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Renal Exam 1 > Tubulointestersitial Nephritis > Flashcards

Tubulointestersitial Nephritis Flashcards

1
Q

What is the most common kidney disease?

A

UTI

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2
Q

UTI Types

A

Asymptomatic bacteriuria
Lower UTI (urethritis, cystitis)
Pyelonephritis

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3
Q

Define Urethritis

A

Infection of the urinary bladder

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4
Q

Define Cystitis

A

Infection only in the lower UT

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5
Q

Define pyelonephritis

A

Infection that spreads to the kidneys

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6
Q

UTI Etiology

A

85% gram negative bacilli

Most caused by normal flora

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7
Q

Immunecompromised UTI Etiology

A

Virus!

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8
Q

UTI typicals

A 
Normal flora cause endogenous infections
Typically ascending (starts from the body and goes up)
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9
Q

UTI Pathogenesis

A

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

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10
Q

Infections are more common in females bc

A

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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11
Q

Diseases that can cause obstruction and stasis

A

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

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12
Q

Obstruction and stasis can lead to:

A

Infection bc normally the bacteria are being flushed out

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13
Q

Define Vesicoureteral reflux

A

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

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14
Q

Define Intrarenal reflux

A

Urine flowing back into the pelvis

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15
Q

Pyelonephritis Etiology

A

Renal lesion associated with UTI

Caused by a bacterial infection

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16
Q

Kidney structures affected in pyelonephritis

A

Tubules
Intersititium
Pelvis

17
Q

Acute vs Chronic Pyelonephritis

A

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

18
Q

Predisposing conditions for Acute pylonephritis

A 
Obstruction of UT
Instrumentation of UT
Vesicoureteral reflux
Pregnancy
Gender/Age
Pre-existing renal lesions
DM
Immunosuppresion and immunodeficiency
19
Q

Acute pyelonephritis shows as

A

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

20
Q

Complications of acute pyelonephritis

A

Papillary necrosis
Pyonephrosis
Perinephric abscess

21
Q

Papillary necrosis is common in

A

DM and UT obstruction

22
Q

Clinical picture of pyelonephritis

A 
Sudden onset
Pain at the costovertebral angle
Fever and malaise
Dysuria, freqency, urgency
Pyuria and pus casts
23
Q

Polyomavirus Nephropathy

A

Pyelonephritis caused by polymavirus

Viral infection of tubular epithelial cells

24
Q

Chronic pyelonephritis

A

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

25
Q

Reflux Nephropathy

A

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

26
Q

Chronic Obstructive Pyelonephritits

A

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

27
Q

Chronic Pyelonephritis Morphology

A

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

28
Q

Why would unilateral chronic pyelonephritics not show symptoms?

A

Because the kidney can compensate for lack of functioning parts

29
Q

Chronic pyelonephritis + reflux =

A

Silent onset

30
Q

Loss of tubular function leads to

A

Polyuria and nocturia

31
Q

Why is recognition of obstruction important?

A

Increases susceptibility to ifection and to stone formation

Unrelieved obstruction almost always leads to renal atrophy (hydronephrosis or obstructive uropathy

32
Q

Acute UT Obstruction

A

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

33
Q

Calculi lodged in the ureters may give rise to

A

renal colic

34
Q

Prostatic enlargments may give rise to

A

bladder symptoms

35
Q

Unilateral complete or partial hydronephrosis

A

Remain silent for long periods bc of compensation

36
Q

Bilateral partial obstruction

A

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

37
Q

Complete bilateral obstruction

A

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

Renal Exam 1 (8 decks)

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