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Medicine > Pyelonephritis, Lupus Nephritis > Flashcards

Pyelonephritis, Lupus Nephritis Flashcards

1
Q

2 forms of pyelonephritis

A

Acute

Chronic

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2
Q

Acute suppurative inflammation of kidney caused by bacteria or viral infection

A

Acute Pyelonephritis

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3
Q

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

A

Chronic Pyelonephritis

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4
Q

Patchy interstitial suppurative inflammation
Intratubular aggregates of neutrophils
Tubular necrosis

A

Acute Pyelonephritis

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5
Q

Acute Pyelonephritis complication

A

Papillary necrosis
Pyonephrosis
Perinephric abscess

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6
Q

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

A

Chronic Pyelonephritis

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7
Q

Chronic pyelonephritis forms

A

Reflux nephropathy - most common
Chronic obstructive nephropathy
Xanthogranulomatous pyelonephritis

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8
Q

Etiology of Pyelonephritis

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

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

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9
Q

Clinical manifestations Mild Pyelonephritis

A

Low grade fever

With or without lower back or costovertebral angle pain

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10
Q

Severe Pyelonpehritis

Clinical Manifestation

A

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

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11
Q

Main feature distinguishing pyelonephritis and cystitis

High, spiking “picket-fence” pattern

Resolves over 72 hours of therapy

A

Fever

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12
Q

Pyelonephritis Diagnostic Procedures

A

Urine dipstick test (Nitrite, Leukocyte esterase)

Urinalysis (Pyuria, Hematuria 30%)

Urine culture - Gold Standard

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13
Q

First line therapy for acute uncomplicated pyelonephritis

Highly effective against gram negative and gram positive bacteria

Mechanism: target bacterial DNA gyrasenand Topoisomerase IV

A

Ciprofloxacin 500mg 1 tab twice a day for 7 days

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14
Q

Prevents reduction of dihydrofolate to tetrahydrofolate

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

A

Trimethoprim-Sulfamethoxazole

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15
Q

Most fatal side effect of TMP-SMZ

A

SJS

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16
Q

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

A

Lupus nephritis

17
Q

Hallmark of pathogenesis of Lupus Nephrotis is

A

deposition of circulating immune complexes

18
Q

Lupus Nephritis Pathologic hallmark

A

Wire loop lesion with granular deposits in subendothelial basement

19
Q

5 patterns of involvement in SLE LN

Most severe and most common form is

A

Type IV
Diffuse Proliferative Lupus Nephritis

Wire loop with granular deposits in subendothelial basement

20
Q

Renal clinical manifestions of LN

A 
Recurrent hematuria
Acute nephritis
Nephrotic syndrome
Chronic Renal Failure
Hypertension
21
Q

LN Type I

A

Normal

22
Q

LN Type II

A

Mesangial Lupus GN

Proliferation of mesangial cells

23
Q

Type III LN

A

Focal Proliferative GN

24
Q

Type IV LN

A

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

25
Q

Type V LN

A

Membranous GN

thickening of capillary walls

26
Q

Type VI LN

A

Advanced scleorsing lupus nephritis

>90 glomerulosclerosis

27
Q

Most common type of LN
Most severe LN

Hyaline thrombus in one capillary
Global endocapillary proliferation

A

Lupus Nephritis Class IV

Diffuse proliferative

28
Q

Lupus Nephritis Tx

Induction and Maintenance

A 
Steroids: Methylprednisone vs Prednisone
Cyclophosphamide - hemorrhagic cystitis
Mycophenolate mofetil
Azathioprine - hematologic 
CNIs: Cyclosporine, Tacrolimus
Rituximab (Anti-CD20)
Plasma exchange
29
Q

Return to near-normal renal function with proteinuria = 330 mg/dl per day

Achieved with treatment, excellent renal outcome

A

Remission

30
Q

Hemangioblastoma or cavernous hemangioma of cerebellum, brainstem or retina

Cysts of the liver, kidney, pancreas

Nearly 35% of patients, develop renal cell cancer

A

Von Hippel Lindau Syndrome

31
Q

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

A

Renal cell carcinoma

32
Q

Hematuria
Flank pain
Abdominal mass

A

Renal cell carcinoma

33
Q

Most common type of renal cell carcinoma

A

Clear cell renal carcinoma

34
Q

RCC with poor prognosis

A

Bellini duct Renal Carcinoma

Anaplastic Renal Carcinoma

35
Q

Four hereditary syndromes associated with Renal Cell Carcinoma

A

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

Medicine (29 decks)

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