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Renal Week 2 > Tubulointerstitial Disease I > Flashcards

Tubulointerstitial Disease I Flashcards

1
Q

What is acute pyelonephritis?

A

suppurative inflammation of the kidney and the renal pelvis caused by bacterial infection and usually associated with infection of the lower urinary track that has ascended

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2
Q

What is the main cause of acute pyelonephritis?

A

E. coli (proteus, klebsiella, enterobacter, and pseudomonas also common)

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3
Q

What patient population is prone to UTIs?

A

women (due to anatomy) and diabetics (due to stasis of urine in the bladder) and older men with BPH or those with uterine prolapse

or vesicoureteral reflex

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4
Q

How else can acute pyelonephritis occur?

A

Hematogenous spread (common in those with infective endocarditis)

ascending is far more common

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5
Q

What is vesicoureteral reflex?

A

urethral valves are defective (usually in children) leading to repetitive episodes of acute pyelonephritis (caused by urinary stasis)

can lead to chronic pyelonephritis (pus filled kidneys)

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6
Q

T or F. Liquefactive necrosis is seen in acute pyelonephritis

A

T. See Yellow raised abscesses on the surface on gross image

abscesses wall off and can be hard to treat with antibiotics

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7
Q

Where does the inflammation in acute PN present first?

A

in the interstitium and then enters the tubules (generally, glomeruli are usually spared)

in chronic they are affected

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8
Q

How can acute NP obstruct urinary flow?

A

pus can actually build up and obstruct it and reduce GFR (more in chronic)

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9
Q

What gross endgame does acute PN lead to?

A

papillary necrosis

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10
Q

What other things can cause papillary necrosis?

A

Sickle cell
Obstructive pyelonephritis
Diabetes
Analgesics

SODA

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11
Q

In XPN, urine cultures almost always grow what?

A

P. mirabilis or E. coli.

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12
Q

What is the response to chronic cystitis caused by obstruction?

A

Hypertrophy with trabeculation of the wall

Or thin and distended bellies from urine retention

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13
Q

Glomeruli have a ____-like appearance in chronic pyelonephritis

A

thyroid

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14
Q

What are the two forms of chronic pyelonephritis?

A

Chronic obstructive

  • Stones, BPH
  • Posterior urethral valves

Chronic reflux

  • More common
  • Superimposed UTI on congenital reflux and intrarenal reflux
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15
Q

Gross appearance of chronic pyelonephritis?

A

Dips in gross appearance give a pitting appearance in the cortex due to scarring in the pelvis that almost pulls it downward

blunting and scarring

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16
Q

What are the main causes of acute drug-induced tubulointersittial nephritis (TIN)?

A

synthetic penicillins (methicillin, ampicillin),

other synthetic antibiotics (rifampin),

diuretics (thiazides),

NSAIDs

numerous other drugs (phenindione, cimetidine)

17
Q

Describe acute drug-induced tubulointersittial nephritis (TIN)

A

Thought to be an IgE- and T cell–mediated immune reaction to a drug;

characterized by interstitial inflammation, often with abundant EOSINOPHILS
and edema

18
Q

What are the main causes of acute tubular injury?

A
  • ischemic
  • nephrotoxic (drugs, poison, contrast)

ATI results from ischemic or toxic injury to renal tubules, and is associated with intrarenal vasoconstriction resulting in reduced GFR and diminished delivery of oxygen and nutrients to tubular epithelial cells.

19
Q

What kinds of casts are seen in acute tubular injury?

A

granular and tubular as the tubular epithelial cells are sloughed off

20
Q

What things can cause ischemic acute tubular injury?

A
  • Decreased blood flow
  • Mismatched blood transfusions
  • Hemolytic crises
21
Q

Does urine output increase or decrease in ATI?

A

decrease (sloughed off cells can cause an obstruction)

22
Q

How can you differentiate between ischemic and nephrotoxic ATI?

A

Ischemic is more segmental while nephrotoxic damage is more continuous
/diffuse and more prominent in the PT

23
Q

T or F. In ATI, glomeruli are usually spared

A

T.

24
Q

What viral infection is common in renal transplant patients?

A

BK virus (can shed into urine as decoy cells)

25
Q

What causes AD PKD?

A

PKD-1 encoding polycystin-1 and PKD-2 encoding polycystin-2 control epithelial cell development and maturation.

26
Q

ASD PKD patients also often get what?

A

often get calcium oxalate crystals

27
Q

What causes AR PKD?

A

PKHD1 – most common

Causes abnormal fibrocystin protein – expressed on cilia of renal tubules and bile ducts (so they also have congenital hepatic fibrosis)

28
Q

Medullary sponge kidney

A

Congenital, bilateral

Most sporadically

No inheritance pattern

May become symptomatic in young adults

Hematuria and/or urinary tract infection

Calculi in 60%

29
Q

What causes horseshoe kidney?

A

trisomy 18 or incidental

Renal Week 2 (13 decks)

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