Tubular Disease Flashcards by Taylor Spry

Types of Acute Tubular Injury?

Ischemic

Nephrotic

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What is the most common cause of Acute Kidney Injury?

Acute tubular injury

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Is ATI reversible?

Yes 100% if caught early

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What causes ATI

Epithelium injury causes detaching and obstruction

This leads to a decrease in GFR and O2 delivery

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ATI morphology?

swollen kidneys

pale cortex

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What do you see in Ischemic ATI?

Segmental necrosis

Skip areas

Tubulorrhexis

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What do you see in Nephrotoxic ATI?

Uniform involvement

No tubulorrhexis

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Where do you see casts in ATI

DCT and CD

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Where is the extensive necrosis in nephrotoxix ATI

PCT

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Initiation phase of ATI?

36 hrs

Slight decrease in urine output

inc in BUN

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Maintenance phase of ATI?

5-7 days

Oliguria (4-400ml/day)

Na/H2O overload with inc BUN

hyperkalemia

acidosis

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Recovery ATI phase?

10-14 days

steady inc urine volume

vulnerable to infection

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What area does acute pyelonephritis effect

Lower urinary tract infection

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What causes acute pyelonephritis

85% gram neg bacilli

E. Coli (Num 1)
Proteus
Klebsiella
Enterobacter

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What types of infection can cause acute pyelonephritis

Hematogenous

Ascending infection (more common)

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Explain ascending infection

acute pyelonephritis

urethra to bladder (women more prone)

bladder to kidney (urine outflow obstruction BPH)

Intrarenal reflux goes to upper and lower poles

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In ascending infection, what reflux do we see

vesicoureteral reflux

Vesicoureteral valve is incompetent

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Test for vesicoureteral reflux

voiding cystourethrogram

What is the most common cause of tubulonephritis

acute pyelonephritis

What are white streaks running throught the medulla showing

purulent exudate in acute pyelonephritis

Signs of acute pyelonephritis

fever

costovertebral angle pain and tenderness

UTI

WBC casts

Types of chronic pyelonephritis

Reflux nephropathy

Chronic Obstructive pyelonephritis

Reflux nephropathy is the most common what?

cause of pyelonephritic scarring

When does Reflux nephropathy occur

early childhood from UTI and congenital vesicoureteral and intrarenal reflux

What causes chronic obstructive pyelonephritis

recurrent infections AND obstructive lesion

If someone has chronic pyelonephritis bc of vesicourethral reflux, what would you see

damage at polar ends of kidney

What does chronic obstructive pyelonephritis cause

blunted calyces Thyroidization

What would you see in Drug induced tubulointerstitial nephritis

eosinophils

What problem do NSAIDS cause

inhibit COX 2 leads to less vasodilation which causes ischemia

How long does TIN drug induced take to start

~15 days after drug exposure

What do you see in TIN drug induced

fever eosinophils rash rising creatinine

Where do you see acute uric acid nephropathy

leukemia or lymphomas when first getting chemo due to nucleic acid release

What does acute uric acid nephropathy caused by

uric acid precipitation in collecting duct acute renal failure

What does chronic urate nephropathy cause

aka gouty neuropathy urate crystals precipitate in distal tubule, collecting duct, and intersititium interact with giant cells and obstruct tubules

What are present in 22% of gout patients

uric acid stones (nephrolithiasis)

Nephrocalcinosis is caused by

deposition of calcium phosphate in tubules

What is a multiple myeloma

plasma cell neoplasme characterized by involvement of the skeleton at mulitple sites

What is there an abundance of multiple myeloma

IgG and IgA

What kind of cast is in multiple myeloma

light-chain cast nephropathy

What causes the casts in multiple myeloma

light chains plue Tamm Horsfall proteins

Type of proteinuria in multiple myeloma?

Bence Jones

What are punched out lesions indicitave of

punched out lesions

What is monoclonal immunoglobulin graph with a super heightened gamma section mean

multiple myeloma

What are angulated and tubular casts

light chain cast nephropathy from multiple meyloma