Tubulointerstitial Dz Pathology Flashcards
Acute TID; characterized by active inflammation; see eosinophils and lymphocytes (left) and neutrophils (right)
Normal kidney tubules and glomerulus
Tubular necrosis; necrotic cells slough off into the tubular lumen; seen in Acute TID
Edema; seen in interstitium as foamy/vacuoles between tubules. Characteristic of Acute TID
Interstitial fibrosis; seen in Chronic TID; fibrinous tissue is very pale and separates the renal tubules
Tubular atrophy; tubules shrink in diameter, the epithelium simplifies and the basement membrane thickens; seen in Chronic TID where tubules atrophy in response to slow ischemia
Chronic inflammation; uniform small lymphocytes which are remnants of a previous active inflammation. Seen in Chronic TID.
Acute TID; active inflammatory cells in interstitium: lymphocytes, neutrophils, plasma cells, macrophages
Chronic TID; fibrosis of interstitium; tubular atrophy
Interstitial Nephritis; inflammation localized to interstitum primarily, with minor involvement of the tubules
Acute interstitial nephritis; infiltration of plasma cells, eosinophils, lymphyocytes, macrophages; also see edema
Acute interstitial nephritis; diffuse infiltration of inflammatory cells; tubules relatively unaffected.
Acute allograft rejection; form of acute interstitial nephritis; where lymphyocytes actually infiltrate the tubules
Acute Tubular Necrosis (main photo); normal photo in bottom Right corner; ATN most commonly affects the Prox. CT and can be caused by ischemia or toxins
Ischemic ATN; caused by shock, hypovolemia, and hypoxemia; usually milder than toxic ATN, the tubular epi. cells fall off individually.
ATN urine sediment; contains epithelial cells and necrotic debris
Ascending Acute Pyelonephritis; with white-pus streaks located in the renal medulla.
Acute Ascending Pyelonephritis; with pus-streaks within the medulla; also see papillary necrosis
Hematogenous pyelonephritis; has “flea-bitten” appearance
Acute pyelonephritis; neutrophil infiltration
Bacteria in Acute Pyelonephritis; look like pale blue smudges
Fungus (arrow) in Acute Pyelonephritis
WBC casts in the medulla in acute pyelonephritis
Chronic interstitial nephritis; with fibrosis, atrophy and chronic inflammation
Chronic interstitial nephritis; tubular atrophy, interstitial fibrosis, chronic inflammation, glomeruli unaffected
Chronic interstitial nephritis; tubular atrophy, interstitial fibrosis, chronic inflammation, glomeruli unaffected
Lithium induce chronic tubulointerstitial nephropathy; causes atrophy and fibrosis, but can also cause tubular dilatation and cyst formation in the distal tubule and CD.
Papillary necroses develops in obstructed acute pyelonephritis as well as in pt’s wtih DM (and acute pyelo).
Chronic pyelonephritis, obstructed type; see dilated pelvis and calyxes as well as thinning of the renal cortex; generally uniform involvement.
Chronic pyelonephritis, reflux type; appears as focal, often polar changes
Chronic pyelonephritis; see dilated calyx, destruction of papilla, and scarring of overlying cortex.
Name the type of kidney dz; also identify the regions indicated by the arrows on the right
Chronic pyelonephritis
Chronic pyelonephritis; focal fibrosis, chronic inflammation, and tubular loss
Light chain cast nephropathy, due to multiple myeloma; Ig light chains made by neoplastic plasma cells are filtered/precipitate in the renal tubules forming angula/fractured appearing casts; the casts obstruct and can injure epithelial cells; see macrophage-rich inflammatory response
Light chain casts seen in the Multiple Myeloma kidney; casts are angular and fractured appearing.
