Tubulointestersitial Nephritis Flashcards by Beth Cocker

What is the most common kidney disease?

UTI

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UTI Types

Asymptomatic bacteriuria
Lower UTI (urethritis, cystitis)
Pyelonephritis

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Define Urethritis

Infection of the urinary bladder

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Define Cystitis

Infection only in the lower UT

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Define pyelonephritis

Infection that spreads to the kidneys

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UTI Etiology

85% gram negative bacilli

Most caused by normal flora

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Immunecompromised UTI Etiology

Virus!

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UTI typicals

Normal flora cause endogenous infections
Typically ascending (starts from the body and goes up)

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UTI Pathogenesis

Colonization of the distal urethra and introitus (vagina opening)
From the urethra to the bladder (urethral catheterization

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Infections are more common in females bc

Shorter urethra
Absence of antibacterial properties
Hormone changes affecting adherence of bacteria in the mucosa
Urethral trauma during sex
Urinary Tract Obstruction and urine statis
Vesicoureteral reflux

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Diseases that can cause obstruction and stasis

Bengin prostatic hypertrophy
Tumors
Calculi (kidney stones)
Bladder dysfunction bc of DM or spinal cord injury

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Obstruction and stasis can lead to:

Infection bc normally the bacteria are being flushed out

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Define Vesicoureteral reflux

Incompetence of the vesicoureteral valve (back flow of the urine)

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Define Intrarenal reflux

Urine flowing back into the pelvis

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Pyelonephritis Etiology

Renal lesion associated with UTI

Caused by a bacterial infection

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Kidney structures affected in pyelonephritis

Tubules
Intersititium
Pelvis

Acute vs Chronic Pyelonephritis

A: 1-3 weeks, may just go away
C: progressive disease that leads to more serious complications

Predisposing conditions for Acute pylonephritis

Obstruction of UT
Instrumentation of UT
Vesicoureteral reflux
Pregnancy
Gender/Age
Pre-existing renal lesions
DM
Immunosuppresion and immunodeficiency

Acute pyelonephritis shows as

Patchy interstitial suppurative inflammation
Accumulation of pus in the kidney
Unsmooth surface
Tubular necrosis

Complications of acute pyelonephritis

Papillary necrosis
Pyonephrosis
Perinephric abscess

Papillary necrosis is common in

DM and UT obstruction

Clinical picture of pyelonephritis

Sudden onset
Pain at the costovertebral angle
Fever and malaise
Dysuria, freqency, urgency
Pyuria and pus casts

Polyomavirus Nephropathy

Pyelonephritis caused by polymavirus

Viral infection of tubular epithelial cells

Chronic pyelonephritis

Chronic tubulointerstitial inflammation and renal scarring with involvement of calyces and pelvis –> ESRD
Occurs over many years

Reflux Nephropathy

Childhood Superimposition of a urinary infection on vesicoureteral and intrarenal reflux Leads to scarring and atrophy of one kidney or both

Chronic Obstructive Pyelonephritits

Recurrent infection superimposed on diffuse or localized obstructive lesions --> renal inflammation and scarring Associated with obstruction of urinary flow

Chronic Pyelonephritis Morphology

20% of kidney parenchyma is normal 80% is scar tissue No tubules, glomeruli nor nephrons --> limited function

Why would unilateral chronic pyelonephritics not show symptoms?

Because the kidney can compensate for lack of functioning parts

Chronic pyelonephritis + reflux =

Silent onset

Loss of tubular function leads to

Polyuria and nocturia

Why is recognition of obstruction important?

Increases susceptibility to ifection and to stone formation | Unrelieved obstruction almost always leads to renal atrophy (hydronephrosis or obstructive uropathy

Acute UT Obstruction

Provoke pain attributed to distention of the collecting system Underlying hydronephrosis = symptoms

Calculi lodged in the ureters may give rise to

renal colic

Prostatic enlargments may give rise to

bladder symptoms

Unilateral complete or partial hydronephrosis

Remain silent for long periods bc of compensation

Bilateral partial obstruction

Inability to concentrate the urine (polyuria, nocturia) Acidosis, renal salt wasting, secondary calculi, or chronic tubulointerstitial nephritits with scarring and atrophy of the papilla medula HTN

Complete bilateral obstruction

Oliguria/anuria Incompatible with survival unless the obstruction is relieved Diuresis occurs after wards which NaCl urine