Pyelonephritis, Lupus Nephritis Flashcards
2 forms of pyelonephritis
Acute
Chronic
Acute suppurative inflammation of kidney caused by bacteria or viral infection
Acute Pyelonephritis
Disorder in which chronic tubulointerstitial inflammation and renal scarring are associated with pathologic involvement of the calyces and pelvis
Chronic Pyelonephritis
Patchy interstitial suppurative inflammation
Intratubular aggregates of neutrophils
Tubular necrosis
Acute Pyelonephritis
Acute Pyelonephritis complication
Papillary necrosis
Pyonephrosis
Perinephric abscess
An important cause of end-stage kidney disease in adults and kidney destruction in children with severe lower urinary tract abnormalities
Chronic Pyelonephritis
Chronic pyelonephritis forms
Reflux nephropathy - most common
Chronic obstructive nephropathy
Xanthogranulomatous pyelonephritis
Etiology of Pyelonephritis
E coli (75-90%) S saprophyticus (5-15%)
Klebsiella (5-15%)
Enterococcus
Proteus - staghorn calculi, alkaline urine from urease
Citrobacter
Clinical manifestations Mild Pyelonephritis
Low grade fever
With or without lower back or costovertebral angle pain
Severe Pyelonpehritis
Clinical Manifestation
High fever
Rigors
Nausea and vomiting
Flank and/or loin pain
Main feature distinguishing pyelonephritis and cystitis
High, spiking “picket-fence” pattern
Resolves over 72 hours of therapy
Fever
Pyelonephritis Diagnostic Procedures
Urine dipstick test (Nitrite, Leukocyte esterase)
Urinalysis (Pyuria, Hematuria 30%)
Urine culture - Gold Standard
First line therapy for acute uncomplicated pyelonephritis
Highly effective against gram negative and gram positive bacteria
Mechanism: target bacterial DNA gyrasenand Topoisomerase IV
Ciprofloxacin 500mg 1 tab twice a day for 7 days
Prevents reduction of dihydrofolate to tetrahydrofolate
Inhibits bacterial synthesis of dihydrofolate by competing with paraaminobenzoic acid (PABA)
PABA antagonsit
Trimethoprim-Sulfamethoxazole
Most fatal side effect of TMP-SMZ
SJS
Influenced by age, gender, ethnicity, geographic region, diagnostic criteria employed and method of ascertainment
Peaks in incidence in 15-45 years
Females:Males -> 10:1 (less pronounced in children and older individuals)
Affects both genders equally and is more severe in children and men and less so in older adults
Lupus nephritis
Hallmark of pathogenesis of Lupus Nephrotis is
deposition of circulating immune complexes
Lupus Nephritis Pathologic hallmark
Wire loop lesion with granular deposits in subendothelial basement
5 patterns of involvement in SLE LN
Most severe and most common form is
Type IV
Diffuse Proliferative Lupus Nephritis
Wire loop with granular deposits in subendothelial basement
Renal clinical manifestions of LN
Recurrent hematuria Acute nephritis Nephrotic syndrome Chronic Renal Failure Hypertension
LN Type I
Normal
LN Type II
Mesangial Lupus GN
Proliferation of mesangial cells
Type III LN
Focal Proliferative GN
Type IV LN
Diffuse proliferative GN -> (+) Wire-loop capillaries
Type V LN
Membranous GN
thickening of capillary walls
Type VI LN
Advanced scleorsing lupus nephritis
>90 glomerulosclerosis
Most common type of LN
Most severe LN
Hyaline thrombus in one capillary
Global endocapillary proliferation
Lupus Nephritis Class IV
Diffuse proliferative
Lupus Nephritis Tx
Induction and Maintenance
Steroids: Methylprednisone vs Prednisone Cyclophosphamide - hemorrhagic cystitis Mycophenolate mofetil Azathioprine - hematologic CNIs: Cyclosporine, Tacrolimus Rituximab (Anti-CD20) Plasma exchange
Return to near-normal renal function with proteinuria = 330 mg/dl per day
Achieved with treatment, excellent renal outcome
Remission
Hemangioblastoma or cavernous hemangioma of cerebellum, brainstem or retina
Cysts of the liver, kidney, pancreas
Nearly 35% of patients, develop renal cell cancer
Von Hippel Lindau Syndrome
3% of adult malignancies
90-95% of neoplasms arising from the kidney
Characterized by lack of early warning signs, diverse clinical manifestation, resistance to radiation and chemotherapy
Internist’s tumor
Renal cell carcinoma
Hematuria
Flank pain
Abdominal mass
Renal cell carcinoma
Most common type of renal cell carcinoma
Clear cell renal carcinoma
RCC with poor prognosis
Bellini duct Renal Carcinoma
Anaplastic Renal Carcinoma
Four hereditary syndromes associated with Renal Cell Carcinoma
Von Hippel Lindau
Hereditary papillary renal carcinoma
Familial renal oncocytoma
Hereditary renal carcinoma