Lecture 23+24 Flashcards

Question

Alteplase

Answer 1

recombinant of tissue plasminogen factor used for acute stroke acute STEMI acute pulmonary embolism

Answer 2

TPF recombinant with longer half life used for acute STEMI

Answer 3

AMINOCAPROIC ACID & TRANEXAMIC ACID Inhibits plasminogen activation. Uses: adjunctive therapy in hemophilia, and therapy for bleeding from fibrinolytic therapy.

Answer 4

Chemical antagonist of heparin | high in arginine

Answer 5

Can be ischemic or toxic usually in the form of necrosis of tubular epithelial cells

Answer 6

- Absence of nephritic or nephrotic syndrome - Presence of defects in tubular function impaired ability to concentrate urine salt wasting metabolic acidosis

Answer 7

ischemia = epithelial dysfunction = vasoconstriction = reduced GFR and oliguria

Answer 8

toxic damage can be reversible or irreversible reversible = loss of polarity and detachment irreversible = necrosis and apoptosis

Answer 9

tubular necrosis patchy; relatively short lengths of tubules affected, and proximal straight tubule (PST) segments and ascending limbs of Henle’s loop (HL) most vulnerable

Answer 10

extensive necrosis along the proximal convoluted tubule (PCT) segments with many toxins (e.g., mercury), ALSO necrosis of the distal tubule, particularly ascending HL, also occurs

Answer 11

inflammatory injuries of the tubules and interstitium that are often insidious in onset and are principally manifest by azotemia ``` first seen in sulfonamides Synthetic penicillins like methicillin, ampicillin Rifampin Diuretics like thiazides NSAIDs ```

Answer 12

Inflammation affecting the tubules, interstitium, and renal pelvis * Bacterial infections * Associated with urinary tract infections

Answer 13

Inflammation affecting the tubules, interstitium, and renal pelvis * Bacterial infections * Associated with vesicoureteric reflux, obstruction * Repeated infections

Answer 14

begins 2 to 40 days after drug exposure features: • Fever, eosinophilia (which may be transient), rash in about 25% of patients • Renal abnormalities- hematuria, mild proteinuria, and leukocyturia (often including eosinophils) • 50% cases: rising creatinine or acute kidney injury with oliguria patho: • Drugs function as haptens and covalently bind to some plasma membrane or extracellular component of tubular cells • These modified self antigens then become immunogenic • The resultant injury is due to IgE or cell-mediated immune reactions directed against the tubular cells or their basement membranes

Answer 15

``` urine: • Eosinophils • Sterile pyuria • WBC casts • Proteinuria (mild) ``` blood: • Increased BUN AND creatinine • Increased eosinophil count • Tubular dysfunction: High K, low HCO3 histo: • Interstitium shows variable but frequently pronounced edema and infiltration by mononuclear cells, principally lymphocytes and macrophages • Eosinophils and neutrophils may be present often in clusters and large numbers • Smaller numbers of plasma cells and mast cells are sometimes also present

Answer 16

Escherichia coli, followed by Proteus, Klebsiella, and Enterobacter are most common Streptococcus faecalis, also of enteric origin, staphylococci, and virtually every other bacterial and fungal agent can also cause lower urinary tract and renal infection In immunocompromised persons, particularly those with transplanted organs: polyomavirus, cytomegalovirus, and adenovirus

Answer 17

urethra... bladder..... kidney From the urethra to the bladder, organisms gain entrance during urethral catheterization or other instrumentation. Long-term catheterization, in particular, carries a risk of infection

Answer 18

Suppurative inflammation of the kidney caused by bacterial and sometimes viral infection, which can reach the kidney by hematogenous spread or, more commonly, through the ureters in association with vesicoureteral reflux gross: Discrete, yellowish, raised abscesses are grossly apparent on the renal surface ``` histo: • Patchy interstitial suppurative inflammation • Intratubular aggregates of neutrophils • Neutrophilic tubulitis • Tubular injury ```

Answer 19

Usually presents with a sudden onset of pain at the costovertebral angle and systemic evidence of infection, such as fever, nausea, vomiting and malaise Along with indications of bladder and urethral irritation, such as dysuria, frequency, and urgency lab: • Pyuria: urine contains many leukocytes derived from the inflammatory infiltrate • Bacteriuria • Leukocyte casts: typically rich in neutrophils (pus casts), indicates renal involvement (because casts are formed only in tubules) • Elevated BUN, creatinine

Answer 20

complication of acute pyelonephritis Seen mainly in diabetics, sickle cell disease and urinary tract obstruction Ischemic and suppurative necrosis Leukocytic response is limited to the junctions between preserved and destroyed tissue

Answer 21

complication of acute pyelonephritis In case of obstruction, suppurative exudate is unable to drain and fills the renal pelvis, calyces, and ureter with pus

Answer 22

complication of acute pyelonephritis extension of suppurative inflammation through the renal capsule into the perinephric tissue

Answer 23

complication of acute pyelonephritis disorder in which chronic tubulointerstitial inflammation and scarring involve the calyces and pelvis; recurrent or persistent renal infections etio: recurrent infections superimposed on diffuse or localized obstructive lesions like posterior urethral valves and kidney stones lead to recurrent bouts of renal inflammation and scarring Reflux nephropathy (more common): superimposition of a UTI on congenital vesicoureteral reflux and intrarenal reflux CF: • Gradual onset of renal insufficiency or because signs of kidney disease are noticed on routine laboratory tests • Loss of tubular function- in particular of concentrating ability- gives rise to polyuria and nocturia • Development of hypertension • Mild proteinuria or development of FSGS

Answer 24

Gross: asymmetrical • VUR – preferential scarring & calyceal dilatation at poles • Obstructive – diffuse dilatation of calyces & scarring histo: • Uneven interstitial fibrosis and an inflammatory infiltrate of lymphocytes and plasma cells Dilation or contraction of tubules, with atrophy of the epithelial lining Many of the dilated tubules contain pink to blue, glassy-appearing casts- looks like thyroid hence this change is called “thyroidization” Chronic inflammatory cell infiltration and fibrosis Arteriolosclerosis may be caused by associated hypertension Glomerulosclerosis that usually develops as a secondary process

Answer 25

• Obstructive lesions of the urinary tract increase susceptibility to infection and to stone formation • Unrelieved obstruction almost always leads to permanent renal atrophy, termed hydronephrosis or obstructive uropathy types of obstruction: • Sudden or insidious • Partial or complete • Unilateral or bilateral Caused by intrinsic lesions of the urinary tract or extrinsic lesions that compress the ureter

Answer 26

Term used to describe dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction to the outflow of urine Tubular functional defects and interstitial inflammation with fibrosis

Answer 27

Etiology: Idiopathic or specific disease usually between 20 and 30 types: calcium, triple/struvite, uric acid, cystine patho: • Increased concentration of stone constituents • Changes in urinary pH • Decreased urine volume • Presence of bacteria influence the formation of calculi CF: • Silent if remain in the renal pelvis • Symptomatic if stone passes into ureters: • Renal colic: abrupt onset of flank pain radiating to the groin (intermittent), nausea, vomiting, gross or microscopic hematuria (ulceration of urothelium) • Superimposed UTI – urinary stasis, trauma • Hydronephrosis due to obstruction of the ureter

Answer 28

Treatment options: • IV antibiotics • Urosurgical intervention Prevention By decreasing urinary concentration of the causative substances • Increased fluid intake (2L/day) • Low sodium diet → decrease urinary calcium excretion • Alkalinisation of urine to increase solubility of uric acid