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DT3 Exam 2 > Tubular Disease > Flashcards

Tubular Disease Flashcards

1
Q

Types of Acute Tubular Injury?

A

Ischemic

Nephrotic

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2
Q

What is the most common cause of Acute Kidney Injury?

A

Acute tubular injury

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3
Q

Is ATI reversible?

A

Yes 100% if caught early

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4
Q

What causes ATI

A

Epithelium injury causes detaching and obstruction

This leads to a decrease in GFR and O2 delivery

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5
Q

ATI morphology?

A

swollen kidneys

pale cortex

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6
Q

What do you see in Ischemic ATI?

A

Segmental necrosis

Skip areas

Tubulorrhexis

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7
Q

What do you see in Nephrotoxic ATI?

A

Uniform involvement

No tubulorrhexis

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8
Q

Where do you see casts in ATI

A

DCT and CD

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9
Q

Where is the extensive necrosis in nephrotoxix ATI

A

PCT

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10
Q

Initiation phase of ATI?

A

36 hrs

Slight decrease in urine output

inc in BUN

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11
Q

Maintenance phase of ATI?

A

5-7 days

Oliguria (4-400ml/day)

Na/H2O overload with inc BUN

hyperkalemia

acidosis

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12
Q

Recovery ATI phase?

A

10-14 days

steady inc urine volume

vulnerable to infection

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13
Q

What area does acute pyelonephritis effect

A

Lower urinary tract infection

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14
Q

What causes acute pyelonephritis

A

85% gram neg bacilli

E. Coli (Num 1)
Proteus
Klebsiella
Enterobacter

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15
Q

What types of infection can cause acute pyelonephritis

A

Hematogenous

Ascending infection (more common)

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16
Q

Explain ascending infection

A

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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17
Q

In ascending infection, what reflux do we see

A

vesicoureteral reflux

Vesicoureteral valve is incompetent

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18
Q

Test for vesicoureteral reflux

A

voiding cystourethrogram

19
Q

What is the most common cause of tubulonephritis

A

acute pyelonephritis

20
Q

What are white streaks running throught the medulla showing

A

purulent exudate in acute pyelonephritis

21
Q

Signs of acute pyelonephritis

A

fever

costovertebral angle pain and tenderness

UTI

WBC casts

22
Q

Types of chronic pyelonephritis

A

Reflux nephropathy

Chronic Obstructive pyelonephritis

23
Q

Reflux nephropathy is the most common what?

A

cause of pyelonephritic scarring

24
Q

When does Reflux nephropathy occur

A

early childhood from UTI and congenital vesicoureteral and intrarenal reflux

25
Q

What causes chronic obstructive pyelonephritis

A

recurrent infections AND

obstructive lesion

26
Q

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

A

damage at polar ends of kidney

27
Q

What does chronic obstructive pyelonephritis cause

A

blunted calyces

Thyroidization

28
Q

What would you see in Drug induced tubulointerstitial nephritis

A

eosinophils

29
Q

What problem do NSAIDS cause

A

inhibit COX 2

leads to less vasodilation which causes ischemia

30
Q

How long does TIN drug induced take to start

A

~15 days after drug exposure

31
Q

What do you see in TIN drug induced

A

fever

eosinophils

rash

rising creatinine

32
Q

Where do you see acute uric acid nephropathy

A

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

33
Q

What does acute uric acid nephropathy caused by

A

uric acid precipitation in collecting duct

acute renal failure

34
Q

What does chronic urate nephropathy cause

A

aka gouty neuropathy

urate crystals precipitate in distal tubule, collecting duct, and intersititium

interact with giant cells and obstruct tubules

35
Q

What are present in 22% of gout patients

A

uric acid stones (nephrolithiasis)

36
Q

Nephrocalcinosis is caused by

A

deposition of calcium phosphate in tubules

37
Q

What is a multiple myeloma

A

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

38
Q

What is there an abundance of multiple myeloma

A

IgG and IgA

39
Q

What kind of cast is in multiple myeloma

A

light-chain cast nephropathy

40
Q

What causes the casts in multiple myeloma

A

light chains plue Tamm Horsfall proteins

41
Q

Type of proteinuria in multiple myeloma?

A

Bence Jones

42
Q

What are punched out lesions indicitave of

A

punched out lesions

43
Q

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

A

multiple myeloma

44
Q

What are angulated and tubular casts

A

light chain cast nephropathy from multiple meyloma

DT3 Exam 2 (18 decks)

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