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D&T 3 Test 3 > Tubular and Interstitial Disease - Sigdel > Flashcards

Tubular and Interstitial Disease - Sigdel Flashcards

1
Q

What space is the kidney found in

A

retroperitoneum

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2
Q

what are the superior and inferior landmark borders of the kidney

A

Superior: T12
Inferior: L3

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3
Q

what part of the kidney is the glomeruli found

A

cortex

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4
Q

what is the tip of the pyramid called

A

papilla

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5
Q

What is the space between pyramids

A

renal column

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6
Q

Gerota’s fascia encompasses what organs

A

adrenal gland and kidney

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7
Q

What is acute renal failure

A

defined clinically as sudden decrease in renal function

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8
Q

oliguria

A

less urine formation

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9
Q

anuria

A

almost no urine

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10
Q

What are 3 separate causes of acute renal failure? Which one is most common

A

prerenal
postrenal - hypovolemia
intrinsic - obstruction, most common

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11
Q

What are some gross features of acute tubular necrosis

A
  • enlarged, swollen kidney

- pale cortex with hyperemic medulla

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12
Q

What are the 2 most common etiology of acute tubular necrosis

A
  1. ischemia

2. toxic injury: exogenous vs. endogenous

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13
Q

ischemia induced acute tubular necrosis is often preceded by what

A

prerenal azotemia

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14
Q

What are early microscopic features of acute tubular necrosis

A
  • cell swelling to focal tubular epithelial necrosis
  • thinning or loss of PAS+ brush border
  • eosinophilic hyaline casts of Tamm-Horsfall protein
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15
Q

What are late microscopic features of acute tubular necrosis

A

epithelial regeneration

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16
Q

What are 3 stages of acute tubular necrosis

A

initiation
maintenance
recovery

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17
Q

What is the clinical feature of acute tubular necrosis in initiation stage

A

brief azotemic period

few hours to few days

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18
Q

What is the morphological feature of acute tubular necrosis in initiation stage

A

interstitial edema
tubular dilation
leukocytes in vasa recta

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19
Q

What is the clinical feature of acute tubular necrosis in maintenance stage

A
  • acute suppression of renal function; oliguria
  • dialysis
  • lasts 5-7 days
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20
Q

What is the morphology feature of acute tubular necrosis in maintenance stage

A 
degeneration 
necrosis 
sloughed cells
apoptosis 
cast formation
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21
Q

What is the clinical feature of acute tubular necrosis in recovery stage

A

profuse diuresis
replacement of losses needed
susceptible to infection
10-14 days

