Renal14

Question 1

Acute Pyelonephritis.

Answer 1

• Affects cortex with relative sparing of glomeruli
• S/S: Fever, Costovertebral angle tenderness, Nausea, Vomiting
• White Cell Casts in urine are classic

Question 2

Chronic Pyelonephritis.

Answer 2

• Result of reccurent episodes of acute pyelonephritis

- Requires predispostion to infection (i.e., vesicoureteral reflux or chronically obstructing kidney stones)

Question 3

Chronic Pyelonephritis:

-Histo

Answer 3

• Coarse, asymmetric corticomedullary scarring
• Blunted calyx
• Tubules can contain eosinophilc casts (thyroidization of kidneys)

Question 4

Drug-Induced Interstitial Nephritis (tubulointerstitial nephritis).

Answer 4

• Acute interstitial renal inflammation
• Pyuria (classical eosinophils)
• Azotemia
• Follows meds that act as haptens, inducing hypersensitiviey
• Typically occurs 1-2 weeks after drugs
• Can occur months after starting NSAIDs

Question 5

What drugs are associated with Drug-Induced Interstitial Nephritis?

Answer 5

• Diuretics
• Penicillin derivatives
• Sulfonamides
• Rifampin

Question 6

Drug-Induced Interstitial Nephritis (tubulointerstitial nephritis):
-Signs/Symptoms

Answer 6

• Fever
• Rash
• Hematuria
• Costovertebral angle tenderness
• Can be asymptomatic

Question 7

What is Diffuse Cortical Necrosis?

Answer 7

-Acute generalized cortical infarction of both kidneys

Question 8

Diffuse Cortical Necrosis is likely due to a combination of what?

Answer 8

Vasospasm & DIC

Question 9

What is Diffuse Cortical Necrosis associated with?

Answer 9

• Obstetric castastrophes (e.g., abruptio placentae

- Septic shock

Question 10

Histo: Lymphocytic invasion with fibrosis

Answer 10

Chronic pyelonephritis

Question 11

Histo: Neutrophilic infiltration into renal interstitium

Answer 11

Acute pyelonephritis

Question 12

Histo: Acute pyelonephritis

Answer 12

-NEUTROPHILIC infiltration into renal INTERSTITIUM

Question 13

Histo: Chronic pyelonephritis

Answer 13

-LYMPHOCYTIC invasion with FIBROSIS

Question 14

What is the most common cause of intrinsic renal failure?

Answer 14

Acute Tubular Necrosis

Question 15

Acute Tubular Necrosis:

-Stages

Answer 15

1-Inciting event
2-Maintenance phase – Oliguric; lasts 1-3 weeks; Risk of HIGH potassium
3-Recovery phase – Polyruic; BUN and serum creatinine fall; Risk of LOW potassium

Question 16

What is the key finding in Acute Tubular Necrosis?

Answer 16

Granular (“Muddy Brown”) Casts

Question 17

At what stage of Acute Tubular Necrosis does death most often occur?

Answer 17

Phase 2 (Oliguric):

• Lasts 1-3 weeks
• Risk of HIGH K+

Question 18

What is Acute Tubular Necrosis associated with?

Answer 18

• Renal ischemia (e.g., shock, sepsis)
• Crush injury (myoglobinuria)
• Drugs (e.g., Statins)
• Toxins

Question 19

Renal Papillary Necrosis.

Answer 19

• Sloughing of Renal Papillae
• Hematuria
• Proteinuria

Question 20

What is Renal Papillary Necrosis associated with?

Answer 20

Triggered by a recent infection or immune stimulus

• Diabetes Mellitus
• Acute Pyelonephritis
• Chronic Phenacetin use (acetaminohen is phenacetin derivative)
• Sickle cell anemia & trait