Robbins Basic Pathology: Tubulointerstitial nephritis

Question 1

What causes most cases of tubulointerstitial nephritis (TIN)?

Answer 1

Bacterial infection

Question 2

What is interstitial nephritis?

Answer 2

TIN that is non-bacterial in origin

Question 3

What are some major causes of interstitial nephritis?

Answer 3

(1) drugs
(2) metabolic disorders (hypokalemia)
(3) Irradiation
(4) viral infections
(5) immune reactions

Question 4

What is Acute pyelonephritis?

Answer 4

A suppurative inflammation of the kidney and renal pelvis caused by bacterial infection.

Question 5

What are the predisposing factors for acute pyelonephritis?

Answer 5

(1) Female
(2) Foreign objects (eg catheters)
(3) obstruction of urinary tract
(4) Vesiculouretral reflux (VUR) (20-40% of UTI in children
(5) increasing age

Question 6

What are the common causes of acute pyelonephritis?

Answer 6

Gram- enteric rods usually are the causative organism

1) E. coli (most common
(2) proteus
(3) klebsiella
(4) Enterobacter
(5) Psuedomonas

Question 7

What are the complications of cystitis?

Answer 7

Hypertrophy of the bladder wall. Or thinning of the bladder wall due to urine retention.

Question 8

What is the gross pathology associated with acute pyelonephritis?

Answer 8

(1) normal to enlarged kidneys (usually unilateral)

(2) discrete yellow abcesses on the renal surface

Question 9

What are the microscopic findings associated with acute pyelonphritis?

Answer 9

(1) suppurative necrosis beginning in the interstitium and moving to the tubules
(2) Neutrophil white cell casts in the urine
(3) papillary necrosis (more common with diabetes and analgesic abuse.

Question 10

What are the symptoms of acute pyelonephritis?

Answer 10

(1) infection (chills, fever, malaise)
(2) pain at the costovertebral angle
(3) Dysuria
(4) frequency
(5) Urgency

Question 11

What are the signs of acute pyelonephritis?

Answer 11

(1) Pyuria

(2) Bacturia

Question 12

How is acute pyelonephritis diagnosed?

Answer 12

The presence of leukocytes in the urine is most indicative of acute pyelonephritis.

Question 13

What is the prognosis for acute pyelonephritis?

Answer 13

The prognosis is relatively good. The disease is usually self limiting and the symptomatic phase typically clears in a week. However, papillary necrosis is associated with a much poorer prognosis.