Renal: Tubular & Interstitial Diseases, Cancer Flashcards
list lab findings in acute tubular necrosis (ATN)
- acute decline in GFR
- serum BUN & creatinine increased
- metabolic acidosis (low HCO3)
- hyperkalemia
- hyperphosphatemia
- anemia (decreased EPO)
describe urinary findings in ATN
- muddy brown granular casts
- epithelial cells casts
- free epithelial cells
- proteinuria (mild)
- microscopic hematuria (mild)
- no pyuria
list physical findings in ATN
- hypotension
- low urine output (oliguria/anuria)
- uremic signs (pericardial friction rub; confusion)
list ischemic causes of ATN
- hypotension
- vasodilatory (septic shock)
- hemorrhagic shock
- hypovolemic shock (vomiting, diarrhea)
list endogenous causes of nephrotoxicity leading to ATN
hemoglobinuria, myoglobinuria
list exogenous causes of nephrotoxicity leading to ATN
aminoglycosides
contrast media; CT/cardiac cath
list the major causes of acute vs. chronic tubulointerstitial nephritis
the pathogenesis of acute drug-induced interstitial nephritis (AIN) is an ____ reaction manifested by interstitial infiltration of ___, ___ and ____
the pathogenesis of acute drug-induced interstitial nephritis (AIN) is an allergic type reaction manifested by interstitial infiltration of eosinophils, lymphocytes and macrophages
the onset of AIN is usually ____ after starting medication which is the first exposure or
____ if second exposure
the onset of AIN is usually 2 weeks after starting medication which is the first exposure or
3-5 days if second exposure
describe what is seen in the urine in AIN
- eosinophils
- sterile pyuria
- WBC casts
- proteinuria (mild)
describe what is seen in blood tests in AIN
- increased BUN & creatinine
- increased eosinophils count
- tubular dysfunction: high K, low HCO3
____ is when bacteria travel retrograde up the ureters to the kidneys, causing pyelonephritis
vesicoureteral reflux is when bacteria travel retrograde up the ureters to the kidneys, causing pyelonephritis
the condition seen in the image is most commonly caused by ____
the condition seen in the image is most commonly caused by E. coli
the condition seen in the image occurs more commonly in which gender? why?
the condition seen in the image occurs more commonly in females due to shorter urethra
describe how the condition in the image can come from the bloodstream
bloodstream: seeding of kidney from sepsis or infective endocarditis
describe the 3 causes of the ascending form of the condition seen in the image
- post-renal obstruction: cervical, prostate or bladder cancer, urethral stricture, kidney stones, vesicoureteral reflux (incompetent valves allow retrograde flow of urine) = hydronephrosis
- neurogenic bladder: autonomic neuropathies, such as diabetes, spinal fractures
- catheter
describe the presentation of the condition seen in the image
- sudden onset of high fever, chills, flank pain, CVA tenderness, dysuria
____ is the most accurate way of diagnosing the condition seen in the image
urine culture is the most accurate way of diagnosing the condition seen in the image
describe what is seen on urine microscopy of the condition seen in the image
- WBCs (neutrophils) & white cell casts
list complications of the condition seen in the image
pyonephrosis, papillary necrosis & perinephric abscess
list the 2 forms of the condition seen in the image
-
chronic obstructive pyelonephritis
- posterior urethral valves
- kidney stones
-
reflux nephropathy (more common):
- vesicoureteral reflux → preferential scarring & calyceal dilatation at poles
describe gross differences in VUR and obstructive forms of the condition seen in the image
-
VUR: preferential scarring & calyceal dilatation at poles
- entire surface of kidney looks abnormal
-
obstructive: diffuse dilatation of calyces & scarring
- abnormality at upper and lower poles of kidney
chronic pyelonephritis leads to “____” of the kidney
explain
chronic pyelonephritis leads to “thyroidization” of the kidney
atrophic tubules contain eosinophilic proteinaceous material reminiscent of thyroid follicles
a complication of the condition seen in the image is that it can progress to ____
a complication of the condition seen in the image is that it can progress to FSGS
describe the pathogenesis of papillary necrosis caused by chronic analgesic abuse
- ingestion of large quantities → papillary damage due to direct toxic effect (acetaminophen)
- ischemic effect of ASA: inhibit PG → abnormal vasoconstriction of intrarenal arteries → chronic tubulointerstitial nephritis
describe what is seen on intravenous pyelogram (IVP) in papillary necrosis
ring defect at the tips of minor calyces
in papillary necrosis caused by pyelonephritis, there is interstitial inflammation that compresses ____
in papillary necrosis caused by pyelonephritis, there is interstitial inflammation that compresses medullary vasculature and leads to ischemia and papillary necrosis
describe the etiology of the condition seen in the image
- BPH
- cervical, prostate or bladder cancer
- kidney stones
- retroperitoneal adenopathy
- papillary necrosis → sloughed off papillae
- strictures
- horseshoe kidney
the condition in the image occurs when there is continued ____ but unable to excrete due to obstruction, which leads to dilatation of ___ and ____
the condition in the image occurs when there is continued glomerular filtration but unable to excrete due to obstruction, which leads to dilatation of renal pelvis and calyces
in the condition in the image, high pressure in pelvis is transmitted through ___ Into the ____ causing _____
in the condition in the image, high pressure in pelvis is transmitted through collecting tubules Into the renal cortex causing renal atrophy
describe the presentation of the condition in the image when it is unilateral vs. bilateral
- unilateral = asymptomatic
- incomplete bilateral = initially polyuria b/c affects ability of tubule to concentrate urine → develop chronic renal failure (waxy casts) and white cell casts → anuria and uremia
list types of renal stones; what is the most common?
describe the pathogenesis of the condition seen in the image
excessive excretion of minerals in urine
the condition in the image becomes symptomatic once it passes into ____
describe symptoms
the condition in the image becomes symptomatic once it passes into the ureters
- renal colic: abrupt onset of flank pain radiating to groin
- superimposed UTI due to urinary stasis
- hydronephrosis due to obstruction of ureter
the overall theme of preventing the condition seen in the image is to decrease ____
what are methods to do this?
the overall theme of preventing the condition seen in the image is to decrease urinary concentration of the causing substance
- increased fluid intake
-
low sodium diet; decrease urinary Ca2+ excretion
- Ca2+ reabsorbed in PCT with Na
-
alkalinization of urine
- increases solubility of uric acid
the condition in the image occurs due to long-standing ____
the condition in the image occurs due to long-standing HTN
the condition in the image occurs when ___ leaks into the ____ causing _____
the condition in the image occurs when plasma proteins leaks into the tunica media causing hyaline arteriosclerosis
in the condition seen in the image, there is ___ and ____thickening
in the condition seen in the image, there is medial and intimal thickening
the presentation of the condition seen in the image is generally ____ with mild ____
the presentation of the condition seen in the image is generally asymptomatic with mild proteinuria
a complication of the condition in the image is that it can progress to ____, with prominent risk factors being ___, ___ and ____
a complication of the condition in the image is that it can progress to chronic renal failure, with prominent risk factors being blacks, high BP and underlying diabetes
diagnosis of the condition seen in the image is by seeing ____ with ___ on urinalysis
diagnosis of the condition seen in the image is by seeing bland urine sediment with mild proteinuria on urinalysis
list extrarenal manifestations of the condition seen in the image
- other manifestations:
- LVH
- retinopathy
- stroke