Tubulointerstitial Diseases

Question 1

Describe the pathogenesis of acute tubular injury

Answer 1

Ischemia: disrupts membrane polarity resulting in increased sodium supply to the distal tubules which produces vasoconstriction
Subsequently this insult Will increase secretion of inflammatory markers Causing further damage

Question 2

What happens to injured tubular cells And what complications does this create

Answer 2

injured cells detached from the basement membrane Causing luminal obstruction
physiologic Consequences: Decreased GFR, increased entritubular pressure

Question 3

Compare and contrast the histologic differences between ischemic induced ATI and toxic induced ATI

Answer 3

ischemic type: patchy-focal necrosis of the proximal Straight tubules and Thick ascending limb (more rarely the PCT)
toxic type: Extensive continuous necrosis along BOTH the proximal straight & convoluted tubules, patchy-focal necrosis of TAL
BOTH: digital convoluted tubules and collecting ducts contained casts

Question 4

Papillary necrosis is associated with what conditions

Answer 4

Diabetics, sickles, urinary tract obstruction

Question 5

the curses Of the papillary Muscles affects what structure of the kidney

Answer 5

The renal pyramids

Question 6

What conditions are associated with pyonephrosis

Answer 6

Superative exodates that are unable to drain So fluid backs up in the pelvis the calises and the ureter

Question 7

What is perinephric Access

Answer 7

Extension of superior inflammation through the renal capsule and into the perinephrat tissues

Question 8

Describe the gross features of acute pyro nephritis

Answer 8

Dark zones of infarction Surrounded by hyperuremic borders

Question 9

The gross characteristics of Perry Network Abscesses

Answer 9

Cortical surfaces show grayish wide areas of inflammation

Question 10

Describe the histologic features of acute pylo nephritis

Answer 10

Neutrophilic exodate within the tubules and in the interstitium

Question 11

Kidney stones are commonly asymptomatic But they can still damage the kidney structures overtime. what do we call this condition and what are the clinical manifestations

Answer 11

chronic pylonephritis
gradual onset of renal insufficiency and hypertension
subsequent protein area and end stage renal failure

Question 12

Describe the gross features of chronic pylo nephritis

Answer 12

Asymmetric irregularly scarred Galaxies

Question 13

unlike acute pylo nephritis, What is usually seen in chronic pylon nephritis

Answer 13

Colloid casts

Question 14

Describe the process of hapton induced Tubulo interstitial nephritis

Answer 14

Some drugs Are known to produce haptons And when these haptons bind to the basement membrane It triggers an IgE mediated response

Question 15

Drugs are known to produce haptons or being a potential hapten.

Answer 15

sulphonamides, methicillin, ampicillin, rifampin, diuretics, cimetidine

Question 16

Describe the pathogenesis of insanes to Tube below interstitial nephritis

Answer 16

Watch the video on YT channel

Question 17

What kind of nephropathies produce bifurcate needle like crystals

Answer 17

Chronic urea nephropathy and gouty nephropathy
Typically found in the interstitial and the tubular lumen
Can lead a cortical atrophy in scarring

Question 18

Acute uric acid nephropathy is commonly associated with what?

Answer 18

chemotherapy

Question 19

The pathogenesis of tumor lysis induced acute uric acid neuropathy

Answer 19

Tumor cells are killed and broken down they release nucleic acids that get produced into uric acid; The PKA of Uric acid It’s very close to Reno Lumen PH which favors the precipitation of uric acid molecules to form uric acid crystals which eventually leads to obstruction of the nephrons and the development of frenal ailure