Lecture 19 - Renal Tubule, Interstitial, and Vessel Disease

Question 1

ATI (Acute Tubular Injury), evidenced by Muddy Brown Casts and sloughing epithelial cells, can be caused by what two things?

Answer 1

Ischemia or Toxic injury

Question 2

In both Ischemic and Nephrotoxic ATI, there is Tubular cell injury as well as disturbance to ____ ____ –> the latter leads to vasocontriction via RAAS.

Answer 2

Blood flow

Question 3

Pyelonephritis is caused by _______ or _______ infection. Which is more common?

Answer 3

Ascending (up the urinary tract)

Hematogenous

Ascending is most common –> typically caused by Gram - (i.e. E. coli)

Question 4

________ nephropathy is a common cause of Acute Pyelonephritis in Transplant patients.

Answer 4

Polyomavirus nephropathy

Question 5

There are two types of Chronic Pyelonephritis:

1. Reflux (non-obstructive)
2. Obstructive

Which is more common in children and which is more common in adults?

Answer 5

Reflux –> Children

Obstructive –> adults

Question 6

Gross imaging of Chronic Pyelonephritis will show _____ calyces and _____ scarring (at opposite ends of the kidney) in a _____ shape within the renal cortex.

Answer 6

Blunted calyces

Polar scarring in a U-shape

Question 7

_____-induced tubulointerstitial nephritis is the second most common cause of AKI (Pyelonephritis is first).

Pathogenesis involves which types of hypersensitivity reactions?

Answer 7

Drug-induced

Type I –> IgE mediated
OR
Type IV –> T-cell mediated delayed

Question 8

Analgesic Nephropathy is characterized by renal _____ necrosis. Look for patients using MIXED analgesic compounds.

Answer 8

Renal Papillary Necrosis

Question 9

Nephroclerosis in a vascular kidney disease associated with ______. Groups with higher risk are African Americans, especially those with ______ mutations, patients with underlying disease like DM, and patients with high ____.

Answer 9

Hypertension

APO-L1

High BP

Question 10

Remember that while Pyelonephritis exhibits ___-shaped polar scarring, Renal Vascular disease exhibits ____-shaped scarring.

Answer 10

U-shaped

V-shaped

Question 11

Malignant Nephrosclerosis is associated with BP > ____/____. Look for these patients to present with neurological symptoms associated with the _____ (central or peripheral nervous system?).

Answer 11

> 200/120

CNS –> so altered mental status, headache, nausea, spots before their eyes, seizures, etc.

Question 12

Thrombotic angiopathy –> look for ______ (shear RBCs)

Answer 12

Shistocytes

Question 13

Patients that demonstrate Fever, Neurologic symptoms, microangiopathic hemolytic anemia, thrombocytopenia, and renal failure should be suspected of TTP caused by loss of function of ______.

Answer 13

Thrombotic thrombocytopenic Purpura (TTP) caused by los of function of ADAMTS13

Question 14

Typical Hemolytic Uremic Syndrome (HUS) is a Thrombotic microangiopathy most commonly caused by which bacteria? Does it more so affect children or adults?

Atypical HUS is caused by a deficiency of complement regulatory proteins, most commonly Factor ___. Does this HUS more so affect children or adults?

Which has better prognosis, typical or atypical HUS?

Answer 14

Typical –> E. Coli

More so affects children or elderly.

Atypical –> deficiency in Factor H.

More so affects adults.

Typical has better prognosis.

Question 15

Renal artery stenosis is most commonly caused by atheromatous plaques, but it can also be caused by _______ dysplasia. Which is more common in men and which is more common in women?

Answer 15

Fibromuscular dysplasia

Atheromatous plaques –> more common in men

Fibromuscular dysplasia –> more common in women.

Question 16

Patients with Renal Artery Stenosis will have characteristic _____ on auscultation of the renal artery.

Answer 16

Bruit

Question 17

Atheroembolic renal disease –> look for patients with recent catherterization of the _____ (think dislodged emboli that travel to the kidney).

Answer 17

Aorta

Question 18

Diffuse cortical necrosis is most commonly a complication of _______ emergency. It is caused by Microthrombi in glomerular capillaries and arterioles, which can lead to sudden _____ and acute renal failure.

Answer 18

Obstetric emergency (so think pregnant patients)

Sudden Anuria

Question 19

Renal Infarcts –> look for patients with recent or concurrent _____ and presenting with ______ angle pain.

Answer 19

MI

Costovertebral Angle Pain

Question 20

Urate Nephropathy –> look for patients suffering from what? What shape are the crystals in this disease state?

The crystals commonly cause occlusion of the _____ _____, leading to renal failure.

Answer 20

Look for patients with GOUT.

The Crystals are Rhomboid or Football-shaped.

Collecting Duct

Question 21

Consumption of Antifreeze is associated with which crystal precipitate in the kidneys? What shape are the crystals?

Answer 21

Antifreeze –> Ca++ Oxalate

Envelope-shaped