
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9
Q

Etiology of Acute Tubulointerstitial Nephritis

  • Idiopathic
A
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10
Q

Pathophysiogy of Acute Tubulointerstitial Nephritis

A
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11
Q

Pathophysiogy of Acute Tubulointerstitial Nephritis

  • Principal mechanism
A
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12
Q

CP of Acute Tubulointerstitial Nephritis

A
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13
Q

CP of Acute Tubulointerstitial Nephritis

  • Asymptomatic
A

…

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14
Q

CP of Acute Tubulointerstitial Nephritis

  • Symptomatic
A
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15
Q

CP of Acute Tubulointerstitial Nephritis

  • Onset
A

within days of exposure to the offending drug in most instances.

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16
Q

CP of Acute Tubulointerstitial Nephritis

  • Symptoms
A
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17
Q

Dx of Acute Tubulointerstitial Nephritis

A
  • Hx
  • Labs
  • Bx
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18
Q

Dx of Acute Tubulointerstitial Nephritis

  • Hx
A

HISTORY OF :
▪ Drug intake
▪ Exposure to toxic substance
▪ Infection.

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19
Q

Dx of Acute Tubulointerstitial Nephritis

  • Labs
A
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20
Q

Dx of Acute Tubulointerstitial Nephritis

  • KFTs
A

Increased plasma creatinine.

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21
Q

Dx of Acute Tubulointerstitial Nephritis

  • CBC
A

Eosinophilia

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22
Q

xDx of Acute Tubulointerstitial Nephritis

  • urinalysis
A
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23
Q

Dx of Acute Tubulointerstitial Nephritis

  • FENA
A

High fractional sodium excretion (FENa) may be >2 %

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24
Q

Dx of Acute Tubulointerstitial Nephritis

  • Signs of Tubulointerstitial Diseases
A

Such as Fanconi syndrome and renal tubular acidosis.

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25
Q

Dx of Acute Tubulointerstitial Nephritis

  • What to make of absence of eosinophilia and eosinophiluria?
A

Absence of eosinophilia and eosinophiluria doesn’t exclude the disease.

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26
Q

Dx of Acute Tubulointerstitial Nephritis

  • Bx
A
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27
Q

Bx in Dx of Acute Tubulointerstitial Nephritis

  • Value
A

Definitive diagnosis of AIN is made by kidney biopsy.

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28
Q

Dx of Acute Tubulointerstitial Nephritis

  • Findings of Bx
A
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29
Q

managment of Acute Tubulointerstitial Nephritis

A
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30
Q

Management of Acute Tubulointerstitial Nephritis

  • Algorithm
A
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31
Q

Def of Chronic Interstitial nephritis

A
  • Chronic inflammation of the renal tubules and interstitium that can progress to end-stage renal disease (ESRD) after months or years.
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32
Q

Pathophysiology of Chronic Interstitial nephritis

A

① Chronic inflammation of the renal tubules and interstitium ⇨ Interstitial scarring, fibrosis, and tubule atrophy ⇨ Progressive chronic kidney insufficiency

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33
Q

Etiology of Chronic Interstitial nephritis

A
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34
Q

Etiology of Chronic Interstitial nephritis

  • Meds
A

① Analgesic nephropathy.
② Calcineurin inhibitors (e.g., Cyclosporine - Tacrolimus).
③ Chemotherapeutic agents (e.g., Cisplatin).
④ Nucleoside inhibitors (e.g., Cidofovir).
⑤ Others: Mesalamine - Lithium.

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35
Q

Etiology of Chronic Interstitial nephritis

  • Toxins
A

① Lead (i.e., chronic lead nephropathy).
② Cadmium.

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36
Q

Etiology of Chronic Interstitial nephritis

  • infections
A

① Chronic pyelonephritis.
② Tuberculosis.

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37
Q

Etiology of Chronic Interstitial nephritis

  • Systemic diseases
A

① Multiple myeloma - Lymphoma.
② SLE - Sjogren syndrome - Sarcoidosis.
③ Sickle cell disease - Vasculitis.
④ IgG4-related systemic disease.
⑤ Tubulointerstitial nephritis with uveitis

38
Q

Etiology of Chronic Interstitial nephritis

  • Metabolic Diseases
A

① Hyperuricemia.
② Hypercalcemia.

39
Q

Etiology of Chronic Interstitial nephritis

  • Miscellaneous
A

① Radiation nephritis.
② Kidney graft rejection.
③ Hypertension.
④ Ischemia.

40
Q

CP of Chronic Interstitial nephritis

41
Q

TTT of Chronic Interstitial nephritis

42
Q

Compare between Pyelonephritis & Pyelitis in terms of

  • Infection Site
  • Constitutional Symptoms
43
Q

etiology of Acute Pyelonephritis

44
Q

etiology of Acute Pyelonephritis

  • Organisms
45
Q

etiology of Acute Pyelonephritis

  • Most Common Organism
46
Q

etiology of Acute Pyelonephritis

  • Routes of Infection
47
Q

etiology of Acute Pyelonephritis

  • Risk factors
48
Q

Risk Factors for Acute Pyelonephritis

  • Impaired Urine Flow
A

▪ Anatomical abnormalities (as vesico-ureteric reflux - ureteric stricture).

