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Renal 2 > Robbins Ch. 20 - Tubulointerstitial Disease > Flashcards

Robbins Ch. 20 - Tubulointerstitial Disease Flashcards

1
Q

6 types of tubulointerstitial injury

A
  • Tubular injury (ischemic or toxic)
  • Tubulointerstitial nephritis (inflammation)
  • Acute Pyelonephritis
  • Chronic pyelonephritis
  • Papillary necrosis
  • Nephrolithiasis
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2
Q

Acute tubular injury

2 types?

A

Tubular necrosis –> decreased renal function

  1. Ischemic
  2. Toxic
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3
Q

Ischemic causes of tubular necrosis

A
  • Decreased blood volume (shock, hypotension)

- Renal BV compromise (HTN, microangiopathy, HUS, TTP, DIC)

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4
Q

Tubular necrosis generally occurs where?

A

Proximal convoluted tubule

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5
Q

Tubular necrotic cell cast formation/blockage generally occurs where?

A

DCT and CD

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6
Q

Phases of acute tubular injury

A
  1. Initiation (36 hours, oliguria)
  2. Maintenance (oliguria, uremia, hyperkalemia)
  3. Recovery (polyuria, hypokalemia, infection)
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7
Q

How to tell if patient is in maintenance or recovery phase of acute tubular injury?

A 
Maintenance = hyperkalemia, oliguria
Recovery = hypokalemia, polyuria
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8
Q

Tubulointerstitial nephritis:

Patient presentation

A

Azotemia + polyuria + metabolic imbalances

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9
Q

Acute vs. chronic tubulointerstitial nephritis

A 
Acute = edema, neutrophils, eosinophils
Chronic = lymphocytes, fibrosis, tubular atrophy
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10
Q

Causes of tubulointerstitial nephritis

A
  • Infection (UTI, cystitis, pyelonephritis)
  • Toxins
  • Metabolic disease
  • Obstruction
  • Neoplasm
  • Immuno reaction
  • Vascular disease
  • Other
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11
Q

Infection categories causing tubulointerstitial nephritis

A
  • Acute pyelonephritis (via UTI or hematogenous spread)
  • Chronic pyelonephritis (via VUR or obstruction)
  • UTI (anywhere along the tract)
  • Cystitis (bladder)
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12
Q

Predisposing conditions for acute pyelonephritis

A
  • Vesicoureteral reflux / intrarenal reflux
  • Diabetes
  • Pregnancy
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13
Q

Vast majority of acute pyelonephritis infections arrive how?

A

Via ascension from bladder infection

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14
Q

Vast majority of pyelonephritis infections are from what group of organisms?

A

Own fecal flora (enteric bacteria)

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15
Q

Vast majority of acute pyelonephritis requires the combo of what two things to occur?

A
  1. Ascending cystitis

2. Anatomic defect

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16
Q

Pathology of acute pyelonephritis

A
  • Tubular inflammatory cell infiltration

- Yellow-gray (pus) areas and abscesses on cortical surface

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17
Q

3 complications of acute pyelonephritis

A
  • Papillary necrosis
  • Pyonephrosis (pus in pelvis, calyces, ureter)
  • Perinephric abscess
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18
Q

See acute pyelonephritis + papillary necrosis…

Think ______

A
  • Diabetic
  • Sickle cell
  • Obstruction
19
Q

See acute pyelonephritis + pyonephrosis…

Think ______

A

Obstruction (higher in urinary tract)

20
Q

See damaged renal calyces…

Think ______

A
  • Chronic pyelonephritis

- Analgesic nephropathy

21
Q

Corticomedullary scars in pyelonephritis seen on gross exam of kidneys are due to what?

A

Destruction of papillae and calyces that receives the filtration from that area

22
Q

Foamy macrophages, immune cells, giant cells

Accumulation in the tubulointerstitium

A

Xanthogranulomatous pyelonephritis

- Via PROTEUS infection

23
Q

Initially diagnosed as renal cell carcinoma, then later determined to be pyelonephritis

A

Xanthogranulomatous pyelonephritis via PROTEUS infection

24
Q

Acute drug-induced interstitial nephritis

Other name?

A

Analgesic drug –> IgE-mediated hypersensitivity –> inflammation of papillae –> tubulointerstitial infiltrates/eosinophilia + fever

Analgesic nephropathy

25
Those with analgesic nephropathy may develop what?
Urothelial carcinoma of the renal pelvis
26
Top 2 causes of acute kidney injury
1. Pyelonephritis | 2. Drug-induced tubulointerstitial nephritis
27
Acute uric acid nephropathy (cause)
Leukemia/lymphoma patient + chemotherapy --> nucleic acids released from killed cells --> uric acid build-up
28
Chronic uric acid nephropathy (cause)
Urate deposits (GOUT) --> mononuclear response --> tubular obstruction --> cortical atrophy and scarring
29
Myeloma kidney
Bence-Jones (Ig light chain) proteinuria
30
Benign nephrosclerosis Causes?
- Small vessel hyaline sclerosis --> multifocal ischemia | - Aging, HTN, Diabetes --> intimal thickening due to hemodynamic changes
31
Malignant hypertension - pathophysiology
Renal vascular damage (hemodynamic) --> endothelial injury --> vascular cell death (--> hemorrhage) --> platelet deposition (--> thrombosis) --> fibrinoid necrosis of arterioles --> renal failure
32
What starts the malignant hypertension cycle?
Ischemic damaged kidney --> RENIN --> HTN
33
Gross pathology of malignant hypertension
"Flea-bitten" appearance (via tiny hemorrhages)
34
Pathophysiology of renal artery stenosis Causes?
Decreased perfusion of kidney --> renin --> water retention --> increased blood volume --> HTN exacerbated Atherosclerosis (elderly/obese), fibromuscular dysplasia (young women)
35
Cause of thrombotic microangiopathies 3 types?
Diverse insults --> excess platelet activation --> thrombi in renal capillary beds Typical HUS, Atypical HUS, TTP
36
Triggers for endothelial cell injury that starts the process of thrombotic microangiopathies
Bacterial toxins, cytokines, viruses, medications, anti-endothelial Ab's
37
Typical HUS
Diarrhea due to consuming food w/ Shiga-like toxin - E. coli O157:H7 - CHILDREN
38
Atypical HUS
- NON-diarrheal, inherited mutations in complement regulation - ADULTS - Caused by a variety of endothelial injury (chemo, immunosuppressive drugs, PREGNANCY, etc.)
39
TTP
Mutations in ADAMTS13, dysregulation of vWF - ADULTS - NEUROLOGIC INVOLVEMENT is prominent - Caused by platelet activation/aggregation
40
How to diagnose atypical HUS?
Genetic testing for abnormalities in complement regulators
41
Clinical pentad of TTP (NEED ALL 5)
Fever, neurologic symptoms, microangiopathic hemolytic anemia, decreased platelets, renal failure
42
Most common embolism to reach the kidney and cause necrosis
Mural thrombosis from L heart
43
Sickle cell nephropathy Can also progress to what?
Hematuria + polyuria + patchy papillary necrosis Progressive glomerulosclerosis --> PROTEINURIA/nephrotic syndrome
44
Diffuse cortical necrosis
Obstetric emergency, septic shock, surgery --> microthrombi --> diffuse coagulative CORTICAL necrosis (glomeruli AND tubules)

Renal 2 (11 decks)

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