Tubular and Interstitial Dz Flashcards
Acute Tubular Injury
Ischemic: patchy necrosis in PCT, descending and ascending limbs of loop of Henle
Toxic: continuous necrosis in PCT, descending limb; patchy ascending limb
Mercury: acidophilic inclusion
CCl4 - neutral lipids
Ethylene glycol: ballooning and hydronic/vacuolar degeneration of PCT, Ca2+-oxalate crystals in tubular lumens
Casts obstruct flow - Tamm-Horsfall protein
Tubulorrhexis
Leukocytes in dilated vasa recta
Other causes: hemoglobinuria, myoglobinuria; RAS, endothelia, tubuloglomerular feedback, shock
Progression of ATI clinically
Initiation: 36 hr oliguria, rise in BUN
Maintenance: oliguric crisis, uremia; salt and water overload, hyperkalemia, metabolic acidosis
Recovery: large urine volumes, large water, NA, K loss
Acute Pyelonephritis
Ecoli, Proteus, Klebsiella, Enterobacter (polyomavirus in allografts)
Patchy, interstitial suppurative inflammation - neutrophilic tubulitis, tubular necrosis
focal abscess to wedge like
Candida destroys glomeruli
Abscess formation in cortical surface
Ischemic coagulative necrosis of papilla - gray-white to yellow, outlines of tubules
Pyonephrosis
Perinephritic abscess
jigsaw scaring
Chronic Pyelonephritis
polar scarring, irregular, asymmetric kidney
chronic tubulointerstinal inflammation, scared calyces, pelvis
parenchymal atrophy
reflux nephropathy
Xanthogranulomatous pyelonephritis
foamy macrophages with plasma cells
Proteus
yellow-orange nodules
Analgesic Nephropathy
Type 1 Hypersensitivity - IgE Type 4 - + skin tests to drug haptens Papillary necrosis IgE plasma cells and basophils in lesion Interstitial edema, eosinophils and neutrophils medulla inflammation
Methicillin and thiazides - interstitial nonnecrotizing granulomas
NSAID - minimal change, nephrotic syndrome
Analgesic - papillae necrosis, calcification, fragmentation, sloughing
15 days after exposure
Rash
Rising creatinine or AKI with oliguria
Urate Nephropathy
Acute: uric acid crystals in CD obstructs flow leads to ARF
Cause: tumor lysis syndrome
Chronic - monosodium urate crystals in CD, intersititum
Tophus: birefringement needle like crystals in tubular lumens or interstitial - foreign body giant cells; cortical atrophy and scarring
Nephrolithiasis - uric acid stones
Acute Phosphate Nephropathy
Oral phosphate for colonoscopy prep with dehydration
Calcium phosphate crystals in tubules - renal insufficiency weeks after exposure
Light Chain Cast Nephropathy “Myeloma Kidney”
Bence-Jones proteins + Tamm-Horsfall protein in acidic conditions form tubular casts - obstruct lumen, inflammation, fibrosis (Pink to blue amorphous laminated, fractured)
Casts surrounded by multinucleate giant cells
granulomatous inflammatory run due to tubular rupture
Amyloidosis (AL type) - lambda light chains
K type on GBM, mesangium, tubular BM
Hyperuricemia
Bile cast nephropathy
choleric nephrosis -bile cast distal nephron extend to PT
Yellow-green to pink casts
High serum bilirubin, jaundice
Hepatorenal syndrome
