renal disease II

Question 1

Acute Pyelonephritis

Answer 1

AKA: tubulointerstitial nephritis
suppurative inflammation in the renal pelvis, tubules and interstitium caused by bacterial infection
-neutrophil infiltration, clustering in the tubular lumens
-sudden onset of pain at the costovertebral angle

Question 2

Drug induced interstitial nephritis

Answer 2

caused by AB, NSAIDS and duiretics

Question 3

pathogenesis of drug induced interstitial nephritis

Answer 3

hypersensitive, drug binds to tubular or interstitial cells and act as a hapten with an immunogenic response (eosinophils and PMNs)
-glomeruli NOT involved

Question 4

clinical drug induced intersitial nephritis

Answer 4

rapid onset  ( 2 to 40 days)
 fever, eosinophilia, renal dysfunciton with HEMATURIA but no real protenuria

Question 5

pathologic findings of drug induced interstitial nephrtis

Answer 5

interstitial mononuclear cell infiltration and edema, eosinophils, non-nectroitizing granulomas, dilation of tubules, necrosis of epithelium

Question 6

drug induced interstitial nephritis prognosis

Answer 6

generally good, full recovery (6 - 8 weeks) with removal of the drug and corticosteroids

Question 7

Acute tubular necrosis

Answer 7

clinical and path condition where renal funciton declines rapidly with evidence of tubular epithelial damage/necrosis from ischemia (shock) or toxin
-acute kidney injury - oliguria (1/4-1/2 normal pee), electroylte imbalance and decreased GFR

Question 8

what causes acute tubular necrosis

Answer 8

severe trauma, ischemia, septicemia, toxins

Question 9

features of acute tubular necrosis

Answer 9

dilation of tubules, edema, necrosis of tubular epithelium

• focal pathology with ischemic injury
• diffuse injury from a toxin

Question 10

tx of acute tub necrosis

Answer 10

supporative care, dialysis
prognosis is the absence of preexisting kidney disease fully recover, harder when other kindey disease present
-regeneration of tubular epithelium in a few weeks

Question 11

Arterionephrosclerosis

Answer 11

thickening and sclerosis of renal arteries associated with benign hypertension
apolipoprotein L1 gene deficiency - malignant form

Question 12

pathology of arterionephrosclerosis

Answer 12

• grossly small kidney / atrophic (granular), thin cortex
• hylaine arteriosclerosis and fivroelastic hyperplasia in mm. arteries (benign form)
• hyperplasia artherioslcerosis (malignant form)
• tubular atrophy and fibrosis
• global sclerosis of glomeruli

Question 13

contributing factors arterionephrosclerosis

Answer 13

• malignant hypertension (200/120) assoc with the malignant hyperplastic arteriosclerosis form
• diabetes

Question 14

clinical arterionephrosclerosis

Answer 14

cranial pressure, proteinuria, ischemia leading to acute kidney injury

Question 15

thrombotic microangiopathies

Answer 15

TTp (thrombotic thrombosytopenia purpura) and hemolytic uremic syndrome (HUS)
-widespread microthrombi in capillaries with RBC damage (schistocytes)

Question 16

HUS

Answer 16

endothelial cell injury leads to comsumption of platelets and activation

• mainly from shiga toxin of e. coli
• often occurs in children

Question 17

TTP

Answer 17

acquired or inherited defect of ADAMTS (plasma protease) - degrades vWF, activates platelets

Question 18

difference in HUS and TTP

Answer 18

HUS predominately kidney, TTP can affect other organs (widespread)

Question 19

Urolithiasis

Answer 19

aka renal stones

• result in urinary tract obstruciton, ulceration and urothelial bleeding
• small stones to ureters and produce flank pain (serious)
• large stones remain in the pelvis and may be manifested by hematuria and superimposed infection

Question 20

pathology urolithiasis

Answer 20

stones are unilarteral 80% of the time within calyces and pelvis (maybe bladder)

Question 21

staghorn calculi

Answer 21

large stones will form a cast of the pelvis and calyceal system

Question 22

types of stones

Answer 22

calcium (increased pee calcium), magnesium ammonium phosphate (infection with proteus or staph pre-disposes and alkaline pee)and uric acid (gout, leukemia or acidic urine)

Question 23

Hydronephrosis

Answer 23

dilation of renal pelvis/calyces with parenchymal atrophy becasue of obstruction

Question 24

causes of hydronephrosis

Answer 24

renal stones, UTI, enlarged prostate, neoplasms, meurogenic bladder, pregnancy

Question 25

renal cell carcinoma risk factors

Answer 25

older adult males
-smoking, hypertension/obesity, aqcuired polycystic disease from chronic dialysis, cadmium exposure and von hippel-lindau syndrome

Question 26

clinical renal cell carcinoma

Answer 26

hematuria, mass, pain, fever, polycythemia (tumor producing erythropoietin) and paraneoplastic syndromes

Question 27

pathology renal cell carcinoma

Answer 27

tumor invades renal vein from tubular epithelium, pale/clear forms common (large size prior to diagnosis)

Question 28

Wilms tumor/ nephroblastoma

Answer 28

one of the most common cancers in children

-abdominal mass, pain - increased frequency in inherited syndromes

Question 29

pathology wilms tumor

Answer 29

triphasic prolif cells with epi, stromal and blastemal components - busy looking
-appears like early nephron formation

Question 30

tx wilms tumors

Answer 30

surgery and chemo

• very good prognosis
• 92 - 95 % 5 year survival rate

Question 31

spread of acute pyelonephritis

Answer 31

-spread from urinary bladder, up the ureters and into the renal pelvis
ASCENDING
-can also spread hematongenously

Question 32

acute pyelonephritis etiology

Answer 32

urinary tract obstruciton, instrumentation, vesicoureteral reflux, pregnancy, gender (female) and age, diabetes and immune supression

Question 33

repeated bouts of pyelonephritis

Answer 33

lead to chronic pyelonephritis

-mononuclear inflammatory inflammation and irregular scarring

Question 34

large doses of analgesics may lead to..

Answer 34

interstitial drug induced nephritis with papillary necrosis

Question 35

clinical presentation of arterionephrosclerosis malignant form

Answer 35

rapid onset of renal failure, increased cranial pressure (naseau, vomiting and visual impairment and protenuria

Question 36

frequency of stones

Answer 36

by age 70, 11% of men and 6% of women will have had kidney stone

Question 37

renal cell carcinoma prognosis

Answer 37

stage dependent survival
stage 1 - 81%
stage 4 - 8%
tx: surgery ad radiation