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Renal > Tubulointerstitial Pathologies > Flashcards

Tubulointerstitial Pathologies Flashcards

1
Q

Acute tubulointerstitial nephritis clinical features

A

Presents with AKI
Biopsy shows inflammatory infiltrate in interstitium ± tubule
Residual CKD in up to 40%

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2
Q

Acute tubulointerstitial nephritis causes

A

Drugs: Abx, NSAIDs, PPIs, diuretics, ranitidine, anticonvulsants, warfarin
Infection: Strep, Pneumococcus, Staph, Camplylobacter, E.coli, Mycoplasma, CMV, EBV, HSV, Hep A-C
Autoimmune: SLE, sarcoid, Sjogren’s, ANCA

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3
Q

Acute tubulointerstitial nephritis treatment

A

Stop causative agent/treat underlying cause

Steroids used in practice but poor evidence

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4
Q

Chronic tubulointerstitital nephritis features

A

Slowly progressive renal impairment

Biopsy shows interstitial fibrosis + tubular atrophy

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5
Q

Chronic tubulointerstitital nephritis causes

A

Most commonly (70%) drugs: NSAIDs, lithium, calcineurin inhibitors, chemo, aminosalicyclates
Infection: TB, pyelonephritis, HIV
Immune disease
Nephrotoxins: lead, cadmium, mercury, aristolochic acid (plant poison)
Haem disorders (myeloma)
Genetic disease

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6
Q

Chronic tubulointerstitital nephritis treatment

A

Stop/treat cause

Reduce progression risk as with CKD (BP, lipids etc)

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7
Q

Nephrotoxic analgesics

A

NSAIDs

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8
Q

Nephrotoxic antimicrobials

A 
Aminoglycosides
Co-trimoxazole
Penicillins
Rifampicin
Amphotericin (anti fungal)
Aciclovir
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9
Q

Nephrotoxic anticonvulsants

A

Phenytoin
Lamotrigine
Valproate

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10
Q

Nephrotoxic other drugs

A

PPIs

Furosemide
Thiazides
ACEI/ARB

Lithium
Iron

Calcineurin inhibitors
Cisplatin

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11
Q

Nephrotoxic anaesthetics

A

Methoxyflurane

Enflurane

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12
Q

Nephrotoxic proteins

A

Igs/light chains in myeloma
Hb in haemolysis
Myoglobin in rhabdomyolysis

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13
Q

Nephrotoxic crystals

A

Urate

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14
Q

Nephrotoxic bacteria

A 
Strep
Legionella
Brucella
Mycoplasma
Chlamydia
TB
Salmonella
Campylobacter
Leptospirosis
Syphilis
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15
Q

Nephrotoxic viruses

A

EBV, CMV, HIV
Polyomavirus
Adenovirus
Measles

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16
Q

Nephrotoxic parasites

A

Toxoplasma

Leishmania

17
Q

Nephrotoxic other items

A

Ethylene glycol
Radiation
Aristolochic acid (in plants)

18
Q

Analgesic nephropathy presentation

A

History of chronic painkiller use

Often silent until CKD

19
Q

Analgesic nephropathy diagnosis

A

Normal/sterile pyuria urine
Mild proteinuria
Small irregular kidneys on USS
IVU shows ‘cup and spill’ appearance
Non-contrast CT shows decreased renal mass + papillary calcification
Biopsy shows CTIN 2˚ to papillary necrosis

20
Q

Analgesic nephropathy treatment

A

Stop analgesia
Manage CKD
USS/CT urogram to exclude obstruction from sloughed papilla if sudden flank pain

21
Q

Aminoglycoside nephropathy presentation

A

Mild non-oliguric AKI after 1-2 wks aminoglycoside therapy

22
Q

Aminoglycoside nephropathy treatment

A

Prevention: single daily dose may be less nephrotoxic

Streptomycin least nephrotoxic, gentamicin most

23
Q

Radiocontrast nephropathy presentation

A

AKI 48-72hrs post IV contrast

24
Q

Radiocontrast nephropathy treatment

A

Prevention only
Pre-hydrate with IV crystalloid
Discontinue other nephrotoxics 24h pre + post procedure

25
Q

Rhabdomyolysis nephropathy pathology

A

Skeletal muscle breakdown contents increase cytokines and decrease nitric oxide so renal vasoconstriction
Myoglobin filtered by glomeruli so obstruction + inflammation

26
Q

Rhabdomyolysis nephropathy presentation

A

Hx of trauma/ surgery/ immobility/ hyperthermia/ seizures
Muscle pain/swelling/ tenderness
AKI
Red-brown urine

27
Q

Rhabdomyolysis nephropathy diagnosis

A

Serum myoglobin
Plasma CK 5x upper limit
Myoglobinuria false +ve for blood on dipstick with no RBC seen on microscopy
Inc K+ and PO4, dec Ca

28
Q

Rhabdomyolysis nephropathy treatment

A

Supportive
Urgently treat hyperkalaemia
IV fluid rehydration + maintain urine output until myoglobinuria stops
RRT may be needed

29
Q

Urate nephropathy pathology

A

Uric acid crystals precipitate within tubulointerstitium causing dec GFR + 2˚ inflammation
Seen in tumour lysis syndrome

30
Q

Urate nephropathy treatment

A

Tumour lysis - aggressive hydration, allopurinol

Chronic disease - unclear evidence but diet/uric acid treatment may help

31
Q

Radiation nephritis presentation

A

6mths-1yr post irradiation
Inc BP, protein/haematuria progressing to renal failure
Prognosis linked to HT

32
Q

Radiation nephritis treatment

A

Decrease radiation dose with shielding (prevention)

CKD control measures

33
Q

Aristolochic acid nephropathy presentation

A

Disproportionate anaemia
Mild proteinuria
Renal dysfunction
More common in Balkan areas where aristolochic acid detected in wheat

34
Q

Aristolochic acid nephropathy treatment

A

Avoid exposure
Treat as CKD
Screen for malignancy

Renal (10 decks)

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