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pathology > TUBULOINTERSTITIAL DISEASES > Flashcards

TUBULOINTERSTITIAL DISEASES Flashcards

1
Q

early feature of hydronephrosis

A

Simple dilation of pelvis & calyces
Blunted papillae, hydroureter
Variable interstitial inflammation

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2
Q

Main cause of functional derangement

A

extreme decrease in gfr due :
Arteriolar vasoconstriction
Tubular obstruction
Back-leak into interstitium
Possibly Mesangial contraction

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3
Q

chronic Drug induced interstitial nephritis clinical

A

htn, crf, hu, renal colic & anemia

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4
Q

chronic drug induced interstitial nephritis complecations

A

uti and urothelial carcinoma

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5
Q

Chronic pyelonephritis clincal course

A

Polyuria & nocturia, FSGS, nephrotic

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6
Q

Chronic pyelonephritis morphology

A

asymmetrical
irregular scarred contracted kidney
blunted, deformed calyces

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7
Q

Acute Drug induced interstitial nephritis clinical course

A

ARF may develop in 50% of patients
Fever, eosinophilia, skin rash (25%)
Renal abnormalities:
Hematuria, mild PTNuria, leukocyturia, Oliguria, creatinine

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8
Q

Acute pyelonephritis urinary findings

A

bacturia, wbc cast, pyuria

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9
Q

atn Maintenance stage

A

Marked ↓ urine output (40-400ml/day)
All the features of ARF: severe oliguria, uremia, fluid overload (few days to several weeks)

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10
Q

Acute pyelonephritis causes

A

Analgesia abuse & sever obstruction

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11
Q

Chronic pyelonephritis microscopic

A

Asymmetrical, fibrosis + inflammation/ PCS & interstitium.
Thyroidization of tubules or contraction and atrophy.
Vasculopathy/ Glomerulosclerosis & FSGS
Periglomerular fibrosis
Xanthogranulomatous PN: Chronic PN + foamy macrophages

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12
Q

causes of papillary necrosis

A

dm, ut obstructon & scd

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13
Q

ATN Initiating stages

A

Slight ↓ urine output & ↑ BUN due to ↓ B.supply to kidney (up to 36 hrs)

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14
Q

ATN morphology

A

Subtle tubulorrhexis, tubular necrosis.
Proteinaceous & cellular casts
Interstitial edema and mild inflammation.
Regeneration of tubules if BM intact.
Ischemic ATN lesions focal & patchy at multiple points.
Nephrotoxic lesions at pct

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15
Q

chronic features of hydronephrosis

A

Cortical tubular atrophy
Marked diffuse interstitial fibrosis.

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16
Q

Acute pyelonephritis symptoms

A

UUTI: Fever & loin pain.
LUTI: dysuria, frequency & urgency

17
Q

urolithiasis is more common in elderly women

A

false, males 20-30

18
Q

obstructive uropathy causes

A

Congenital anomalies (urethral atresia, valve, VUR)
Foreign bodies: calculi, necrotic papillae, blood clot
inflammation: prostatitis, urethritis, retroperitoneal fibrosis
Neurogenic: spinal cord damage, diabetic nephropathy
Normal pregnancy, Uterine prolapse & cystocele
Tumors: Benign Prostatic Hyperplasia, Carcinoma: prostate, cervix or uterus, Bladder Tumors, retroperitoneal lymphoma

19
Q

ATN Recovery phase

A

Steady ↑ urine volume (3l/d)
Gradual return of concentrating ability electrolytes imbalance, infections

20
Q

chronic Drug induced interstitial nephritis etyology

A

long term use of NSAIDSs
phenacetin
mixture with phenacetin
aspirin
acetaminophen

21
Q

Nephrotoxic ATN causes

A

Drugs ( gentamicin, X-ray contrast media & ab)
Endogenous (hb & mb)
Chemicals ( metals & organic solvents).

22
Q

urolithiasis pathogensis

A

Organic mucoprotein matrix, super-saturation of stone constituents.
Change of urine pH decreased urine volume, presence of bacteria.
Deficiency of inhibitors of crystal formation in the urine

23
Q

Dilatation of pelvis & calyces associated with progressive kidney atrophy due to obstruction to the outflow of urine

A

Hydronephrosis

24
Q

most common cause of UTI

A

e.coli

25
Q

commenst cause of arf

A

ACUTE TUBULAR NECROSIS

26
Q

Initial disturbances in hydronephrosis

A

tubular cause impaired contraction ability

27
Q

Acute pyelonephritis morphology

A

Pyonephritis, papillary necrosis & perinephric abscess

28
Q

Acute Drug induced interstitial nephritis drugs

A

Sulphonamides
Synthetic penicillins,
antibiotics (rifampin)
Diuretic (thiazides)
NSAIDs

29
Q

why is uti more common in females?

A

Short urethra, urethral trauma
Absent antibacterial properties or hormonal changes

30
Q

most and least common urothialisis

A

calcium oxalate & phosphate 70%
cystine 1-2%

31
Q

Ischemic ATN causes

A

Medical ( septicemia, gastroenteritis, mi & pneumonia)
Surgery ( burns, multiple injuries, massive hemorrhage, pancearitis & peritonitis)
Obstetric ( pre-eclamptic toxemia, ante-partum hemorrhage).

32
Q

ATN urine microscopy

A

Protein (Hyaline) cast, Red cell cast, White cell (pus cell) cast, Epithelial cell cast (desquamated tubular epithelial cells), Granular cast (remnants of necrotic tubular epithelial cells), Fat bodies, Crystals, Organism & Ova
Individual red cells, pus cells & epithelial cells
Casts are cylindrical forms due to molding in tubules

33
Q

chronic Drug induced interstitial nephritis morphology

A

patchy papillary necrosis
interstitial atrophy & scarring
anagelsic microangiopathy

pathology (5 decks)

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