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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
Q

Nephrotoxic AKI/ATN some characteristics

A
  1. uniform involvement of proximal nephron ( no skip areas)
  2. spares distal nephron
  3. to tubulorrhexis
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26
Q

What is seen in lead AKI/ATN

A
  • large acidopholic inclusions in nuclei
  • little calcifcation
  • no crystal formation
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27
Q

What is seen in mercury AKI/ATN

A
  • large eosinophilic inclusions in necrotic cells

- prominent calcification

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28
Q

What is seen in carbon tetrachloride AKI/ATN

A
  • neutral lipid inclusions
  • fatty change
  • necrosis without calcification
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29
Q

What is seen in ethlyene glycol AKI/ATN

A

oxalate crystal formation

calcification

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30
Q

What is the difference between ischemic type tubular necrosis and toxic acute tubular necrosis

A

Ischemic: short lengths of tubules are impacted

Toxic: extensive necrosis is present along the proximal tubules segments (PCT)

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31
Q

What is present in ischemic tubular necrosis in histology

A

Tubulorrhexis

32
Q

What are 3 distinguishing words for ischemic tubular necrosis

A
  1. segmental
  2. skip areas
  3. tubulorrhexis
33
Q

What causes acute pyelonephritis

A

gram negative bacilli: E.coli

proteus, klebsiella, enteriobacter

34
Q

What are risk factors for acute pyelonephritis

A

previous UTI
reflux
DM
pregnancy

35
Q

What are 3 major clinical signs for acute pyelonephritis

A
  • systemic signs
  • costovertebral angle tenderness
  • WBC casts
36
Q

Where is costovertebral angle

A

made by 12th rib and vertebra

kidney is right behind it

37
Q

in acute pyelonephritis what is shown in cortical surfaces

A

grayish-white areas of inflammation and abscess formation

38
Q

Internally what does acute pyelonephritis look like

A

white streaks through medulla
white blotches in cortex
both purulent exudate in tubules and interstitial tissue

39
Q

What does severe acute pyelonephritis look like

A

thinned cortex

blunted and necrotic papilla

40
Q

What is in tubules and renal substances in acute pyelonephritis

A

neutrophilic exudate

41
Q

what virus can cause acute pyelonephritis

A

polyoma virus nephropathy

42
Q

what does polyoma virus look like under EM

A

Crystalline-like lattices

43
Q

What are 3 complications of pyelonephritis

A
  1. papillary necrosis
  2. pyonephrosis
  3. perinephric abscess
44
Q

What is the gross appearance of chronic tubulointerstitial disease of chronic pyelonephritis

A

irregular asymmetric scars with contracted kidney

45
Q

chronic pyelonephritis is always associated with what

A

anatomic abnormality

- vesicoureteral reflux

46
Q

where are scars usually located for chronic pyelonephritis? what are the scars associated with?

A

polar ends, associated with underlying blunted calyces

47
Q

What is seen in histology for chronic pyelonephritis

A

lymphocytes
plasma cells
interstitial fibrosis
thyroidization

48
Q

what is thyroidization

A

kidney looks like thyroid tissue
tubular atrophy
dilatation
pink filled protein in tubule

49
Q

What are 2 things that can cause chronic pyelonephritis

A

reflux

obstructive

50
Q

who is more likely to get reflux nephropathy

A

early childhood

51
Q

what is a characteristic for chronic pyelonephritis caused by reflux

A

polar scars

52
Q

what is a characteristic for chronic pyelonephritis caused by obstruction

A

obstruction and blunt calyces

53
Q

What usually causes drug-induced interstitial nephritis

A

penicillins
rifampin
diuretics
NSAIDS

54
Q

what does Drug-induced interstitial usually begin

A

begins about 15 days after exposure

55
Q

what is seen in urine for drug-induced interstitial nephritis

A

eosinophils and eosinophil casts in urine

56
Q

What is seen in histo for drug induce interstitial nephritis

A

pathcy interstitial inflammation at CM junction with lymphocytes and some eosinophils

57
Q

What is the gross appearance of analgesic (phenacetin) nephropathy ? what response does it induce

A

papillary necrosis

- scan inflammatory response

58
Q

What is the histo appearance of analgesic (phenacetin) nephropathy

A

loss/atrophy of tubules

fibrosis

59
Q

what us urate nephropathy

A

deposition of uric acid crystals

tophus

60
Q

what causes urate nephropathy

A

elevated uric acid - metabolic disease, chemotherapy , gout

61
Q

What is tophus

A

inflammatory response with giant cells surrounding uric acid crystals

62
Q

What is nephroscalcinosis

A
  • deposition of calcium phosphate

- basement membrane of Bowman’s capsule

63
Q

what happens in late stages in nephroscalcinosis

A

interstitial fibrosis

64
Q

Light-chain cast nephropathy is associated with what disease

A

multiple myeloma

65
Q

what is multiple myeloma

A

plasma cell neoplasm characterized by involvement of skeleton at multiple sites

66
Q

dumps of light-chains in the urine is of what protein

A

Bence-Jones protein

67
Q

Light-chain cast nephropathy is associated with what other disease

A

primary amyloidosis

68
Q

what is seen on radiograph for multiple myeloma

A

punched out defects

69
Q

multiple myeloma has an increase of what protein

A

M protein

70
Q

what is seen in histo for amyloidosis

A

pink insular areas

71
Q

what is the stain for amyloidosis

A

congo red

apple-green biregdrignement crystals

72
Q

how does multiple myeloma impact kidney

A
  • light chains obstruct tubules
  • inflammatory reaction with giant cells surroudning tubular casts
  • nephrocalcinosis
73
Q

What can xanthogranulomatous pyelonephritis be confused with? what is xantho?

A

renal cell carcinoma

benign inflammatory disease

74
Q

what can cause xanthogranulomatous pyelonephritis

A

proteus and obstructions

75
Q

what does histo look like for xanthogranulomatous pyelonephritis

A

foamy macrophages

76
Q

Tubulorrhexis

A

fragmentation of basement membrane

D&T 3 Test 3 (7 decks)

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