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REGUB > L5: Pathology 2 > Flashcards

L5: Pathology 2 Flashcards

1
Q

What is pyelonephritis?

A

infection + inflammation of the kidney (renal pelvis)

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2
Q

What are the main causes of acute pyelonephritis?

A
  1. Ascending UTI
  2. Haematogenous (septicaemia, infective endocarditis…)
  3. Urinary Tract Obstruction/Stasis of Urine
    - e.g. renal calculi, hydronephrosis, vesicoureteral reflux
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3
Q

What is the vesicoureteral reflux? What is it usually caused by?

A
  • urine flows back up to the kidneys
  • may cause hydronephrosis
  • possible cause: horizontal ureter path
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4
Q

Vesicoureteral reflux can lead to what?

A

a UTI

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5
Q

When looking at histology/tissue samples of acute pyelonephritis - what will be seen?

A
  • pus in tubules**
  • PMNs (neutrophils) in interstitium + tubules
  • mainly affects the cortex (spares the glomeruli)

note: AP affects the kidney focally (so acute renal failure is not common)

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6
Q

What parts of the kidney does pyelonephritis normally affect (especially when healing by fibrosis/scarring)?

A

the poles (upper and lower papilla)

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7
Q

What are some of the features/characteristics of chronic pyelonephritis?

A
  • asymmetrical scarring of kidneys
  • thyroidisation of tubules
  • glomerular hypertrophy (blunting of calyces)
  • secondary focal + segmental glomerular sclerosis
  • vascular changes
  • predisposition to struvite calculi
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8
Q

List the 2 special types of chronic pyelonephritis

A
  1. Xanthagranulomatous

2. Malakoplakia

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9
Q

What is chronic xanthogranulomatous pyelonephritis?

A
  • inadequate macrophage destruction of e. coli

- aggregation of FOAMY macrophages around e. coli

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10
Q

What is chronic malakoplakia pyelonephritis?

A
  • inadequate macrophage destruction of e. coli
  • accumulation of macrophages that have calcified structure
  • looks like a RCC
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11
Q

What is acute tubulo-interstitial nephritis (TIN)? What are the possible causes of TIN?

A
  • immunological, inflammatory condition
  • begins in the interstitium and invades the tubule
  • possible causes: drug-induced, allergic, hypersensitivity, familial, immune complex disorders
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12
Q

What are some DRUGS that cause acute tubulo-interstitial nephritis?

A
  1. PPIs
  2. Antibiotics (Penicillins*, Sulphonamides…)
  3. NSAIDs
  4. Molecular Agents
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13
Q

What is the most common drug that causes acute tubulo-interstitial nephritis?

A

PPIs

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14
Q

Does acute tubulo-interstitial nephritis or acute pyelonephritis cause acute renal failure?

A

TIN may cause renal failure

uncommon for AP to cause renal failure

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15
Q

When looking at a histological specimen of acute TIN, what will be seen?

A

eosinophils in the interstitium

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16
Q

Sarcoidoisis may cause acute tubulo-interstitial necrosis - on a histological specimen, what would be seen?

A

granulomas

17
Q

What is hydronephrosis? (definition)

A

a dilatation of the renal pelvis, calyces, and/or the proximal ureter due to a distal obstruction to the outflow of urine

18
Q

What are the possible causes of hydronephrosis? [3]

A
  • PUJ obstruction (neuromuscular abnormality)
  • tumours
  • calculi
19
Q

What will happen to the structure of the kidney in hydronephrosis?

A
  • dilation of renal pelvis + calyces
  • flattening of papilla
  • atrophy of renal cortex
20
Q

List the 5 types of renal calculi

A
  1. Calcium (Phosphate or Oxalate)
  2. Magnesium Ammonium Phosphate
  3. Uric Acid
  4. Cystine
  5. Oxalate (malabsorption syndromes/anti-freeze ingestion)
21
Q

What is the most common type of renal calculi?

A

Calcium (Phosphate or Oxalate)

22
Q

What is the treatment for renal calculi?

A

Lithotripsy (blasted w/ high level ultrasound beams to break it up)

or conservative management

23
Q

What is the pathogenesis of calcium renal stones?

A

usually normal serum calcium - patient’s kidney does not handle calcium properly

24
Q

What are the common causes of oxalate renal stone formation?

A
  • malabsorption syndromes

- anti-freeze (ethylene glycol) ingestion

25
What are the pre-renal causes of acute renal failure?
the abrupt drop of perfusion of the kidneys... - hypovolaemia (e.g. shock causes acute tubular necrosis) - congestive cardiac failure - sepsis - hepatic failure (hepatorenal failure) - renal artery stenosis (bilateral!) - NSAIDs (can cause arteriole constriction)
26
What are the renal causes of acute renal failure?
- glomerular nephritis (acute and crescenteric) - vascular causes (vasculitis, thrombosis, emboli - BILATERAL) - tubulo-interstitial nephritis - acute tubular necrosis (toxic causes such as drugs - e.g. Gentamicin) - tubule obstruction w/in kidney (e.g. casts)
27
What are the post-renal causes of acute renal failure?
- ureter obstruction (e.g. calculi, tumour) - bladder obstruction (e.g. calculi, tumour) - prostate obstruction (e.g. BPH w/ inflammation) - retroperitoneal obstruction (e.g. mets in nodes) NEEDS TO BE BILATERAL
28
If there are dysmorphic RBCs present in the urine, what is the cause of the patient's acute renal failure?
glomerulonephritis
29
If there are non-dysmorphic RBCs present in the urine, what are the possible causes of the patient's acute renal failure?
tumour, calculi, infection
30
If there are WBCs present in the urine, what are the possible causes of the patient's acute renal failure?
tubulo-interstitial nephritis (TIN)
31
If there are granular casts present in the urine, what are the possible causes of the patient's acute renal failure?
acute tubular necrosis
32
Upon urinalysis, if the urine is normal, what are the possible sources/causes of the patient's acute renal failure?
pre-renal or post-renal causes
33
List some of the risk factors for developing acute pyelonephritis
- female - pregnancy - immunosuppression - kidney scars
34
What is thyroidisation of the tubules and what condition is it a/w?
- eosinophilic casts in the tubules that resemble thyroid tissue - a/w chronic pyelonephritis
35
List some of the possible causes of acute tubulo-interstitial nephritis (TIN)
- drug-induced - allergic - hypersensitivity - familial - immune complex disorders
36
Shock is a cause of pre-renal acute renal failure. What can it lead to? Give 1 histological features
can lead to acute tubular necrosis | - presents with granular casts (mitochondria aggregates)
37
Give an example of an antibiotic that can cause acute tubular necrosis and lead to acute renal failure
Gentamicin

REGUB (22 decks)

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