L8. Interstitial diseases Flashcards
What do we call an infection of the bladder or that of a kidney
- Bladder = cystitis
- Kidney = pyelonephritis
What distinguishes uncomplicated from complicated UTI infections
- Uncomplicated –> occurs w/normal urinary tract
- Complicated –> Associated with abnormal urinary tract = structural or functional
Age and sex in which UTI presents more commonly in children - explain
- More common in male <1 yrs –> likely due to congenital urinary tract defects
- After 1st year –> most common in females
- If recurrent –> Vesicoureteral reflux (VUR)
Distinguishing factors btwn ascending renal infection and hematogenous infection (organisms and mode of infection)
- Ascending –> most common due to colonization of urethra by colonic organisms (E. col, Enterobacter) –> ascend into bladder, ureter and kidney
- Hematogenous –> (Staph / E. coli) from bacterimia due to drug use among other causes and infect the kidney
What are the different types and subtypes of pyelonephritis
- Acute PN
- Chronic PN
- Chronic nononstructive PN or Reflux nephropathy
- Chronic obstructive PN
ACUTE PYELONEPHRITIS
- Age and sex range
- Clinical preserntation
- Pathology
- Pathogenesis
- Prognosis
- Age and sex range: females 20-30, older males (prostatic hyperthrophy)
- Clinical preserntation: Fever, pain, dysuria, pyuria, WBC casts (indicates kidney involvement)
- Pathology: Cortical abscesses, aggregates of neutrophils in tubular lumens and interstitial inflammatory infiltrates
- Pathogenesis:
Ascending infection
E.coli most common –> w/adhesion molecules (adhesins) on the P-fimbriae (pili)
Hematogenous in fection = less common –> Staph aureus
- Prognosis: Abx –> revovery usually no sequelae
REFLUX NEPHROPATHY
Age and sex group:
Pathology:
Pathogenesis:
Prognosis:
Age and sex group: Childhood - -> Infant male and older femals (1-10yr)
Pathology: U shape cortical scars overlying deformed papillae and calyces. Interstitial fibrosis and tubular atrophy. Secondary FSGS
Pathogenesis: VUR and intrarenal reflux –> scaring in compund papillae at renal poles
Prognosis: Depends on severity of VUR
Normal and abnormal bladder and intravesical ureter in relaxed and micturition
Relax –> flap open to allow flow of urine into bladder
Micturition –> flap closes to prevent reflux
ABNORMAL –> flap does not close urine flows back into ureters
Disorders associated w/vesicoureteral reflux
- Absence of intravesical ureter
- Paraureteral diverticulum
- Inflammation
What causes paraureteral diverticulum
Repetitive bladder infection –> scaring of bladdr wall and formation of diverticulim
Thyroidization is characteristic of what kind of kidney pathology
Chronic pyelonephritis
What are the gross difference btwn chronic pyelonephritis caused by VUR and that caused by obstruction of urinary tract
- VUR: Polar scar mostly. Dilation of polar calyces
- Obstruction: Global scaring and dialation of the calyces and pelvis
What is the most common cause of interstitial nephritis?
Drug: Abx, NSAIDs diuretics
ACUTE INTERSTITIAL NEPHRITIS
- Clinical manifestations:
- Pathology
- Pathogenesis
- Prognosis
- Clinical manifestations: 3wks after drug exposure. fever, flank pain, rash, eosinophilia and acute renal insufficiency
- Pathology: Mononuclear cells (lymphocytes and macros) infiltrates w/ direct invasion of tubules = tubulitis. Maybe eosinophils
- Pathogenesis: Immunologic reaction not dose-dependent
- Prognosis: TX–> stop the drug. Usually favorable
ANALGESIC NEPHROPATHY
Cause:
Pathology
Pathogenesis
Cause: Prolonged ingestion of analgesics containing aspirin in combination w/phenacetin, acetaminophem and caffeine or codeine
Pathology: Papillary necrosis and chronic interstitial nephritis
Pathogenesis: Deplete glutathione in renal medulla –> arylation of proteins and oxidative stress –> papillary necrosis