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22
Q

What is the morphology feature of acute tubular necrosis in recovery stage

A

tubular epithelial cell regeneration

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23
Q

what does cell regeneration mean

A

flattened cells with hyperchromatic nuclei, nucleoli, mitosis

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24
Q

What are some common causes of nephrotoxic acute tubular necrosis

A

mercury
carbon tetrachloride
ethylene glycol
lead

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25
Nephrotoxic AKI/ATN some characteristics
1. uniform involvement of proximal nephron ( no skip areas) 2. spares distal nephron 3. to tubulorrhexis
26
What is seen in lead AKI/ATN
- large acidopholic inclusions in nuclei - little calcifcation - no crystal formation
27
What is seen in mercury AKI/ATN
- large eosinophilic inclusions in necrotic cells | - prominent calcification
28
What is seen in carbon tetrachloride AKI/ATN
- neutral lipid inclusions - fatty change - necrosis without calcification
29
What is seen in ethlyene glycol AKI/ATN
oxalate crystal formation | calcification
30
What is the difference between ischemic type tubular necrosis and toxic acute tubular necrosis
Ischemic: short lengths of tubules are impacted Toxic: extensive necrosis is present along the proximal tubules segments (PCT)
31
What is present in ischemic tubular necrosis in histology
Tubulorrhexis
32
What are 3 distinguishing words for ischemic tubular necrosis
1. segmental 2. skip areas 3. tubulorrhexis
33
What causes acute pyelonephritis
gram negative bacilli: E.coli | proteus, klebsiella, enteriobacter
34
What are risk factors for acute pyelonephritis
previous UTI reflux DM pregnancy
35
What are 3 major clinical signs for acute pyelonephritis
- systemic signs - costovertebral angle tenderness - WBC casts
36
Where is costovertebral angle
made by 12th rib and vertebra | kidney is right behind it
37
in acute pyelonephritis what is shown in cortical surfaces
grayish-white areas of inflammation and abscess formation
38
Internally what does acute pyelonephritis look like
white streaks through medulla white blotches in cortex both purulent exudate in tubules and interstitial tissue
39
What does severe acute pyelonephritis look like
thinned cortex | blunted and necrotic papilla
40
What is in tubules and renal substances in acute pyelonephritis
neutrophilic exudate
41
what virus can cause acute pyelonephritis
polyoma virus nephropathy
42
what does polyoma virus look like under EM
Crystalline-like lattices
43
What are 3 complications of pyelonephritis
1. papillary necrosis 2. pyonephrosis 3. perinephric abscess
44
What is the gross appearance of chronic tubulointerstitial disease of chronic pyelonephritis
irregular asymmetric scars with contracted kidney
45
chronic pyelonephritis is always associated with what
anatomic abnormality | - vesicoureteral reflux
46
where are scars usually located for chronic pyelonephritis? what are the scars associated with?
polar ends, associated with underlying blunted calyces
47
What is seen in histology for chronic pyelonephritis
lymphocytes plasma cells interstitial fibrosis thyroidization
48
what is thyroidization
kidney looks like thyroid tissue tubular atrophy dilatation pink filled protein in tubule
49
What are 2 things that can cause chronic pyelonephritis
reflux | obstructive
50
who is more likely to get reflux nephropathy
early childhood
51
what is a characteristic for chronic pyelonephritis caused by reflux
polar scars
52
what is a characteristic for chronic pyelonephritis caused by obstruction
obstruction and blunt calyces
53
What usually causes drug-induced interstitial nephritis
penicillins rifampin diuretics NSAIDS
54
what does Drug-induced interstitial usually begin
begins about 15 days after exposure
55
what is seen in urine for drug-induced interstitial nephritis
eosinophils and eosinophil casts in urine
56
What is seen in histo for drug induce interstitial nephritis
pathcy interstitial inflammation at CM junction with lymphocytes and some eosinophils
57
What is the gross appearance of analgesic (phenacetin) nephropathy ? what response does it induce
papillary necrosis | - scan inflammatory response
58
What is the histo appearance of analgesic (phenacetin) nephropathy
loss/atrophy of tubules | fibrosis
59
what us urate nephropathy
deposition of uric acid crystals | tophus
60
what causes urate nephropathy
elevated uric acid - metabolic disease, chemotherapy , gout
61
What is tophus
inflammatory response with giant cells surrounding uric acid crystals
62
What is nephroscalcinosis
- deposition of calcium phosphate | - basement membrane of Bowman's capsule
63
what happens in late stages in nephroscalcinosis
interstitial fibrosis
64
Light-chain cast nephropathy is associated with what disease
multiple myeloma
65
what is multiple myeloma
plasma cell neoplasm characterized by involvement of skeleton at multiple sites
66
dumps of light-chains in the urine is of what protein
Bence-Jones protein
67
Light-chain cast nephropathy is associated with what other disease
primary amyloidosis
68
what is seen on radiograph for multiple myeloma
punched out defects
69
multiple myeloma has an increase of what protein
M protein
70
what is seen in histo for amyloidosis
pink insular areas
71
what is the stain for amyloidosis
congo red | apple-green biregdrignement crystals
72
how does multiple myeloma impact kidney
- light chains obstruct tubules - inflammatory reaction with giant cells surroudning tubular casts - nephrocalcinosis
73
What can xanthogranulomatous pyelonephritis be confused with? what is xantho?
renal cell carcinoma | benign inflammatory disease
74
what can cause xanthogranulomatous pyelonephritis
proteus and obstructions
75
what does histo look like for xanthogranulomatous pyelonephritis
foamy macrophages
76
Tubulorrhexis
fragmentation of basement membrane

D&T 3 Test 3 (7 decks)

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