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renal > tubule-interstitial diseases of the kidney > Flashcards

tubule-interstitial diseases of the kidney Flashcards

1
Q

what kind of kidney injury are tubulointerstitial diseases?

A

intrinsic kidney injury

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2
Q

acute tubulointerstitial nephritis definition

A

an acute inflammation of the renal interstitial and tubules that causes a decline in renal function over days to weeks

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3
Q

acute interstitial nephritis urine findings

A

WBCs, eosinophils

WBC casts

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4
Q

acute tubular necrosis urine findings

A

muddy brown granular casts

renal tubular epithelial cells/casts

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5
Q

Acute tubular injury/necrosis pathophys

A

ischemic or toxic injury to tubular cells causes cells to swell and undergo apoptosis/necrosis
cell debris obstructs tubules leading to decreased GFR

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6
Q

ischemic causes of ATN

A

blood loss
hypotension
septic shock
aortic surgery

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7
Q

toxic causes of ATN

A 
radiocontrast
abx: aminoglycosides
amphotericin B
antivirals
Chemo (cisplatin)
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8
Q

presentation of ischemic ATN

A

low BP
shock syndrome
blood loss signs
oliguria (<400ml/day)

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9
Q

toxic ATN clinical presentation

A

non-specific
tends to have non-oliguric urine flow because there is less tubular injury

get a good history to find out if a drug could be causing it

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10
Q

ATN lab findings

A 
increased BUN and Cr
hyperkalemia
metabolic acidosis
uremia
granular cases and tubular casts in urine
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11
Q

granular casts usually indicate

A

acute tubular injury

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12
Q

difference in urination between toxic and ischemic ATN

A

toxic=non-oliguria

ischemic=oliguria

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13
Q

toxic ATI/ATN is very common among ___

A

ill hospitalized patients (10-20% of patients!)

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14
Q

acute interstitial nephritis pathophys

A

usually a drug allergy

acute attack on tubules by inflammatory (T) cells. T cells migrate into tubule lumens which become obstructed leading to kidney injury and GFR decline

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15
Q

AIN clinical presentation

A

often asymptomatic

fever, malaise, rash, arthralgia, flank pain

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16
Q

AIN etiology

A

inflammation due to:
allergic response
autoimmune response
infectious response

17
Q

AIN diagnosis

A 
clinical context (new drug, disease)
WBCs/casts in urine
kidney biopsy is definitive
18
Q

AIN kidney biopsy findings

A

interstitial cellular infiltrate with T cells and tubulitis

19
Q

chronic interstitial nephritis definition

A

chronic inflammation of the renal interstitial and tubules that usually progresses to tubular atrophy and interstitial fibrosis

20
Q

causes of chronic interstitial nephritis

A 
drugs
chronic infection in the bladder
autoimmune
heavy metals
infiltrative diseases
metabolic diseases
21
Q

chronic interstitial nephritis clinical features

A

asymptomatic,

fatigue, fever, nocturne, polyuria

22
Q

chronic interstitial nephritis labs and imaging

A

BUN and Cr increase slowly

renal US shows small echogenic kidneys

23
Q

chronic interstitial nephritis urinalysis

A

bland urine sediment
waxy or granular casts
+/- WBC cells/casts

24
Q

renal sarcoidosis

A

granulomatous multi-system autoimmune disease that affects the kidneys

25
Q

primary and enteric hyperoxaluria

A

elevated level of oxalic acid in urine leading to calcium oxalate crystal deposition in the kidneys

common in pts with gastric bypass or taking weight loss rx

26
Q

autosomal dominant polycystic kidney disease

A

a common inherited kidney disease due to a mutation on either chromosome 16 or 4 that leads to the development of multiple cysts in the kidneys

27
Q

PKD clinical presentation

A

usually asymptomatic until advanced

polyuria, hematuria, flank pain, HTN

28
Q

PKD diagnosis

A

kidney ultrasound is most commonly used
CT scan or MRI
showing 2-3 cysts in both kidneys

29
Q

PKD treatment

A

ACEi to lower BP
increase water intake
Tolvaptan to slow cyst growth

renal (17 decks)

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