Sigdel 1&2 Flashcards by Brian Warner

Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN)

Regeneration

Replace fluid in this phase (1/3 fatalities here), regenerations, flattened cells, high NC ration, LOTS OF URINATION HERE

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Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN)

3 phases

Initiation, maintenance, regeneration

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Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN)

Initiation

Degeneration cells, fluid build up, loss of microvilli

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Chronic pyelonephritis

Chronic obstructive pyelonephritis morphology (2nd most common cause)

Multiple irregular scars

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Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN)

Ischemia

Late:

Regeneration, flattened epithelium, dilated lumen, large nuclei with nucleoli

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Pyelonephritis

Chronic findings

Fibrosis, THYROIDIZATION, chronic inflammatory cells, irregular scars, papillae blunting

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Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN)

MC causes

Ischemic and toxic injuries

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Acute pyelonephritis

Gross

Petechiae, renal abscesses, thinned cortex, blunted papilla

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Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN)

Ischemia

Pathology, morphology

Vasoconstriction, dec GFR, TUBULORRHEXIS, has skip areas

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Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN)

Maintenance

Suppression of fxn, oliguria, dialysis (2/3 OF FATALITIES IN THIS PHASE), sloughed cells, apoptosis, necrosis,, cast formation

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Light chain cast nephropathy

Stain for amyloidosis

Congo red stain

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Chronic pyelonephritis

Morphology

Irregular scars (fibrosis) ass. With anatomical abnormalities, blunted calyces

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Acute pyelonephritis

Clinical signs

Systemic signs, costovertebral angle tenderness, WBC CASTS IN URINE

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Xanthogranulomatous Pyelonephritis

Cause

Proteus (don’t confuse with renal cell carcinoma)

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Drug induced interstitial nephritis

Causes

Synthetic penicillins

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Acute pyelonephritis

Histology

Collections of neutrophils and casts

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Drug induced interstitial nephritis

Histology

Eosinophils casts surround tubules

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Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN)

MC phase ass. With fatalities

Maintenance phase

Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN)

Toxic

Causes

Ethylene glycol, mercury, gentamicin, dye

Acute pyelonephritis

MC cause

E. Coli, ascending infxn from bladder (reflux)

Chronic pyelonephritis

Histology

Lymphocytes and plasma cells, fibrosis, THYROIDIZATION (tubular atrophy and dilation)

Light chain cast nephropathy

Urine test for…

M protein (gamma or light chain spike)

Chronic pyelonephritis

MC cause

Reflux nephropathy

Where are casts formed?

Tubules of kidneys (glomerulus)

Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN) Mercury

Large eosinophilic inclusions in necrotic cells, Calcium deposits

Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN) Morphology

Sharp demarcation of corticomedullary jxn. Pale cortex, hyperemic medulla, kidney edema

Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN) Carbon tetrachloride

Neutral lipid inclusions, no Calcium deposits

Light chain cast nephropathy Amyloidosis Congo red stain findings

Apple green birefringent crystals

Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN) Continuous Necrosis at PCT

Toxic type AKI

Light chain cast nephropathy (MM) Disease association

Amyloidosis

Urate nephropathy Histology

Tophus (crystals surrounded by inflammatory cells and giant cells)

NSAIDs nephropathy

Spares GI

Pyelonephritis Acute findings

Neutrophils, edema, neutrophil casts

Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN) Toxic Morphology

Effects PCT, no tubulorrhexis (rupture of basement membrane), uniform involvement/no skip areas

Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN) Ischemia Histology Early:

Fluid build up, casts, degeneration

Light chain cast nephropathy And MM

Plasma cell neoplasm, light chains in urine (BENCE JONES proteins) even effects glomeruli

Light chain cast nephropathy AKA and associated with

"Myeloma kidney" Ass. With multiple myeloma

Analgesic (Phenacetin) Nephropathy Morphology

Papillary necrosis, fibrosis, chronic inflammation

Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN) Patchy necrosis at PCT and DCT

Ischemic type AKI

Acute Kidney Injury (AKI)/Acute Tubular Necrosis (ATN) Ethylene glycol

Oxalate crystal formation (know pic)

Chronic pyelonephritis Reflux nephropathy common presentation and morphology

MC in child with polar renal scars

Light chain cast nephropathy characteristic amyloidosis finding

Punched out lesion (picture)

Drug induced interstitial nephritis Presentation

About 2 weeks after exposure

Vesicoureteral reflux

Ureter enters in at almost right angle so short intravesicle length