▪ Renal stones.

▪ Senile prostatic enlargement and bladder neck obstruction.

▪ Neurogenic bladder (leads to residual urine in the bladder and stasis).

49
Q

Risk Factors for Acute Pyelonephritis

  • Instruments
A

(as cystoscopy):
▪ May introduce organisms into the urinary tract.

50
Q

Risk Factors for Acute Pyelonephritis

  • Female
A

due to:

▪ Short urethra allows easy passage of bacteria from perineal area to bladder.

▪ Trauma such as honeymoon cystitis (cystitis occurring in early marriage).

▪ Stasis with pregnancy (due to hormones secreted during pregnancy causing relaxation of ureteric muscles and ureteric dilatation).

51
Q

Risk Factors for Acute Pyelonephritis

  • Impaired Immunity
A

▪ Diabetes mellitus.
▪ HIV.
▪ Renal disease (e.g. nephrotic syndrome - analgesic nephropathy).

52
Q

CP of Acute Pyelonephritis

53
Q

CP of Acute Pyelonephritis

  • Classical Presentation
54
Q

CP of Acute Pyelonephritis

  • Cystitis
55
Q

CP of Acute Pyelonephritis

  • Gross Hematuria
A

Hemorrhagic Cystitis

56
Q

CP of Acute Pyelonephritis

  • Elderly Patients
57
Q

Complications of Acute Pyelonephritis

58
Q

INVx for Acute Pyelonephritis

A
  • urinalysis
  • Urine culture / susceptibilities
  • Blood Culture
  • KFTs
  • Imaging
59
Q

INVx for Acute Pyelonephritis

  • Urinalysis
60
Q

INVx for Acute Pyelonephritis

  • Urine Culture
61
Q

Causes of sterile pyuria (pus cells with negative repeated cultures)

62
Q

INVx for Acute Pyelonephritis

  • Blood Culture
63
Q

INVx for Acute Pyelonephritis

  • KFTs
A

Renal dysfunction could be a preceding event or a complication of pyelonephritis.

64
Q

INVx for Acute Pyelonephritis

  • Imaging
65
Q

INVx for Acute Pyelonephritis

  • Value of Imaging
A
  • Identify predisposing factors (e.g. obstruction).
  • Identify complications (e.g. abscess emphysematous pyelonephritis).
66
Q

INVx for Acute Pyelonephritis

  • CT
67
Q

INVx for Acute Pyelonephritis

  • Others
A
  • Renal US
  • IVP
68
Q

Management of Acute Pyelonephritis

69
Q

Management of Acute Pyelonephritis

  • Supportive
70
Q

Management of Acute Pyelonephritis

  • Antibiotics
71
Q

Management of Acute Pyelonephritis

  • managment of Complications
A

perinephric abscess

72
Q

Management of Acute Pyelonephritis

  • Correct Predisposing Factors
73
Q

Def of Chronic Pyelonephritis

A

Inflammation and scarring induced by recurrent or persistent kidney infection.

74
Q

Predispoing Factors for Chronic Pyelonephritis

A

① Vesicoureteric reflux.

② Urinary tract obstruction (e.g., nephrolithiasis, neurogenic bladder).

75
Q

Pathology in Chronic Pyelonephritis

76
Q

CP of Chronic Pyelonephritis

77
Q

CP of Chronic Pyelonephritis

  • Symptoms
78
Q

CP of Chronic Pyelonephritis

  • Examination
79
Q

INVx for Chronic Pyelonephritis

80
Q

INVx for Chronic Pyelonephritis

  • urinalyisis
A

▪ Pyuria.

▪ Proteinuria may be present (negative prognostic factor).

81
Q

INVx for Chronic Pyelonephritis

  • urine Culture
A

Negative urine culture does not exclude chronic pyelonephritis.

82
Q

INVx for Chronic Pyelonephritis

  • Renal Function tests
A
  • Serum creatinine & blood urea nitrogen (BUN) levels are elevated (azotemia) in late cases.
83
Q

INVx for Chronic Pyelonephritis

  • Imaging
84
Q

INVx for Chronic Pyelonephritis

  • Gold Standard Imaging
85
Q

TTT of Chronic Pyelonephritis

86
Q

Incidence of Xanthogranulomatous pyelonephritis

A
  • Unusual variant of chronic pyelonephritis mostly occurs in the setting of obstruction due to infected kidney stones.
87
Q

Pathology of Xanthogranulomatous pyelonephritis

A
  • Affected patients usually have massive destruction of the kidney due to granulomatous tissue containing lipid-laden macrophages.
88
Q

Presentation in Xanthogranulomatous pyelonephritis

A

Symptoms:
- flank pain, fever, malaise, anorexia and weight loss.

Physical examination:
- A unilateral kidney mass can usually be palpated.

89
Q

Dx of Xanthogranulomatous pyelonephritis

90
Q

TTT of Xanthogranulomatous pyelonephritis

A
  • Surgical removal of affected part (after an initial course of antimicrobials to control the local infection).

Y4R3 - Medicine II 🩺 (35 decks)

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