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Renal > Tubulointerstitial Diseases, Vascular Diseases, and Chronic Kidney Disease > Flashcards

Tubulointerstitial Diseases, Vascular Diseases, and Chronic Kidney Disease Flashcards

1
Q

What is acute interstitial nephritis?

A

Inflammation of renal tubules and interstitium

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2
Q

What are some causes of Acute Interstitial Nephritis?

A
  • Hypersensitivity reaction to drugs (Penicillin derivatives, NSAIDs, sulfonamides, rifampin)
  • Infections
  • Autoimmune diseases (SLE, Sjorgren’s)
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3
Q

Drug related cases or Acute Interstitial Nephritis are usually _______

A

reversible

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4
Q

Urine analysis for acute interstitial nephritis can show…

A

WBCs

WBC casts

RBCs

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5
Q

What features associated with hypersensitivity reactions are clues to diagnosis of acute interstitial nephritis?

A
  • fever, arthralgias, maculopapular rash
  • peripheral blood eosinophilia
  • Eosinophils in the urine
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6
Q

What are some morphologic features of acute interstitial nephritis?

A
  • Inflammation and edema of interstitium with involvement of tubules
    • Spares glomeruli and vessels
  • Lymphocytes, plasma cells, eosinophils
  • May see granulomas
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7
Q

What is acute pyelonephritis?

A

Acute inflammation of the kidney due to a bacterial infection through a urinary or hematogenous route

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8
Q

Urinary tract pathogens in acute pyelonephritis are usually what type of bacteria?

A

Gram negative bacilli

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9
Q

What are some predisposing conditions for pyelonephritis?

A
  • Urinary obstruction – congenital or acquired
  • Urinary tract instrumentation
  • Vesicoureteral reflux
  • Pregnancy
  • Diabetes
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10
Q

How does pyelonephritis appear histologically?

A

Interstitial inflammation and inflammation within the tubules

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11
Q

Multiple myeloma can lead to renal failure in __% of patients

A

25

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12
Q

Chronic renal failure in Multiple myeloma results from…(3)

A
  • Direct tubular toxicity of light chains
  • Tubular obstruction by casts
  • Interstitial inflammation
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13
Q

How does multiple myeloma lead to cast nephropathy?

A
  • Due to excessive production and urinary exretion of light chains
  • Presents as acute kidney injury
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14
Q

What factors favor intratubular precipitation nad cast formation in multiple myeloma?

A

Hypercalcemia

Volume depletion

Nephrotoxins

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15
Q

How does multiple myeloma present?

A
  • Older patients (usually over 40)
  • Renal insufficiency and proteinuria
  • History of bone pain, fractures
  • Hypercalcemia
  • Monoclonal light chains in blood or urine
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16
Q

How does myeloma cast nephropathy appear on light microsope?

A

Crystalline, fractured casts, in tubules with associated cellular reaction

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17
Q

Treatment of myeloma cast nephropathy?

A
  • Acutely, hydration and urinary alkalinization to prevent tubular obstruction by casts
  • Chemotherapy or stem cell transplantation
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18
Q

What are examples of renal vascular diseases?

A

Hypertensive nephrosclerosis

Renovascular hypertension

Atheroembolic disease

Thrombotic microangiopathy

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19
Q

What is hypertensive nephroscleoris?

What symptome is often present?

A

Chronic kidney disease in a patient with long-standing, poorly controlled HTN

Proteinuria is often present

20
Q

What are some morphologic features of hypertensive nephrosclerosis? (grossly and on light microscope)

A

Gross: normal to slightly small kidney with finely granular subscapular surface

Light: Subscapular glomerular sclerosis, tubular atrophy, interstitial fibrosis, arteriolar hyaline

21
Q

What are morphologic features of malignant hypertension in hypertensive nephrosclerosis?

A

Mucoid intimal thickening of arteries, glomerular capillary wrinkling, GBM duplication

22
Q

What are 2 main causes associated with renal artery stenosis as a secondary cause of hypertension?

A

Atherosclerosis

Fibromuscular dysplasia

23
Q

How does renal artery stenosis lead to hypertension?

A

Due to decrease in pressure to kidney, compensation mechanism is activated which increases angiotensin II production

Angiotensin II leads to vasoconstriction and aldosterone release which increase blood pressure

24
Q

A physician should suspect renal artery stenosis in patients with…(4)

A
  • early or late onset HTN
  • difficult to control HTN
  • abdominal or flank bruit
  • Renal failure after starting ACE inhibitor
25
Q

What are some morphologic features associated with atheroscleoris in renal artery stenosis?

