Renal 2

Question 1

• A complication of pyelonephritis seen in diabetics w/ acute pyelonephritis

Answer 1

Renal Papillary Necrosis

Question 2

• Necrosis of renal papillae is a combo of ischemia and necrosis at the tips of renal pyramids
• Gross feature of necrotizing papillitis is sharply defined gray-white to yellow necrosis of apical 2/3 of the pyramids
• Tips can break off and go into pyramids and into ureters and cause a blockage

Answer 2

Renal Papillary Necrosis

Question 3

Renal Papillary Necrosis can lead to what?

Answer 3

Hydronephrosis (swelling of a kidney due to a build-up of urine)

Question 4

• Recurrent infections superimposed on obstructive lesions leads to recurrent bouts of interstitial inflammation and scarring
• May evolve from acute pyelonephritis
• Can cause chronic renal failure (esp if obstruction is cause)

Answer 4

Chronic Pyelonephritis

Question 5

• Loss of renal tissue, kidneys become small/irregularly scarred
• One or both kidneys is involved (which is more common?)

Answer 5

• Chronic Pyelonephritis
• Usually just 1 kidney

Question 6

What is the “hallmark” of chronic pyelonephritis?

Answer 6

Scarring involving the pelvis or calyces (or both), leading to papillary blunting and calyceal deformities

Question 7

• Micro: Interstitial fibrosis w/ mononuclear cell infiltration
• Dilation & contraction of tubular lining epithelium w/ atrophy of cells
• Dilated tubules w/ pink, glassy colloid casts (suggest appearance of thyroid tissue) –> thyroidization

Answer 7

Chronic Pyelonephritis

Question 8

• Proliferative arteriosclerosis
• Blood vessels, tubules, and interstitium are all affected, (so renal function is affected)

Answer 8

Chronic Pyelonephritis

Question 9

What is the #1 cause of acute renal failure?

Answer 9

Acute Tubular Necrosis

Question 10

• Destruction of tubular epithelial cells w/ acute suppression of renal function
• Sudden decrease in arterial pressure will result in acute hypoperfusion of kidney w/ blood

Answer 10

Acute Tubular Necrosis

Question 11

Typically occurs after an MI, all causes of cardiac arrest, and all forms of hypotensive shock

(Hypoxia)

Answer 11

Acute Tubular Necrosis

Question 12

• W/ Acute Tubular Necrosis (ATN), where is the reduction of blood flow most prominent?
• What is most affected by the ischemia?

Answer 12

• Blood flow reduction: Cortex
• Ischemia: Corticol tubules

Question 13

• What are Tamm-Horsfall proteins and what are they associated with?

Answer 13

• Proteinaceous casts in the distal tubules & collecting ducts
• Acute Tubular Necrosis (ATN)

Question 14

Is ATN reversible?

Answer 14

Yes, regenrates w/ new simple cuboidal cells that make up the tubules***

But, some people have to go on dialysis until recovery of tubules is complete…

Question 15

• Which 2 types of ATN are treatable/reversible?
• How long until kidneys are functional again?
• Which type of ATN is non-reversible?

Answer 15

• Hypoxic/Anoxic
• 2 days
• Toxic (destroys kidney)

Question 16

Which condition is seen in patients who attempt suicide w/ driniing radiator fluid?

Answer 16

ATN w/ disruption of basement membrane

(replaced by fibrosis, nephrotoxic)

Question 17

• What is the #1 organ affected by DM?
• Which type of DM?

Answer 17

• Kidneys
• Insulin dependent