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Renal > Tubulointerstitial Disease > Flashcards

Tubulointerstitial Disease Flashcards

0
Q

Acute kidney injury comes in two varieties

A

ischemic

toxic

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1
Q

two reversible diseases that dont require much attention

A 
osmotioc nephrosis (hypertonic solution causes foamy, disteneded PT)
hyaline droplet change (increased protein loss causes increased protein resorption)
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2
Q

Acute renal failure decribed as

A

decreased GFR
oliguria
increased BUN
increased creatinine

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3
Q

mechanisms of acute renal failure

A

VC of aff arteriole–>decreased perfusion–>decreased GFR
casts obstruct the tubule (increase tubule luminal pressure, decreased glomerular transcap perfusion pressure)
tubular backleak–>accum of protein products in interstitum–>increase interstital oncotic and decrease tubular oncotic–>tubules collapse

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4
Q

what kind of catsts in acute kidney injury

A

granular

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5
Q

toxic AKI

A

diffusely hypereosinophilic tubules with necrosis and sloughing of epithelial cells into the lumen

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6
Q

3 phases of AKI

A 
initiating phase (1-2 days)
maintenance phase
recovery phase (days-weeks)
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7
Q

initiating phase

A

mild decrease in urine output

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8
Q

maintenance phase

A

sustained decrease in urine output
water and salt retention
increase in BUN, Cr, K, metabolic acidosis

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9
Q

recovery phase

A

increase in urine output (>3 l/day) with decrease in BUN, Cr, K

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10
Q

clinical manifestations of tubulointerstital disease

A

decreased urine concentration (polyuria)
decrease in Na reabsorption (salt wasting)
decrease in acid secretion (metabolic acidosis)

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11
Q

2 major categories of tubulointerestital disease

A

pyelonephritis: infection

tubulo-interstital: non-infectious

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12
Q

4 types of tubulo-interstital nephritis

A

drug/toxin induced
analgesic abuse
urate nephropathy
myeloma kidney

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13
Q

common bugs of pyelonephritis

A

g negative bacili (e cioli, proteus, klebsiella, enterobacter)
strep fecalis, staph, fungi,

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14
Q

pathogenesis if comes from blood (pyelo)

A

infecting agent enters blood through ALL regions of kidney–>gross miliary distribution of microabsecesses

*lovalized to tubules and interstitum

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15
Q

pathogeneiss if ascending pylo

A

colonization of urethra–>bladder–>incompetence of vescio-ureteral orifice–>reflux–>infectious agent colonizes pailla

16
Q

microscopically with ascending puelo

A

streaking distribution

17
Q

complications of acute pyelonephritis (4)

A

papillary necrosis
pyonephrosis
perinephric abscess
scarring

18
Q

papillary necrosis is common in

A

ascending PN in DM, outflow obstruction

*usually bilateral

19
Q

pyeonephrosis

A

accumulation of pus in kidney to the point where it becomse a big abscess

20
Q

peripnephric abscess

A

when the pyonephrotic kidney bursts, releasing contents into periphery

21
Q

scarring

A

broad shaped or ushaped, more common in upper or lower poles

22
Q

chronic pyeloneprhitis cannot___because___

A

be diagnozed with LM of bx alone because we need to see deformity

23
Q

MC of chornic pyelo

A

reflux, but obstructive exists too

24
Q

most frequent cause of toxic tubulointerstital nephritis

A

synthetic penicillins/antibiotics (rifampin)
diuretics (thiazides)
Nsaids (phenylbutazone)
cimetidine

25
Q

50% of drug tin dvelope

A

acute renal failure

26
Q

pathogenesis of drug TIN

A

delayed
Ige hypersens to lypmphovytes
Macrophages
EOSINOPHILS

27
Q

pathology drug induced TIN

A

lymphocytes in pathces but key is eosinophils

28
Q

anaglesic abuse nephropathy is caused by

A

mass intake of phenacetin, aspirin, caffeine, acetaminophin, codeine

29
Q

how does acetominophin hurt cells

A

covalent binding and oxidation

30
Q

how does aspirin hurt cells

A

blocks PGE–>VC–>ischemia

31
Q

what kind of pathology with analgesic abuse nephro

A

papillary necrosis

32
Q

three types of urate nephropathy

A

acute uric acid
chronic urate
nephrolithiasis

33
Q

acute uric acid nephro

A

ppy of urate crystasls in CD–>obstruction

**common in chemo

34
Q

chronic uratenephropathy

A

patients with hyperuricemia

trophus formation- needle like crystals surrounded by giant cells

35
Q

nephrolithiasis is seen with

A

gout patietns

36
Q

patho in myeloma kidney

A

brittle (fractured) cast formation–>obstruction +/- granulomas

Renal (17 decks)

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