A
  • Stenosis usually in proximal renal artery
  • Eccentric plaque - fibrosis, cell debris, lipid and foam cells (plaque may hemorrhage or dissect)
  • Medial and adventitial fibrosis
  • Calcification may occur
26
Q

What locations are you more likely to find fibromuscular dysplasia in renal artery stenosis?

A

Renal artery - 60-75% (bilateral 35%)

Cervicocranial arteries - 25-30%

Visceral arteries - 9%

Extremity arteries - 5%

27
Q

How does medial fibroplasia in FMD present?

A
  • Alternating thinned media and thickened fibromuscular ridges
  • Forms “string of beads” radiographically
    • Beading is larger than caliber of artery
  • Middle to distal artery
28
Q

What is the treatment for renal artery stenosis?

A
  • Surgical revascularization
  • Angioplasty and stenting
  • Medical management only
29
Q

What are some thromboembolic diseases?

A
  • Cortical infarcts
  • Renal cholesterol microembolism syndrome
  • Thrombotic microangiopathy
30
Q

What are morphologic features of a cortical infarct?

A
  • Renale artery occlusion (extensive parenchymal infarction)
  • Smaller branch - wedge shaped infarct
  • Fibrosis
31
Q

What is atheroembolic disease and when can it occur?

A

Disruption of athersclerotic plaques that can cause acute and subacute renal failure

Occurs after procedures that disrupt plaques in the aorta, leading to a shower of cholesterol emboli that lodge in the renal microvasculature

32
Q

Aside from acute renal failure, other common manifestations of atheroembolic disease include…(3)

A

bowel infarction

Digital infarction (fingers and toes turn blue)

Stroke

33
Q

Cholesterol atheroemboli affect which size arteries?

A

any size artery

34
Q

How does eosinophilia occur with cholesterol atheroemboli?

A

Eosinophilia may be related to activation of C5a which is chemotactic for eosinophils

35
Q

What are different outcomes associated with atheroembolic disease?

A
  • Stabilized or normal renal function in mild, isolated cases
  • Chronic, progressive deterioration in renal function in subacute cases
  • End stage renal disease in severe cases
  • Permanent dialysis may be necessary
36
Q

Thrombotic microangiopathy is characterized by thrombosis in __________ and ________

A

capillaries; arterioles

37
Q

Consequences of thrombotic microangiopathy?

A

Microangiopathic hemolytic anemia

Thrombocytopenia

Renal failure

38
Q

What are some other manifestations of thrombotic microangiopathy?

A

Hemolytic uremic syndrome (associated with E Coli)

TTP (thrombotic thrombocytopenic purpura)

39
Q

What is the pathogenisis of thrombotic microangiopathy?

A

Endothelial injury and activation

Platelet aggretation leading to vascular obstruction and vasoconstriction

40
Q

What is Chronic Kidney Disease and what is the last stage of its progression?

A

Progressive irreversible renal insufficiency that develops over months to years

Ultimately leads to end stage renal disease

41
Q

What are the main causes of CKD?

A

Diabetes (#1)

Hypertension

Glomerular nephritis

Cystic diseases

42
Q

What are some consequences of CKD?

A
  • Anemia (decreased erythropoietin production)
  • Hypertension
  • 2º hyperparathyroidism (decreased synthesis of vitamin D and decreased phosphate excretion)
43
Q

What are some other findings associated with CKD?

A
  • Metabolic acidosis
  • Hyperkalemia
  • Inability to maintain sodium/water balance
  • Coagulopathy
  • Sensorimotor neuropathy
44
Q

What are some physical symptoms of chronic uremia?

A
  • Lethargy
  • Anorexia
  • Pruritus
  • Restless legs syndrome
  • Uremic pericarditis
  • Day-night sleep reversal
45
Q

What are the management goals for CKD?

A
  • Preserve renal function and delaty ESRD
  • Prevent of minimize adverse effects
  • Institute renal replacement therapy when necessary
46
Q

How can we slow the progression of CKD?

A
  • Control blood sugar
  • Smoking cessation
  • Reduce proteinuria
  • Control hypertension
47
Q

ESRD is treated with ______ or ______ ________

A

dialysis; renal transplantation

Renal (17 decks)

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