Pathology 2

Question 1

What happens in acute disease to the interstitium?

Answer 1

The interstitium will swell

Question 2

What is the difference in cell structure between the distal and proximal tubule?

Answer 2

Microvilli

Question 3

What is the most common type of kidney disease?

Answer 3

Tubulointerstitial diseases

Question 4

What are the most important causes of tubulointersititial injury

Answer 4

Ischemic
Infection
Acute or Chronic Tubulointerstitial Nephritis

Question 5

What usually causes Acute tubular necrosis?

Answer 5

Almost always due to ischaemia

Question 6

What happens to dead cells in the tubules?

Answer 6

Epithelial cells degenerate and detach from tubular basement membrane (slough off)

Question 7

What is the result of acute tubular necrosis?

Answer 7

Without functioning epithelium the tubule can no longer fulfil its functions: the glomerular filtration rate falls, electrolyte balance fails, urea and creatinine accumulate in blood etc.

Question 8

Is ATN reversible?

Answer 8

ATN is a reversible lesion; if the patient is supported (which may mean dialysis) regeneration and complete recovery occur but may take weeks

Question 9

What is associated with recovery from ATN?

Answer 9

Recovery is often associated with diuresis (increased production of urine)

Question 10

What are some causes of delayed function after renal transplant?

Answer 10

– Problems due to the transplantation procedure (particularly ischaemia)
– Early rejection (can happen very early)
– Drug toxicity (many immunosuppressive drugs unfortunately potent nephrotoxins !)
– Recurrent primary disease (though it would be very early !)

Question 11

What is the distinction between hypoperfusion and ischemic ATN?

Answer 11

Hypoperfusion is ischemia for a short time, ATN is the same process over an extended period which causes necrosis of tubular epithelium – it’s no longer just a lack of raw material, it’s damage to the machinery (which now needs repair before it can work again).

Question 12

Seen with toxins that affect tubular epithelium?

Answer 12

– Heavy metals (esp. mercury)
– Some antibiotics
– Some cancer chemotherapy drug

Question 13

How does Acute interstitial nephritis present?

Answer 13

Usually presents as acute renal failure, sometimes with some blood or protein in urine

Lymphocytes are seen under the microscope

Question 14

How do drugs cause ATN?

Answer 14

Very often due to drug allergy (e.g. antibiotics)

Question 15

What is Pyelon?phritis

Answer 15

Bacterial infection that affects the kidney

Question 16

What part of the nephron are usually infected by bacteria?

Answer 16

Everything except glomerulus

Question 17

What type of infection is pyelonephritis?

Answer 17

Almost always gram negative

Ascending infection

Question 18

What are the symptoms of pyelonephritis?

Answer 18

– Acute onset
– Fever, chills, lumbar tenderness and pain
– Discomfort when urinating (and frequency)

Question 19

Is kidney function maintained in Pyelonephritis?

Answer 19

Renal function usually preserved. Hypertension not a component

Question 20

Most common gram negative causes of Pyelonephritis?

Answer 20

– E. coli
– Klebsiella sp.
– Proteus sp.
– Pseudomonas sp

Question 21

What causes Chronic Pyelonephritis?

Answer 21

Generally obstruction

Question 22

What occurs as the result of Chronic Pyelonephritis?

Answer 22

Results in interstitial scarring, tubular atrophy, depressed ‘saddle shaped’ scars visible on the renal surface

Question 23

What is reflux nephropathy?

Answer 23

Renal damage due to backflow (NOT obstruction) of urine from the lower tract

Question 24

what is Analgesic nephropathy?

Answer 24

A chronic, progressive tubulo-interstitial disease induced by the prolonged use of particular analgesics

Question 25

What is end stage kidney disease?

Answer 25

Kidneys that are no longer able to perform their tasks, particularly the maintenance of urea and creatinine levels in blood

Question 26

What is the treatment of ESKD?

Answer 26

Treatment requires some form of renal replacement therapy (Dialysis or Transplantation)

Question 27

What happens if ESKD is untreated?

Answer 27

Untreated they lead to worsening ureamia and death

Question 28

What does an ESKD look like macroscopically?

Answer 28

Shrunken, pitted and scarred kidney

Question 29

Causes of dialysis and transplant in Australia?

Answer 29

–32% diabetic nephropathy
–24% glomerulonephritis
–14% hypertension
– other include Analgesic Nephropathy, inherited conditions, chronic pyelonephritis, reflux nephropathy

Question 30

What percentage of the kidney needs to be destroyed to be symptomatic?

Answer 30

90%

Question 31

How do we deal with kidney disease?

Answer 31

Need to tackle the causes