SFP: tubulointerstitial diseases/UTI

Question 1

What does PAS stain highlight?

Answer 1

Proteoglycans (basement membrane)

Question 2

What is acute pyelonephritis?

Answer 2

Bacterial infection of kidney and renal pelvis

Question 3

What is chronic pyelonephritis?

Answer 3

Bacterial infection plus scarring

Question 4

what can cause chronic pyelonephritis

Answer 4

reflux or obstruction

Question 5

What can cause UTIs?

Answer 5

Cystitis (bladder infection), pyelonephritis, or both

Question 6

What are ways pathogens can get into the kidney?

Answer 6

1. Ascending infection 2. Through the filtered blood 3. Reflux

Question 7

What are some main predisposing factors for pyelonephritis?

Answer 7

Pregnancy, catheters, diabetes, immunosuppression, BPH, young female

Question 8

Which papillae are more affected by reflux?

Answer 8

Compound papillae

Question 9

Reflux nephropathy impacts…

Answer 9

Upper and lower poles

Question 10

When do we see white cell casts?

Answer 10

Acute pyelonephritis (usually neutrophilic)

Question 11

Describe papillary necrosis.

Answer 11

Rare complication of pyelonephritis that causes ischemic and suppurative necrosis of the tips of renal pyramids

Question 12

What are predisposing conditions for papillary necrosis?

Answer 12

Diabetes, urinary tract obstruction, sickle cell anemia

Question 13

What is the clinical presentation of acute pyelonephritis?

Answer 13

Costovertebral angle pain, fever/chills/malaise, pyuria, dysuria, maybe papillary necrosis

Question 14

What is glomerulosclerosis?

Answer 14

In chronic pyelonephritis can present with glomeruli scarring themselves off

Question 15

What is thyroidization?

Answer 15

It occurs in chronic renal disease and shows up as little pink blobs

Question 16

Focal segmental sclerosis is a complication of…

Answer 16

Reflux nephropathy

Question 17

What is the clinical presentation of cystitis?

Answer 17

Acute/severe onset of urgency and burning, bacteriuria, hematuria, pain/tenderness

Question 18

When is fever seen in cystitis?

Answer 18

If infection has spread to the kidney

Question 19

What is the most common microorganism causing UTI?

Answer 19

UPEC (uropathogenic E. coli)

Question 20

Which microorganism is only found in uncomplicated UTI?

Answer 20

Strep saprophyticus

Question 21

What are virulence factors of uropathogens?

Answer 21

Adhesins!

Question 22

Compare adhesins in uncomplicated vs complicated UTI.

Answer 22

In uncomplicated they cause pathogen binding directly to urothelium, while in complicated the pathogen is usually binding to urinary stones or catheters

Question 23

Describe UPEC.

Answer 23

They are the most common cause of UTI, live intracellularly, and have FimH antigen that acts as an adhesin and P pili that facilitate kidney infection

Question 24

Describe staph saprophyticus.

Answer 24

Part of normal GI flora, causes UTI in young women, and coagulase negative

Question 25

Describe enterococcus and pseudomonas as causes of UTI.

Answer 25

Cause nosocomial UTI post-surgically or with catheters

Question 26

Describe proteus mirabilis.

Answer 26

Has urease that raises pH, forms calcium crystals and magnesium ammonium phosphate precipitates. They also form crystalline biofilms on catheters

Question 27

What is the pharmacologic treatment of uncomplicated UTI?

Answer 27

3 days of TMP/SMX or 5 days nitrofurantoin

Question 28

What is the pharmacologic treatment in complicated cystitis?

Answer 28

Empiric fluoroquinolone for 7-14 days

Question 29

Why can we not leave urine samples on the counter?

Answer 29

They can replicate and make an inaccurate sample

Question 30

What may be the first sign of UTI in the elderly?

Answer 30

Delirium

Question 31

What virus causes tubular interstitial injury in kidney transplant patients?

Answer 31

BK polyomavirus

Question 32

What drug can be associated with drug induced interstitial nephritis?

Answer 32

NSAIDs

Question 33

What is the most common cause of acute drug-induced interstitial nephritis?

Answer 33

PPIs

Question 34

What is seen histologically in acute drug induced interstitial nephritis?

Answer 34

Looks allergic, eosinophils!

Question 35

What labs would support tubulointerstitial disease diagnosis?

Answer 35

Increased creatinine/BUN, renal tubule acidosis, hyper or hypokalemia, proteinuria

Question 36

What might be the clinical presentation of acute drug induced interstitial nephritis?

Answer 36

Fever and rash 15 days after medication use

Question 37

What is analgesic nephropathy?

Answer 37

Caused by excessive intake of things like aspirin, coffee, caffeine, acetaminophen

Question 38

What is the pathology of analgesic nephropathy?

Answer 38

Renal papillary necrosis and chronic interstitial nephritis

Question 39

What is seen microscopically in analgesic nephropathy?

Answer 39

Coagulative necrosis of the medulla (no nuclei visible)

Question 40

Which condition increases risk of urothelial cancer of renal pelvis?

Answer 40

Analgesic nephropathy

Question 41

What conditions in the kidney are associated with NSAIDs?

Answer 41

Acute interstitial nephritis, minimal change disease, renal papillary necrosis

Question 42

What does Balkan nephropathy lead to?

Answer 42

Tubulointerstitial and end stage renal diseases

Question 43

Describe the presentation of acute phosphate nephropathy.

Answer 43

Renal insufficiency several weeks after exposure

Question 44

Where does calcium phosphate deposit?

Answer 44

In the renal tubules

Question 45

Describe lithium toxicity.

Answer 45

Can lead to mild-moderate tubulointerstitial disease and possibly end stage renal disease. Lithium drug and AKI may lead to this!

Question 46

What is the earliest renal finding of sickle cell disease?

Answer 46

Loss of urine concentrating ability

Question 47

Describe sickle cell in the kidney.

Answer 47

Low oxygen tension in the medulla leads to sickling and fibrosis

Question 48

What can cause acute tubular injury?

Answer 48

Ischemia and toxins