Pyelonephritis, Lupus Nephritis

Question 1

2 forms of pyelonephritis

Answer 1

Acute

Chronic

Question 2

Acute suppurative inflammation of kidney caused by bacteria or viral infection

Answer 2

Acute Pyelonephritis

Question 3

Disorder in which chronic tubulointerstitial inflammation and renal scarring are associated with pathologic involvement of the calyces and pelvis

Answer 3

Chronic Pyelonephritis

Question 4

Patchy interstitial suppurative inflammation
Intratubular aggregates of neutrophils
Tubular necrosis

Answer 4

Acute Pyelonephritis

Question 5

Acute Pyelonephritis complication

Answer 5

Papillary necrosis
Pyonephrosis
Perinephric abscess

Question 6

An important cause of end-stage kidney disease in adults and kidney destruction in children with severe lower urinary tract abnormalities

Answer 6

Chronic Pyelonephritis

Question 7

Chronic pyelonephritis forms

Answer 7

Reflux nephropathy - most common
Chronic obstructive nephropathy
Xanthogranulomatous pyelonephritis

Question 8

Etiology of Pyelonephritis

Answer 8

E coli (75-90%)
S saprophyticus (5-15%)

Klebsiella (5-15%)
Enterococcus
Proteus - staghorn calculi, alkaline urine from urease
Citrobacter

Question 9

Clinical manifestations Mild Pyelonephritis

Answer 9

Low grade fever

With or without lower back or costovertebral angle pain

Question 10

Severe Pyelonpehritis

Clinical Manifestation

Answer 10

High fever
Rigors
Nausea and vomiting
Flank and/or loin pain

Question 11

Main feature distinguishing pyelonephritis and cystitis

High, spiking “picket-fence” pattern

Resolves over 72 hours of therapy

Answer 11

Fever

Question 12

Pyelonephritis Diagnostic Procedures

Answer 12

Urine dipstick test (Nitrite, Leukocyte esterase)

Urinalysis (Pyuria, Hematuria 30%)

Urine culture - Gold Standard

Question 13

First line therapy for acute uncomplicated pyelonephritis

Highly effective against gram negative and gram positive bacteria

Mechanism: target bacterial DNA gyrasenand Topoisomerase IV

Answer 13

Ciprofloxacin 500mg 1 tab twice a day for 7 days

Question 14

Prevents reduction of dihydrofolate to tetrahydrofolate

Inhibits bacterial synthesis of dihydrofolate by competing with paraaminobenzoic acid (PABA)
PABA antagonsit

Answer 14

Trimethoprim-Sulfamethoxazole

Question 15

Most fatal side effect of TMP-SMZ

Answer 15

SJS

Question 16

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

Answer 16

Lupus nephritis

Question 17

Hallmark of pathogenesis of Lupus Nephrotis is

Answer 17

deposition of circulating immune complexes

Question 18

Lupus Nephritis Pathologic hallmark

Answer 18

Wire loop lesion with granular deposits in subendothelial basement

Question 19

5 patterns of involvement in SLE LN

Most severe and most common form is

Answer 19

Type IV
Diffuse Proliferative Lupus Nephritis

Wire loop with granular deposits in subendothelial basement

Question 20

Renal clinical manifestions of LN

Answer 20

Recurrent hematuria
Acute nephritis
Nephrotic syndrome
Chronic Renal Failure
Hypertension

Question 21

LN Type I

Answer 21

Normal

Question 22

LN Type II

Answer 22

Mesangial Lupus GN

Proliferation of mesangial cells

Question 23

Type III LN

Answer 23

Focal Proliferative GN

Question 24

Type IV LN

Answer 24

Diffuse proliferative GN -> (+) Wire-loop capillaries

Question 25

Type V LN

Answer 25

Membranous GN | thickening of capillary walls

Question 26

Type VI LN

Answer 26

Advanced scleorsing lupus nephritis | >90 glomerulosclerosis

Question 27

Most common type of LN Most severe LN Hyaline thrombus in one capillary Global endocapillary proliferation

Answer 27

Lupus Nephritis Class IV | Diffuse proliferative

Question 28

Lupus Nephritis Tx | Induction and Maintenance

Answer 28

``` Steroids: Methylprednisone vs Prednisone Cyclophosphamide - hemorrhagic cystitis Mycophenolate mofetil Azathioprine - hematologic CNIs: Cyclosporine, Tacrolimus Rituximab (Anti-CD20) Plasma exchange ```

Question 29

Return to near-normal renal function with proteinuria = 330 mg/dl per day Achieved with treatment, excellent renal outcome

Answer 29

Remission

Question 30

Hemangioblastoma or cavernous hemangioma of cerebellum, brainstem or retina Cysts of the liver, kidney, pancreas Nearly 35% of patients, develop renal cell cancer

Answer 30

Von Hippel Lindau Syndrome

Question 31

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

Answer 31

Renal cell carcinoma

Question 32

Hematuria Flank pain Abdominal mass

Answer 32

Renal cell carcinoma

Question 33

Most common type of renal cell carcinoma

Answer 33

Clear cell renal carcinoma

Question 34

RCC with poor prognosis

Answer 34

Bellini duct Renal Carcinoma | Anaplastic Renal Carcinoma

Question 35

Four hereditary syndromes associated with Renal Cell Carcinoma

Answer 35

Von Hippel Lindau Hereditary papillary renal carcinoma Familial renal oncocytoma Hereditary renal carcinoma