Renal Pathology IV Flashcards
What is the most common cause of acute kidney failure?
Acute Tubular Injury
What are signs of AKI/ATI?
Rapid reduction of renal function and urine flow (oliguria), uremia and signs of fluid overload
Where does acute tubular injury generally occur?
PT
What does ischemic tubular injury look like?
Focal, with small parts scattered throughout
What does toxic tubular injury look like?
Diffuse, large sections show injury
What is the typical presentation of ATI?
Injury with large amount of blood loss
What are some of the causes of ischemic ATI?
BP drop, severe trauma, acute pancreatitis
What are some of the causes of toxic ATI?
Drugs (antibiotics), contrast dyes, poisons (heavy metal), organic solvents
What ar some of the causes of tubulointerstitial nephritis?
o infections, acute and chronic
o drugs and toxins
o metabolic diseases (urate, oxalate, hypercalcemia)
o neoplasms (multiple myeloma)
What can cause acute pyelonephritis?
Acute pyelonephritis can be caused either by ascending infection or by hematogenous spread of bacteria
What causes vesicoureteral reflux?
Incompetence of the vesicoureteral valve
What are some of the signs of acute pyelonephritis?
Sudden onset, costovertebral angle pain, fever, malaise, urosepsis in severe infection
What is the pathogenesis of acute pyelonephritis?
Acute inflammation with PMNs in tubules & interstitium
What are some of the possible causes of papillary necrosis?
- analgesics
- diabetes
- sickle cell anemia
- obstruction
- TB (tuberculosis)
What is the main cause of chronic pyelonephritis?
Bacterial infection
What is xanthogranulomatous pyelonephritis?
A distinct form of pyelonephritis typically associated with infection by Proteus, obstruction and stones. Clinically and radiologically may mimic cancer!
What are some of the clinical presentations of acute drug induced interstitial nephritis?
Rash (25% of cases)
Acute renal failure
Acute drug-induced interstitial nephritis - pathogenesis
Drugs act as haptens, which covalently bind to cells and become immunogenic. IgE and/or cell-mediated immune reactions to tubular cells/their basement membrane
What is often an abundant cell type in Acute drug-induced interstitial nephritis?
Eosinophils
What are some drugs that can cause Acute drug-induced interstitial nephritis?
- NSAIDs
- Chinese herbs
- Antibiotics
What is the causative agent of Chinese herb nephropathy?
Due to aristolochic acid
Oxalate nephropathy causes
- Bariatric srugery
- Glycol intoxication
What is the clinical presentation of thrombotic microangiopathy?
- microangiopathic hemolytic anemia
- thrombocytopenia
- renal failure
A 26 yo female is discovered to have elevated serum creatinine level.
She has been healthy, well nourished. In fact she has been trying to shed some weight but with no great success…
a. You suspect cancer as a cause of her renal failure
b. You ask her about all her prescription medications
c. She probably has reflux nephropathy
d. She has acute pyelonephritis
e. You ask her about her about herbal preparations
e. You ask her about her about herbal preparations
A 32 yo computer programmer presents with generalized edema and unintentional weight gain. In general he has been healthy. Only recently he complained of a lower back pain during a period requiring long hours at the computer… However, the pain was relieved with some over the counter meds. His urinalysis shows 3+ protein, his serum creatinine is
5.0 MG/DL [n=0.7-1.5]. You are suspecting that …
a. His biopsy will show crescents
b. His biopsy will look normal by light microscopy
c. His biopsy will show subepithelial deposits
d. He most likely has interstitial nephritis and minimal change disease
e. He has postinfectious glomerulonephritis
d. He most likely has interstitial nephritis and minimal change disease
•A 7 yo boy developed malaise followed by bloody diarrhea. He was previously healthy with a good appetite and he really enjoyed his hamburger, which his father bought him from a street stand…His mother noticed that his urine turned red and was also diminished in volume…His kidney biopsy will show:
a. subepithelial hump-like deposits
b. IgA deposits in glomeruli
c. Crescents in >50% of glomeruli
d. IgA deposits in glomeruli and skin capillaries
e. Thrombi in glomerular capillaries
e. Thrombi in glomerular capillaries
A 7 yo boy developed malaise followed by bloody diarrhea. He was previously healthy with a good appetite and he really enjoyed his hamburger, which his father bought him from a street stand…His mother noticed that his urine turned red and was also diminished in volume
The clinical studies most likely will show:
a. renal failure
b. thrombocytopenia
c. schistocytes (fragmented red blood cells) in peripheral blood smears
d. all of the above
d. all of the above
A retired dentist developed a sudden onset of a severe flank pain radiating to the back with nausea and vomiting. Urinalysis showed 10–15 red blood cells per high power field.
He denied any history of alcohol or recreational drug use.
His past medical history includes type 2 diabetes and hypertension.
Ten days ago he underwent an elective surgery for carotid artery stenosis. What should be considered in the differential diagnosis?
a. Nephrolithiasis
b. Ischemic bowel disease
c. Renal infarction
d. All of the above
d. All of the above
Patient described in a previous case passed spontaneously a stone. What would be the best choice?
a. Send stone to pathology for chemical analysis
b. Send stone to pathology for photographic analysis
c. Most likely atheromatous stone
d. Give back stone to patient for safe keeping
e. Discard the stone if patient is not interested in keeping it
a. Send stone to pathology for chemical analysis
A 44 yo male experienced worsening headache, nausea and vomiting over the last 3 days. He had started “seeing spots” before his eyes
PE: BP= 220/135 mmHg, there was also bilateral papilledema
UA: 2+ protein, 1+ hematuria, glucose (-), ketones (-)
The serum creatinine levels were elevated. Which is the best choice?
a. Malignant brain tumor
b. Thromboembolic event
c. Fibrinoid necrosis
d. Food poisoning
e. Acute onion skin changes
c. Fibrinoid necrosis
