Tubulointersitial Nephritis

Question 1

what is the most common cause of kidney disease?

Answer 1

UTI’s (asymptomatic bacteruria; lower UTI’s= urethritis, cystitis; pyelonephritis)

Question 2

urethritis

Answer 2

infection of urinary bladder

These infections can be quite common esp in women

Question 3

pyelonephritis

Answer 3

infection spreads to the kidney (Infxn kind of moves upstream)

Question 4

what is the most common bacteria found in UTI’s?

Answer 4

85% gram (-) bacilli
E.col, Proteus, Klebsiella, Enterobacter
(can also be caused by fungi and viruses)

Question 5

how do most infections reach the kidney?

Answer 5

Most of the infections are ASCENDING infxns

Colonization of lower portion of urinary tract → enters bladder → eventually reaches the kidney

Question 6

lower urinary tract infections

Answer 6

usually don’t have to worry about it affecting the kidneys

Most common= infxns of the ureter

Question 7

what other ways can the kidney develop an infection other than a ureter infection?

Answer 7

Small portion of pts have UTI that bact enter the kidney through the circulation= sepsis and endocarditis
endocarditis= bact colonize valves in the heart → can travel and enter the kidney

Question 8

calculi

Answer 8

stones

causes obstruction of outflow of urine and increased residual vol

Question 9

vesicoureteral reflux

Answer 9

• Reflux= backflow of urine
• Vesicoureteral valve= Prevents flow of urine from urinary bladder to ureter
○ When the valve doesn’t work, urine can flow back up and bring bact with it
• can be caused by congenital absence or shortening of the intravesical portion of the ureter, bladder infection, or spinal injury

Question 10

intrarenal reflux

Answer 10

urine flowing from the pelvis back

Question 11

pyelonephritis definintion

Answer 11

renal lesion assoc with the UTI

Question 12

what is pyelonephritis most commonly caused by?

Answer 12

bact infection

Question 13

types of pyelonephritis

Answer 13

○ Acute= 1-3 weeks; may go away on its own
§ Can develop w/o any special circumstances= everyone can experience it
○ Chronic= progressive; may lead to more serious complications
§ Usually with an underlying condition

Question 14

why can pregnancy increase risk of infection?

Answer 14

b/c you may have compression of urethra and urinary bladder

Question 15

risk factors for acute pyelonephritis

Answer 15

obstruction, catheter, vesicoureteral reflux, PREGNANCY, older men, preexisting renal lesions, DM, immunosuppression

Question 16

histology of acute pyelonephritis

Answer 16

multi-lobulated nuclei

Question 17

complications of acute peylonephritis

Answer 17

• papillary necrosis
• pyonephrosis= sac of connective tissue filled with pus
• perinephric abscess

Question 18

papillary necrosis most commonly occurs when you have ___

Answer 18

DM or UTI

Question 19

clinical picture of acute pyelonephritis

Answer 19

sudden onset, pain at costovertebral angle, fever, dysuria, pyuria (presence of pus in the urine), pus casts (formations which are formed in the tubules)

Question 20

polyomavirus nephropathy

Answer 20

can occur in kidney transplant pts

viral infection

Question 21

chronic pyelonephritis and reflux nephropathy is assoc with ___

Answer 21

pathologic involvement of the calyces and pelvis
** Inflammation → tissue is destroyed → healing phase → scarring → scars cause significant destruction of kidney architecture

Leads to end stage renal disease

Question 22

forms of chronic pyelonephritis

Answer 22

1. ) reflux nephropathy= occurs early in childhood

2. ) chronic obstructive pyelonephritis= recurrent infections lead to recurrent bouts of renal inflammation and scarring

Question 23

morphology of chronic pyelonephritis

Answer 23

• Do not have normal structures

○ No tubules, no glomeruli, nephrons are gone

Question 24

diagnosis of chronic pyelonephritis

Answer 24

Reflux nephropathy is often discovered when HTN in children is investigated
Loss of tubular function= gives rise to polyuria and nocturia
x-ray= asymmetrically contracted kidneys with course scars and blunting of calyceal syst

Question 25

what happens when an obstruction is not treated and goes unrelieved?

Answer 25

leads to permanent renal atrophy AKA hydronephrosis AKA obstructive uropathy

Question 26

where can a renal obstruction happen?

Answer 26

any level of the urinary tract from the urethra to the renal pelvis

Question 27

acute obstruction

Answer 27

may provoke pain attributed to distention of the collecting system or renal capsule
most sx are prod by the underlying cause

Question 28

unilateral complete or partial hydronephrosis

Answer 28

may remain silent since the unaffect kidney can still maintain adequate filtering

Question 29

bilateral partial obstruction

Answer 29

earliest manifestation is inability to concentrate the urine → polyuria and nocturia
scarring and atrophy of the papilla and medulla
HTN is common

Question 30

complete bilateral obstruction

Answer 30

results in oligouria and anuria
will not survive unless the obstruction is resolved!
after relief, a postobstruction diuresis occurs (lots of urine rich in NaCl)