Tubulointerstitial Disease Flashcards
What are some of the key features of this kidney?
• is it normal or abnormal?
In cross section, this normal adult kidney demonstrates the lighter outer cortex and the darker medulla, with the renal pyramids into which the collecting ducts coalesce and drain into the calyces and central pelvis.
What are the two leading findings in diseases affecting the tubules and interstitium?
Inflammation
Ischemic or toxic changes
What are the common causes of inflammation in Tubulointerstitial disease?
- Acute Pyelonephritis
- Chronic Pyelonephritis
- Drug Induced Interstitial Nephritis
What causes ischemic or toxic changes in tubulointerstitial diseases?
• Acute Tubular Injury
Acute Pyelonephritis
• What is it?
• What is the most common cause?
• What condition is acute pyelonephritis often associated with?
What is it?
• a common suppurative inflammation of the kidney and the renal pelvis, is caused by bacterial infection
Associated Diseases:
• majority of cases of pyelonephritis are associated with infection of the lower urinary track
E. Coli - most common cause (females often get UTIs to kidney faster due to short urethra)
Besides E. Coli, what other bacteria are associated with Pyelonephritis?
- Proteus
- Klebsiella
- Enterobacter
- Pseudomonas
What is the most common route of infection for Acute Pyelonephritis?
• most common causes for infection to move via this route?
• Other causes?
Ascending Infection - from lower urinary to upper urinary
Causes (VASOD)
• Vesicouteral Reflux
• Anatomy
• Stasis
• Obstruction (BPH, uterine prolapse)
• Diabetes
Other causes: Hematongenous Spread (far less common, but associated with septicemia and INFECTIVE Endocarditis)
What Key histological features are seen here?
• why could this NOT be an acetamenophen overdose?
- Neutrophils are present so inflammation is ACUTE
- Cells can be seen sloughing into the tubules creating WBC Casts
- No EOS. so its not an allergic rxn to medication
What abnormailites are seen here?
• what is the most likely cause?
Extremely Dialated Ureter with Kidney Stones
• this is indicative of vesicouteral reflux
What is this?
• what is the most likely process and etiologic agent that led to this?
Acute Pyelonephritis
• E. coli that ascends the ureter as a result of Vesicouterine Reflux is the most common cause of this
What has happened to this kidney?
Pustules causes by Acute Pyelonephrosis have combined into a large pus pocket
• Females are most likely to get this for anatomical Reasons
What 3 key histological features are you looking for in ACUTE PYELONEPHROSIS?
• what would be seen an uninalysis?
• if this were allowed to progress, what gross changes would you see in the kidney parenchyma?
3 Key Histological Features:
• NORMAL GLOMERULI
• Inflammatory Infiltrate into the Interstitium
• Abscess formation
Urinalysis:
• WBC casts
Gross Changes:
• Papillary Necrosis
T or F: this image is consistent with Acute Pyelonephritis.
True, you can see abscesses, interstitial infiltrate, and spared glomeruli
A 73 year old man presents with WBC casts in the urine and the following CT is obtained. (GFR normal).
• most likely dx?
Probably Acute Pyelonephritis from BPH
T or F: this image is indicative of Chronic Pyelonephritis
FALSE, this is actue pyelonephritis
What would you see on H and E if this were caused by a drug?
these are WBC casts, if this were drug induced then you would see eos on H and E
If glomeruli are typically spared in Acute Pyelonephritis, then why is GFR reduced as the disease progresses?
Reduced GFR is the result of WBC’s (PUS) clogging up the renal tubules
What pathology is shown here?
• what are some causes?
Papillary Necrosis = COAGULATIVE NECROSIS (b.c its pyogenic)
What is shown here?
• Key Histological Featurs?
• Pale Cells in the center of the Papilla indicated nuclear fallout which means this is acute papillary necrosis likely caused by: Sickle cell, Obstructive Pyelonephritis, Diabetes melatis, or Analgesic Abuse
Describe what is see here?
• likely cause?
Chronic cystitis
• Hypertrophy with trabeculation of the wall
• Or thin and distended from urine retention (Less Common)
Enlarged Prostate can be seen here. BPH has caused chronic cystitis
A 65-year-old woman had experienced increasing malaise with nocturia and polyuria for the past year. Her blood pressure was 170/95. Urinalysis showed 1+ proteinuria. Serum BUN and creatinine were elevated. Her chart indicates a history of multiple UTIs. She developed worsening renal failure and died of pneumonia. What is the BEST diagnosis?
• what appearance would you expect to see in her Renal Cortex? Medulla?
Chronic Pyelonephritis - given her hx of multiple UTIs and slow and progressive symptoms of renal failure suggest a chronic rather than acute process
Cortex - glomerulosclerosis will be seen - note that this differs from acute pyelonephritis where glomeruli are spared
Medulla - thyroidization of the tubules is seen in this chronic process
This is Xanthogranulomatous pyelonephritis what are some of the key histological features?
- **Foamy Macrophages
- Plasma Cells surrounding**
What is seen here?
Pylonephritic Abscess (was pus filled before they cut it open)
What is seen here?
Acute Papillary Necrosis
What are the 2 forms of Chronic Pyelonephritis?
• Which is more common?
Chronic obstructive
• Stones
• Posterior urethral valves
• BPH
Chronic reflux
• More common
• Superimposed UTI on congenital reflux and intrarenal reflux
T or F: Chronic Pyelonephritis primarily invovles the Tubules and shows scar formation.
True, it definitley shows scar formation BUT it does NOT involve the tubules, instead it typically involves INTERSTITIUM