TUBULOINTERSTITIAL DISEASES Flashcards by l een

early feature of hydronephrosis

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

How well did you know this?

Not at all

Perfectly

Main cause of functional derangement

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

How well did you know this?

Not at all

Perfectly

chronic Drug induced interstitial nephritis clinical

htn, crf, hu, renal colic & anemia

How well did you know this?

Not at all

Perfectly

chronic drug induced interstitial nephritis complecations

uti and urothelial carcinoma

How well did you know this?

Not at all

Perfectly

Chronic pyelonephritis clincal course

Polyuria & nocturia, FSGS, nephrotic

How well did you know this?

Not at all

Perfectly

Chronic pyelonephritis morphology

asymmetrical
irregular scarred contracted kidney
blunted, deformed calyces

How well did you know this?

Not at all

Perfectly

Acute Drug induced interstitial nephritis clinical course

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

How well did you know this?

Not at all

Perfectly

Acute pyelonephritis urinary findings

bacturia, wbc cast, pyuria

How well did you know this?

Not at all

Perfectly

atn Maintenance stage

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

How well did you know this?

Not at all

Perfectly

Acute pyelonephritis causes

Analgesia abuse & sever obstruction

How well did you know this?

Not at all

Perfectly

Chronic pyelonephritis microscopic

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

How well did you know this?

Not at all

Perfectly

causes of papillary necrosis

dm, ut obstructon & scd

How well did you know this?

Not at all

Perfectly

ATN Initiating stages

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

How well did you know this?

Not at all

Perfectly

ATN morphology

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

How well did you know this?

Not at all

Perfectly

chronic features of hydronephrosis

Cortical tubular atrophy
Marked diffuse interstitial fibrosis.

How well did you know this?

Not at all

Perfectly

Acute pyelonephritis symptoms

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

urolithiasis is more common in elderly women

false, males 20-30

obstructive uropathy causes

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

ATN Recovery phase

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

chronic Drug induced interstitial nephritis etyology

long term use of NSAIDSs
phenacetin
mixture with phenacetin
aspirin
acetaminophen

Nephrotoxic ATN causes

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

urolithiasis pathogensis

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

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

Hydronephrosis

most common cause of UTI

e.coli

commenst cause of arf

ACUTE TUBULAR NECROSIS

Initial disturbances in hydronephrosis

tubular cause impaired contraction ability

Acute pyelonephritis morphology

Pyonephritis, papillary necrosis & perinephric abscess

Acute Drug induced interstitial nephritis drugs

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

why is uti more common in females?

Short urethra, urethral trauma Absent antibacterial properties or hormonal changes

most and least common urothialisis

calcium oxalate & phosphate 70% cystine 1-2%

Ischemic ATN causes

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

ATN urine microscopy

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

chronic Drug induced interstitial nephritis morphology

patchy papillary necrosis interstitial atrophy & scarring anagelsic microangiopathy