Tubulointerstitial Diseases Flashcards
What is the general pathophysiology behind tubulointerstitial diseases?
- the body is invaded by something that sets up an inflammatory response that primarily effects the tubules and interstitium
- can be acute or chronic
What are the clinical manifestations of tubulointerstitial disease?
- decline in GFR
- proximal tubular damage (fanconi syndrome)
- normal anion gap metabolic acidosis
- polyuria
- proteinuria (<2000 mg/day)
- anemia
What are the causes of a decline in GFR?
- obstruction of tubules
- damage to microvasculature
- interstitial fibrosis**
proximal tubular damage leads to what?
-kidney wasting of glucose, PO4, uric acid, bicarb, and aas
cause of normal anion gap metabolic acidosis
proximal or distal RTA
cause of polyuria
decreased concentrating and diluting ability
cause of proteinuria
- because most of the things that damage the tubules and intertisium also damage the glomerulsus, just to a lesser extent
- usually <2gm/day
cause of anemia
damage to EPO producing cells
What are the autoimmune disorders that can cause tubulointerstitial diseases?
- sarcoidosis
- sjogren syndrome
- SLE
toxic causes of tubulointerstitial diseases (3)
- heavy metal nephropathy:
- lead
- cadmium
- mercury
hereditary tubulointerstitial nephritis (2)
- medullary cystic kidney disease
- mitchondrial disorders
malignancy-related causes of tubulointerstitial disease
- leukemia
- lymphoma
- malignancy-associated monoclonal gammopathies
- multiple myeloma, plasmacytoma
infection related causes
- brucellosis
- CMV
- EBV
- fungal diseases
- legionella species
- mycobacterium tuberculosis
- toxoplasmosis
- chronic pyelonephritis
what is acute peylonephritis?
- infection that travels to the kidney, usually from UTI
- pt presents very sick
sterile pyruria
- WBCs in the urine but doesn’t grow on culture
- b/c cultures are only tested for gram negative bacterias
