Non-Glomerular Dz Flashcards
Objectives
1
Q
Interstitial nephritis Etiologies
A
- 70-95% are due to adverse drug reaction
- Chronic pyelonephritis may cause chronic interstitial nephritis
**highlighted in red in pic are likely on PANCE
2
Q
Interstitial nephritis pathophys
A
- Inflammation of the renal interstitium; glomerulus not involved
- Seems to be type IV (cell mediated immunity) hypersensitivity rxn
- Not involving antibodies, only T-cells
- May cause acute intrarenal renal failure but self-limited if cause identified and eliminated
3
Q
Interstitial nephritis signs, symptoms, and Dx
A
- May see mild proteinuria, pyuria, eosinophiluria, skin rash, fever
- May present as intrarenal acute kidney injury (acute renal failure)
- Renal biopsy, if needed
4
Q
Interstitial nephritis Tx
A
- Stop inciting drug
- Supportive care
- Short term dialysis if needed
5
Q
Polycystic kidney disease (PKD) etiology
A
- 90% autosomal dominant
- Onset in adulthood
- MC inherited kidney disease worldwide, affects 1:1,000 people
- 10% are spontaneous mutations
- 10% autosomal recessive
- Onset in infancy
6
Q
PKD signs, symptoms, and complications
A
- May be asymptomatic
- Hypertension
- Hematuria
- UTIs
- Stones
- May have cysts elsewhere
- Liver, pancreas– abdominal pain
- Brain aneurysms– HA
- Colon diverticula– GI bleeding
- May progress to renal failure in 50%
7
Q
PKD Dx
A
- Imaging
- US
- CT
- MRI
- Genetic testing
- PKD1, PKD2
8
Q
PKD Tx
A
- Supportive
- Control HTN
- Treat infections early
- Avoid nephrotoxins
- NSAIDs
- radiocontrast dye
- Aminoglycosides
- Tolvaptan
- approved by FDA in 2018, previously used for SIADH, may cause reversible liver failure
9
Q
Renovascular diseases
A
- Renal artery stenosis
- Renal infarct
- Renal vein thrombosis
10
Q
Renal artery stenosis
A
- narrowing of the renal artery → dec. blood flow to the kidney Identifiable cause of hypertension
11
Q
Renal artery stenosis etiology
A
- MCC in older men is atherosclerosis
- MCC in young women is fibromuscular dysplasia
- Congenital condition
12
Q
Renal Artery stenosis Dx
A
- Blood and urine tests to evaluate kidney function
- Kidney working or not?
- Kidney US to show kidney size and structure
- Will be shrunken or small
- uDoppler measures blood-flow
- MRA and CT angiography, produce a 3-D image of the kidney and its blood vessels
- Gold standard
13
Q
Management of bilateral stenosis
A
- All pts with significant (>80%) bilateral stenosis or stenosis in a solitary functioning kidney are candidates for revascularization, whether or not they have renal insufficiency.
14
Q
Management of unilateral stenosis with insufficiency
A
- Can revascularize if the objective is recovery of function and prevention of further impairment
- Prerequisites for revascularization are:
- serum creatinine level < 4 mg/dL
- serum creatinine level > 4 mg/dL with recent renal artery thrombosis
15
Q
Management of unilateral stenosis with normal function
A
- revascularization for prevention of insufficiency if:
- degree of stenosis > 80-85%
- degree of stenosis is 50-80%, and captopril-enhanced scintigraphy scan is abnormal
OR
- monitor (Q6 mo duplex scanning), correct dyslipidemia, drugs to block platelet aggregation if:
- stenosis is 50-80%, and scintigraphy findings are negative
- degree of stenosis < 50%
- Has not already progressed too far
16
Q
Renal vein thrombosis
A
- Blood cannot get out of kidney
- Yellow arrow points to blocked renal vein
17
Q
Renal vein thrombosis causes
A
- Nephrotic syndrome – MCC
- B/c hypercoagulable state
- Membranous nephropathy
- DM nephropathy
- Hypercoaguable states
- PCV
- Pregnancy, estrogen therapy
- Protein C, protein S, antithrombin III deficiencies
- Factor V Leiden mutation
- APL syndrome
- Renal tumors
- Extrinsic compression
- Amyloidosis
- Renal vasculitis
- Sickle cell disease
- SLE
- Trauma
- Inflammatory bowel disease
- Dehydration
- Cocaine
- Transplant rejection
18
Q
Renal vein thrombosis signs and symptoms
A
- Renal failure
- N&V
- Flank pain
- Kidney itself does not feel pain
- Capsule is stretched, causing pain
- Hematuria
- Decreased urine output
- Systemic evidence of thromboembolic ds.
19
Q
Renal vein thrombosis Dx
A
- CT
- Fast, sensitive and specific but requires use of nephrotoxic radiocontrast
- Venography
- Gold standard is IVC venography but risks dislodging clots
- Could travel and cause issues elsewhere
- Increasingly, MRV if GFR >30
- Gold standard is IVC venography but risks dislodging clots
- Doppler
- noninvasive but high false + and false - rates
20
Q
Renal vein thrombosis management
A
- Anticoagulation
- Like PE, but in kidney
- Maintenance of renal function
- Treat underlying disorder
- Some patients may need percutaneous thrombectomy/thrombolysis
- Go in and take out/dissolve clot
- Surgical thrombectomy or nephrectomy is needed rarely
- With treatment, prognosis is good
21
Q
Renal infarction
A
- Wedge shaped, yellow = dead
- Think like pulmonary infarct
- If the artery is blocked, all that branches from it is blocked
22
Q
Renal infarction causes
A
- Always due to interruption of blood flow leading to ischemic necrosis of the area supplied by the artery
- MCC = thromboembolism from heart valve, aorta, mural thrombus
- Aorta or renal artery dissection
- Iatrogenic (during angiography)
- Vasculitis
- Malignant HTN
- Renal vein occlusion (usually only in severely dehydrated infants)
- Torsion of transplanted kidney
- Blood supply cut off
23
Q
renal infarction signs and symptoms
A
- Flank pain
- Hematuria
- Proteinuria
- If small, may be asymptomatic
24
Q
Renal Infarct Dx and Tx
A
- CT IVP is modality of choice
- May use sometimes use Doppler which will show absence of blood flow to the area of infarct
- Not as good as CT
- Treatment is uncertain (no good evidence) once infarction has occurred
